L'angiopathie dyshorique (Morel) de l'écorce cérébrale

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Apathie et stimulation cérébrale profonde dans la maladie de Parkinson

Apathy was defined by Marin as diminished motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress. Up to 42% of Parkinson's disease patients could be concerned. It has a pejorative impact on quality of life and could be predictive of cognitive decline. It has been shown that deep brain stimulation in Parkinson's disease may induce apathy. It seems directly related to the stimulation target, i.e. the subthalamic nucleus, since such an effect has not been observed so far in thalamic and pallidal stimulation. It should certainly not make us question the remarkable effectiveness of subthalamic stimulation in Parkinson's disease patients, but encourages us to be very careful about operability criteria. We must, in this sense, improve identification of at risk patients, seeking a thoroughly diminished motivation, loss of interest or blunting affects.     

Répondre à la douleur des enfants atteints de paralysie cérébrale

With SPARCLE studies, the prevalence of pain in children with cerebral palsy is now better known: 60% of children aged 8 to 12-years-old and amounts to 69% in adolescents 13 to 17-years-old. The pain relief was also identified as a priority issue in a prospective study of la Fondation Motrice published in 2009. Yet iatrogenic pain is under-treated in this population although many assessment tools are validated. The use of assessment tools requires good knowledge of their psychometric properties and limitations. But pain assessment is not limited to the application of a scale. Current knowledge regarding the pain expression and ability to cope in this population are essential. International guidelines stress the importance of a multidisciplinary approach from assessment to management, in way to increase the synergistic effects of several therapeutic options (pharmacological and non-pharmacological). Finally, it also seems worthwhile to question our representations of pain reported by those with atypical development.