[Autologous hematopoietic stem cell transplantation for chronic inflammatory demyelinating polyneuropathy]. / Carrefour des spécialités : autogreffe de cellules souches hématopoïétiques périphériques pour la prise en charge thérapeutique des polyradiculonévrites inflammatoires démyélinisantes chroniques.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a dysimmune neuropathy with sensory and/or motor symptoms due to destruction of the myelin sheat secondary to an auto-immune attack. A quarter to a third of patients do not respond to immunomodulatory first line recommended therapies. No second line treatment has shown its effectiveness with a sufficient level of evidence. Autologous hematopoietic stem cell transplantation (AHSCT) is a promising therapy for autoimmune disease, especially for CIDP in recent works. We present in this article an update on the diagnosis of CIDP, its conventional treatments as well as the results of AHSCT in this indication, which was the subject of French recommendations under the aegis of the SFGMTC and neuromuscular disease french faculty (FILNEMUS) as a third line therapy after failure of two first-line and one second-line treatments.

Neglect-like effects induced by tDCS modulation of posterior parietal cortices in healthy subjects.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) over right posterior parietal cortex was shown to induce interference on visuospatial perception in healthy subjects. Transcranial direct current stimulation (tDCS) is another noninvasive brain stimulation technique that works modulating cortical activity. It is applied through easy to use, noncostly, and portable devices. OBJECTIVE/HYPOTHESIS: The aim of the current study was to investigate if the novel approach of "dual" stimulation over parietal cortices compared with the unilateral (right) cathodal one is able to induce greater and/or longer-lasting neglect-like effects in normal subjects performing a computerized visuospatial task. METHODS: Eleven healthy subjects underwent a computerized visuospatial task requiring judgments about the symmetry of prebisected lines in baseline condition, during and after tDCS. Right cathodal and left anodal tDCS were simultaneously applied over homologue posterior parietal cortices in the "dual" approach, whereas right cathodal tDCS was used in the traditional unihemisphere stimulation. RESULTS: A significant rightward bias in symmetry judgments as compared with baseline and sham conditions was observed in both the stimulation approaches. With "dual" tDCS compared with cathodal stimulation the effect was stronger and appeared earlier, but no longer-lasting after effects were found. CONCLUSIONS: We speculate that the resulting modulation of interhemispheric inhibition mediated the additional rightward bias in task performance for "dual" hemisphere compared with unihemisphere tDCS. If "dual" tDCS may better reproduce mechanisms underlying real lesions, it could provide a more suitable model for rehabilitation of negligent patients.

Effects of cerebellar TMS on motor cortex of patients with focal dystonia: a preliminary report.

Recent evidence suggests a role for cerebellum in pathophysiology of dystonia. Here we explored, the cerebellar modulation of motor cortex in patients with focal upper limb dystonia. Eight patients and eight controls underwent a transcranial magnetic stimulation protocol to study the cerebellar-brain-inhibition (CBI): a conditioning cerebellar stimulus (CCS) was followed 5 ms after by the contralateral motor cortex stimulation (test stimulus: TS). We explored the effects of CBI on MEP amplitude, short intracortical inhibition (SICI) and intracortical facilitation (ICF) measures. At baseline no differences in TS-MEP amplitude, SICI or ICF were found between patients and controls. Cerebellar-conditioning significantly reduced TS-MEP amplitude, increased ICF, and decreased SICI in control subjects. In contrast, no changes in these neurophysiological measures were observed in the motor cortex of patients, regardless of which side was tested. If further confirmed, these findings suggest a reduced cerebellar modulation of motor cortex excitability in patients with focal dystonia.

Role of the cerebellum in time perception: a TMS study in normal subjects.

The aim of this study was to investigate the role of the cerebellum in a temporal-discrimination task without movement production in healthy subjects. Ten healthy subjects underwent a time-perception task with somatosensory stimuli. Two pairs of electrical stimuli: the first considered the reference pair (rp) with a standard interval of 400 ms and the second, the test pair (tp), with variable intervals ranging from 300 to 500 ms, were applied by surface electrodes on the right forearm. Subjects were instructed to compare time intervals of rp and tp and to estimate whether the tp interval was shorter than, equal to, or longer than that of rp. The task was performed in baseline and after 1 Hz rTMS over the right and left cerebellar hemisphere. The right cerebellar rTMS worsened temporal discrimination of cutaneous somatosensory electrical stimuli on the ipsilateral hand. rTMS of the left cerebellar hemisphere did not determine significant changes in the subjects' performance with respect to the baseline. These findings suggest that the cerebellum plays a role in merely perceptive aspects of temporal information processing.