Biomedical subjects
Publications and source records attributed to S Brion.
A traumatic injury of the anterior part of the corpus callosum led to a peculiar symptomatology associating motor conflicting behavior (diagnostic dyspraxia or voluntary ambivalence) and conflicting thoughts (emotional ambivalence) inducing a distressing feeling.
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Brain imaging showed extra-hippocampal temporal lesions in two patients with major disturbances of memory for academic knowledge including complete loss of professional knowledge and school learning especially regarding history, but sparing recent episodic memory in both cases and remote episodic memory in one of them. The antero-inferior and/or lateral regions of the temporal lobe could contain critical structures required to evoke and maintain memory of academic knowledge.
Hypofunction of the serotonin (5-HT) system might be involved in depression. Initial effects of the 5-HT reuptake inhibitor clomipramine (CMI) on plasma 5-HT have never been assessed. On Day 1, 27 depressed patients received either a 25-mg CMI slow infusion or a 25-mg CMI tablet in a randomized, double-blind, double-dummy design. The daily dose was subsequently titrated up to 75 mg i.v. or 150 mg orally. The Montgomery-Asberg Depression Rating Scale (MADRS) was rated on Days 1, 4, 7 and 14. High-performance liquid chromatography (HPLC-EC) assays of plasma 5-HT, platelet 5-HT, and CMI were performed on Day 1 before and after the infusion. On Day 1, both groups experienced a mean (nonsignificant) plasma 5-HT increase; in the i.v. group this initial increase correlated with MADRS decrease over 14 days (r = 0.76, p = .0025). Correlations between platelet 5-HT and MADRS decrease were not significant. These preliminary data show that: i) CMI administration results in initial changes in plasma 5-HT; and ii) i.v. CMI-induced initial plasma 5-HT increase is consistent with the CMI 5-HT profile, and might predict the clinical response to CMI.
OBJECTIVES: The aim of this multicenter study was to compare the efficacy, acceptability and impact on quality of life of tianeptine (T) and mianserine (M) in patients over 70 years of age with major depression. METHODS: Fulfilment of the DSM IIIR criteria for major depression with a total Montgomery and Asberg depression rating scale (MADRS) of at least 25 and a Hamilton anxiety rating scale (HARS) of at least 18 were required for inclusion. The 315 men and women enrolled in the study were given, by double blind assignment, either T: 37.5 mg/day, T: 25 mg/day or M: 30 mg/day. Treatment duration was 6 months in all three groups and follow-up continued for 3 months after withdrawal of tianeptine or mianserine. The main efficacy criterion was the MADRS score evaluated at each of 6 visits at day 15 (D15) and month 1 (M1), M2, M4, M4.5 and M6. The HARS score was another efficacy criterion. Overall assessment of efficacy and acceptability was done at each visit by the patient and the investigator. Both the patient and the physician estimated global effectiveness on a quality of life scale at M1, M3, M6 and M9. RESULTS: In the intention-to-treat population (n = 299), the antidepressant efficacy of tianeptine and mianserine was not significantly different, whether assessed as effect on anxiety or on quality of life. Scores however tended to be better in the T: 37.5 mg group. Acceptability was good as shown by the low number of adverse events in all 3 groups, but at D15, the incidence of impaired vigilance or equilibrium was significantly lower in the T: 25 mg group than in the M: 30 mg group, emphasizing the advantage of tianeptine in decreasing the risk of falling. Physician-assessed tolerance and acceptability was significantly different at M3 (p = 0.014) and at M6 (p = 0.028) in favor of T: 37.5 mg, indicating that though increasing dosage does not improve efficacy, there is no risk of poorer acceptability. CONCLUSION: These findings reconfirm the antidepressive efficacy, acceptability and safety of tianeptine. They also confirm the anxiolytic aspect associated with the antidepressive effect of tianeptine without any sedative effect. Tianeptine is particularly well indicated in the treatment of depression in elderly or very elderly subjects.
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For historical reasons, Pick's disease is sometimes misunderstood in the medical literature. However, clinical signs are quite typical, and different from those of Alzheimer's disease. The disease is characterized by a circumscribed fronto-temporal atrophy, without senile lesions. Neuronal loss and ballooned neurons are present in the atrophic cortex. In about 30 p. 100 of cases, Pick's bodies are present, with various shapes, perhaps depending upon the duration of the disease process. Other lesions are described. The symptomatology is characterized by personality changes of the frontal type, associated with verbal and behavioural stereotypies, and bulimia. There is a striking normality of the EEG, and CT scan shows the fronto-temporal cortical atrophy and atrophy of the caudate nucleus. In most cases, memory for recent events is quite normal, but sometimes an amnestic syndrome is closely related with an unusually severe atrophy of the hippocampus. The consequences of atrophy of the caudate nucleus are debated, since extrapyramidal symptoms appear to be mild and late.
A total of 186 patients who met the DSM-III criteria for schizophrenia were admitted to a double-blind randomized multicentre trial in which the efficacy and safety of remoxipride at two dose levels was compared with those of haloperidol. Over a period of six weeks the patients received remoxipride 100-300 mg/day (n = 60), remoxipride 200-600 mg/day (n = 61), or haloperidol 10-30 mg/day (n = 64). There was no significant difference between the three treated groups with regard to the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) scores obtained. Remoxipride, at both dosage ranges used, thus had comparable therapeutic efficacy to that of haloperidol. In contrast, extrapyramidal symptoms occurred significantly more frequently in the group treated with haloperidol. Laboratory tests and cardiovascular investigations showed no specific drug effect in any of the treated patients. Remoxipride is thus effective in acute treatment of schizophrenia at both dosage levels and has an advantage over haloperidol in neurological acceptability.
Primary hematomas of the brain stem are rare. We report the case of a small spontaneous mesencephalic hematoma which occurred in a 50 year-old normotensive male patient. The hematoma produced paresis of the superior oblique muscle and a lesion of the left spinothalamic tract. The outcome was favourable.
Correct recognition of spontaneous linguobucco-facial dyskinesia is at least of interest in that it enables accurate evaluation of the impact of neuroleptic medication on the occurrence of similar neurological disorders. Since 1963, first anecdotal evidence and then series of cases of spontaneous dyskinesia have been reported. This has enabled evaluation of the prevalence of these disorders in subjects aged over 60 to be determined as 10% whereas incidence is over 50% in subjects of the same age receiving neuroleptics. Nonetheless, a number of uncertainties persist. Epidemiological studies produce very variable results suggesting that the concept of tardive dyskinesia is not always adequately defined and that certain disorders of a different type are sometimes confused with that condition. Dyskinetic movements involve the face and trunk, like those of chorea, but do not share the latters' abrupt rapid and unpredictable nature. Dyskinetic movements on the contrary, tend toward a degree of reproducibility, if not stereotypy, in the manner of ballistic movements which may be distinguished by their rotary character and the fact that they are generally localized in one half of the body. Lastly dyskinetic movements frequently have the creeping appearance of athetoid movements from which they may be distinguished by case history. The various characteristics confer a highly specific appearance on dyskinetic movements which was well described by Sigwald back in 1959. It should be stressed that author, who had already studied bucco-lingual dyskinesia in epidemic encephalitis in 1953, discovered, with surprise, the existence of such disorders in an infectious context.(ABSTRACT TRUNCATED AT 250 WORDS)
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Controversies exist about the type of lesions observed in Korsakoff's syndrome or amnestic syndromes. A review of clinicopathologic data in the literature and findings in a personal series of 31 patients with amnestic syndromes (14 with alcoholism and nutritional deficiency, 8 with tumors including 2 with craniopharyngiomas, 5 with Pick's disease and presbyophrenic manifestations, 2 with vascular affections and one each with anoxia and herpetic encephalitis) were used to determine most frequently responsible lesions. Although it is generally accepted that there must be bilateral lesions divergent opinions are found with regard to the significance of limbic-hippocampomammillary circuit lesions. Some authors refute any specific role for the limbic circuit, and particularly any part played by Ammon's horn, in favor of a role for the temporal isthmus while others reject the possible role of the mammillary bodies and implicate the dorsomedian nucleus of the thalamus. The present study confirmed the importance of the limbic-hippocampomammillocingulus circuit in the maintenance of long-term memory. Involvement of the hippocampus appears obvious, particularly in disorders due to lesions of the subiculum and sommer's field. Mammillary body lesions are a constant finding in amnestic syndromes due to alcoholic nutritional deficiency and may also be present in Korsakoff's syndromes of tumoral origin e.g. a compression due to a craniopharyngioma. The rarely mentioned lesions of the cingular convolution are a further possible cause. The role of a thalamic lesion has not been totally confirmed, findings indicating equally frequent involvement of laterodorsal and dorsomedian nuclei. Clinical evidence, however, points to correlations between fabulation, false recognition and a thalamic lesion. The role of the fornix is debatable, although it is difficult to understand how destruction of the hippocampic formation or of the mammillary bodies can provoke memory disorders while an interruption in the structure that links them would have no consequences, unless it is admitted that as in animals other pathways exist that pass little or not at all through the fornix. Clinical expression of bilateral lesions of these structures differs according to whether they affect the posterior Ammon's horn region or lie more anteriorly in the trigonomammillothalamo-cingular complex. Clinical features of hippocampic amnesia include continuous anterograde amnesia with successive periods of forgetfulness, retrograde deficit of variable duration, parallel alterations of verbal and visuospatial memory and absence of fabulation.(ABSTRACT TRUNCATED AT 400 WORDS)
A 39 year-old man with mild stable mental retardation, without family history, developed progressively a gait disturbance and intellectual deterioration. CT scan showed a low density of the periventricular hemispheric white matter which increased on subsequent examinations. Eight months before death he presented with several Grand Mal seizures. He died 29 months after the onset of the clinical disorders. Neuropathological studies included light and electron microscopy of a cerebral biopsy and a post-mortem examination of the brain. It showed a sudanophilic leukodystrophy with unusual features: cavitation of the white matter, oligodendrocyte proliferation and lamellar "fingerprint" dense cytoplasmic inclusions in the oligodendrocytes. Only 3 similar cases have been previously reported.
Anxiolytic effects and tolerance of a four weeks treatment with prazepam (single dose of 40 mg in the evening) and with lorazepam (3 daily doses of 1.25 mg) are compared in a double blind study. Patients were treated by psychiatrists and were suffering from neurotic anxiety. Evaluation for therapeutic efficacy used a clinical global improvement scale and the Hamilton Anxiety Scale. Evaluation for side effects used the side effects symptoms check list. Anxiolytic effects of prazepam and lorazepam are not significantly different. Tolerance of the two treatments is comparable. The side effects are essentially an undesirable sedative action.
Efferent pathways of the LD nucleus of the thalamus were studied in 6 Papio-papio baboons with the retrograde transport technique utilizing HRP. Injections were made in cingular and parietal cortex and hippocampal formation. Large projection from the LD to the cingular and subicular cortex were visualized as reciprocal connections. No pathway to parietal area 7 was found. The course of the fibers is via the fornix, the cingular bundle and the retro-lenticular portion of the internal capsule. The result of this study make it necessary to reconsider neuropathological hypotheses on memory.
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A clinical study of bromazepam was carried out in 34 patients with anxiety (reactional anxiety, neurosis, depression, post-traumatic subjective syndrome). Dosage ranged from 6 to 18 mg/day. Bromazepam was given alone to 15 patients and in association with imipramine to 19 patients. The effects of treatment were assessed by means of the Hamilton scale. Beaumont's visual analogy scale and psychometric tests. Improvement in anxiety and nervous tension was observed in the majority of cases, together with favourable effects on somatic symptoms. The best results were obtained in reactional anxiety and neurotic anxiety. Side-effects ascribable to bromazepam were slight daytime drowsiness; two patients reported decrease in libido.