Neuropsychological assessment in pediatric epilepsy surgery: A French procedure consensus.

Neuropsychological assessment is a mandatory part of the pre- and post-operative evaluation in pediatric epilepsy surgery. The neuropsychology task force of the ILAE - French Chapter aims to define a neuropsychological procedure consensus based on literature review and adapted for French practice. They performed a systematic review of the literature published between 1950 and 2023 on cognitive evaluation of individuals undergoing presurgical work-up and post-surgery follow-up and focused on the pediatric population aged 6-16. They classified publications listed in the PubMed database according to their level of scientific evidence. The systematic literature review revealed no study with high statistical power and only four studies using neuropsychological scales in their French version. Afterwards, the experts defined a neuropsychological consensus strategy in pediatric epilepsy surgery according to the psychometric determinants of cognitive tests, specificity of epilepsy, surgery context, French culture and literature reports. A common French neuropsychological procedure dedicated to pediatric epilepsy surgery is now available. This procedure could serve as a guide for the pre- and post-surgical work-up in French centers with pediatric epilepsy surgery programs. The main goal is to anticipate the functional risks of surgery, to support the postoperative outcome beyond the seizure-related one, while taking into consideration the plasticity and vulnerability of the immature brain and allowing the possibility of collaborative studies.

Social cognition in epilepsy: State of the art and perspectives.

INTRODUCTION: The neuropsychology of epilepsy has been a major area of study for almost a century and cognitive impairments are an integral part of the new definition of epilepsy. Among such impairments, social cognition (SC) dysfunctions are of relatively recent interest. SC abilities refer to the body of knowledge and processes involved in establishing satisfying and appropriate social interactions. In particular, they allow the recognition of emotions in others, emotional experiences which are suitably adapted to social situations, and the ability to infer mental states in oneself and others. METHODS: An overeview was conducted of the available data within the literature, with the objective of presenting the SC disorders associated with certain types of epilepsy and the possible risk factors already explored i.e., localisation of epileptic focus, age of onset/duration of the disease, and effects of treatments including surgery. Studies investigating the potential repercussions of these disorders on patients' daily life have also been included. RESULTS: Social cognition disorders are an integral part of the cognitive disorders traditionally described in epilepsy. Indeed, a growing number of studies highlight the increased prevalence of SC disorders in various domains, and some patients appear to be more at risk than others. These disorders could be a major determining factor in the deterioration of patients' quality of life (QOL), particularly patients' support and social integration. This highlights the importance of assessing and managing these disorders in patients with epilepsy (PWE). Perspectives in the field of research and clinical practice are also evoked, such as exploring the links between disruptions in SC abilities and treatments, or developing specific tools for assessment and rehabilitation within the context of epilepsy.

French neuropsychological procedure consensus in epilepsy surgery.

INTRODUCTION: Neuropsychological assessment is an integral component of the surgical procedure in patients with epilepsy. As no French consensus for neuropsychological assessment was available, the main goal of this work was to define French neuropsychological procedure consensus in regard to literature review. METHOD: A panel of expert in neuropsychology was created within the framework of the French League Against Epilepsy. A systematic search of publications from 1950 to 2017 listed in PubMed database was conducted leading to a classification of articles according to their level of scientific evidence. French neuropsychological procedure consensus was then carried out with an expert panel of expert. RESULTS: Low scientific evidence of neuropsychological data was reported. A panel of expert proposed a comprehensive neuropsychological assessment procedure including the exploration of intellectual efficiency, long-term memory, short-term and working memory, attention, executive functions, processing speed and motor skills, language, visual processing, praxis, psychobehavioral, and social cognition. DISCUSSION: A common procedure for assessing cognitive and psychobehavioral function is now available in patients with epilepsy undergoing surgical evaluation have been established, they may help to improve the quality of care and the patient experience. This work highlights the need of furthers investigations and the necessity to develop specific tools with normative data.

[Recognition of facial expressions of emotions by 3-year-olds depending on sleep and risk of depression]. / Reconnaissance émotionnelle chez les enfants de 3ans en fonction du sommeil et du risque de dépression.

INTRODUCTION: The emotional process is characterized by a negative bias in depression, thus it was legitimate to establish if they same is true in very young at-risk children. Furthermore, sleep, also proposed as a marker of the depression risk, is closely linked in adults and adolescents with emotions. That is why we wanted first to better describe the characteristics of emotional recognition by 3-year-olds and their links with sleep. Secondly we observed, if found at this young age, an emotional recognition pattern indicating a vulnerability to depression. MATERIAL AND METHOD: We studied, in 133 children aged 36 months from the AuBE cohort, the number of correct answers to the task of recognition of facial emotions (joy, anger and sadness). Cognitive functions were also assessed by the WPPSI III at 3 years old, and the different sleep parameters (time of light off and light on, sleep times, difficulty to go to sleep and number of parents' awakes per night) were described by questionnaires filled out by mothers at 6, 12, 18, 24 and 36 months after birth. Of these 133 children, 21 children whose mothers had at least one history of depression (13 boys) were the high-risk group and 19 children (8 boys) born to women with no history of depression were the low-risk group (or control group). RESULTS: Overall, 133 children by the age of 36 months recognize significantly better happiness than other emotions (P=0.000) with a better global recognition higher in girls (M=8.8) than boys (M=7.8) (P=0.013) and a positive correlation between global recognition ability and verbal IQ (P=0.000). Children who have less daytime sleep at 18 months and those who sleep less at 24 months show a better recognition of sadness (P=0.043 and P=0.042); those with difficulties at bedtime at 18 months recognize less happiness (P=0.043), and those who awaken earlier at 24 months have a better global recognition of emotions (P=0.015). Finally, the boys of the high-risk group recognize sadness better than boys in the control group (P=0.015). CONCLUSION: This study confirms that the recognition of emotion is related to development with a female advantage and a link with the language skills at 36 months of life. More importantly, we found a relationship between sleep characteristics and emotional recognition ability and a negative bias in emotional recognition in young males at risk for depression.

[Importance of cognitive disorders in internal medicine: Pathophysiology, diagnosis, management. The example of systemic lupus erythematosus]. / Importance des troubles cognitifs en médecine interne : physiopathologie, évaluation, prise en charge. L'exemple du lupus systémique.

Systemic diseases, which are in France mainly monitored in internal medicine, affect multiple organs or tissues. While cutaneous or articular manifestations are the most common, neurological involvement is often associated with severity. Diagnosis of peripheral (e.g, neuropathies) or central (e.g, myelitis) nervous disorders is quite easy through clinical examination and dedicated complementary tests. However, neuropsychological manifestations that affect cognition, including memory, attention, executive functions or reasoning, are difficult to diagnose, sometimes trivialized by practitioners. Their causes are often numerous and interrelated. Nevertheless, these cognitive manifestations are closely related to patients' quality of life, affecting their social life, family dynamics and professional integration but also the treatment adherence. The purpose of this review, focused on the example of systemic lupus erythematosus, is to raise awareness of cognitive dysfunction in systemic diseases including their management from diagnosis to treatments. The final aim is to go further into setting up research groups and care programs for patients with cognitive impairment followed in internal medicine.

[Clinical and radiologic evaluation of a polylactic acid interposition arthroplasty after trapezectomy]. / Évaluation clinique et radiologique d'un implant d'interposition en acide polylactique après trapézectomie.

Surgical management of trapeziometacarpal osteoarthritis does not obey to strict rules. The use of interposition implants made of different materials leads to enrichment of surgeon's resources. This prospective study reports the radiological and clinical results of 45 patients treated by total trapeziectomy with polylactic acid interposition implant, with an average follow-up of 31 months. Thirty-seven surgical treatments were carried out after ineffective medical treatment. According to Dell classification, there were five stages II, 30 stages III and two stages IV. Mean age was 66 years. Dominant side was involved in 60%. Thumbs were pain free at 5 months in average and 81% of the patients reported good results (Alnot stages 0 and 1). The average opposition was 9.1/10, the average M1M2 angle was 40°, and the average key pinch strength was 4.4 kg. Six patients suffered from sympathetic dystrophy but neither infection nor local inflammatory reaction was observed. Collapse of the trapezium space was constant and the trapezium space ratio was 76% at the follow-up. Seventy-five per cent of patients returned back to their occupation. The satisfaction rate was 89%. The radioclinical results were very good in our series. The interposition of polylactic acid implant permits to avoid the presumed complications of tendon harvesting, and those of other types of material used in the same indication. Its safety seems excellent.

[Cubital tunnel syndrome: a retrospective review of 55 subcutaneous transpositions with minimum 3-year follow-up]. / Étude rétrospective de 55 transpositions antérieures sous-cutanées pour syndrome canalaire du nerf ulnaire à 3ans de recul minimum.

The surgical management of the cubital tunnel syndrome has no strict rules to follow. Surgical treatments are various, but none of them has been shown to be superior to the others. This retrospective study presents the clinical results in 73 patients who underwent an anterior subcutaneous transposition of the ulnar nerve, between January 2000 and January 2010, with a minimum 3-year follow-up. Fifty-five patients were assessed with an average follow-up of 65.7 months. McGowan grading system as modified by Goldberg was used to analyse clinical results, preoperatively and at follow-up. The DASH score was used to assess physical function. The average preoperative evolution of symptoms was 16.7 months, and mean period to resolution was 4.7 months. The grade in McGowan grading system as modified by Goldberg significatively improved at follow-up (P=0.0002). Only five patients kept paresthesia. The mean postoperative DASH score was 7.27/100. The satisfaction rate was 96%, and all the patients except one returned back to their occupation. There was neither infection nor complex regional pain syndrome. The anterior subcutaneous transposition leads to very good clinical results, satisfaction and physical function. It is an effective surgical method, without complication in our study, which gives long-term results.

[Razemon's lateral digital rotation flap in severe Dupuytren contracture of the fifth finger]. / Le lambeau de rotation latéro-digital de Razemon dans les formes graves de la maladie de Dupuytren du cinquième rayon.

In Dupuytren's disease, correction of severe contracture deformities and excision of dermal lesions are often responsible for palmar skin defects. This study aimed to assess the results of the lateral digital flap described by Razemon. Thirty-seven patients were analysed retrospectively for functional and trophic results. Twelve months of follow-up were at least required. The lack of extension was appreciated through Thomine's coefficient. Subjective patient's opinion was noted about function of fifth finger and hand. The flap trophicity was evaluated through softness, coverage quality and esthetic aspect. In the preoperative period, the average lack of extension was 105°; 89% of the patients were ranked as stages 3 or 4 of Tubiana's classification. At the 12th month, the average Thomine's coefficient was 0.74; 70% of the patients were very satisfied. Two patients exhibited some lack of suppleness and seven a dyschromic scars. The lateral digital rotation flap is a quite simple surgical procedure. It allows satisfactory results corresponding to functional and trophic coverage in severe Dupuytren's contracture involving the fifth finger.