Early hyperdopaminergic state following sub-thalamic nucleus deep brain stimulation in Parkinson disease.

BACKGROUND: Hyperdopaminergic state (HS), especially impulse control behaviors (ICBs), are not rare in Parkinson's disease (PD). Controversial data regarding HS prevalence one year following sub-thalamic nucleus deep brain stimulation (STN-DBS) are reported. OBJECTIVE: Our objectives were to describe early postoperative HS (PoOHS) including ICBs, hypomania and psychotic symptoms during the first 3 months following STN-DBS (V1) and their prognosis at 1 year (V2). METHODS: This descriptive study included 24 PD patients treated successively with bilateral STN-DBS between 2017 and 2019. The primary endpoint was prevalence of PoOHS at V1 according to the Ardouin Scale of Behaviour in Parkinson's Disease. RESULTS: Prior to STN-DBS (V0), 25% patients had HS (only ICBs) whereas at V1 (during the 3 first months), 10 patients (41.7%) had one or several HS (P=0.22) (de novo in 29.2%): 7 (29.2%) ICBs, 4 (16.7%) hypomanic mood, 1 (4.7%) psychotic symptoms. At V2, all V0 and V1 HS had disappeared, while 1 patient (4.2%) presented de novo HS (P<0.01). No correlation was found between the occurrence of PoOHS at V1 and any V0 data. Higher levodopa equivalent dose of dopamine agonists at V1 was correlated with ICB at V1 (P=0.04). CONCLUSION: We found that early PoOHS are frequent in PD after STN-DBS, mostly de novo, with ICBs and hypomania being the most frequent. Despite a good prognosis of PoOHS at one year, our work emphasizes the importance of both a cautious adjustment of dopamine agonist doses and a close non-motor monitoring pre- and post-STN-DBS in PD.

A randomized controlled double-blind study of rotigotine on neuropsychiatric symptoms in de novo PD.

Management of apathy, depression and anxiety in Parkinson's disease (PD) represents a challenge. Dopamine agonists have been suggested to be effective. This multicenter, randomized (1:1), double-blind study assessed the 6-month effect of rotigotine versus placebo on apathy, depression and anxiety in de novo PD. The primary outcome was the change of apathy, measured with the LARS. The secondary outcomes were the change in depression and anxiety, measured with BDI-2 and STAI-trait and state. Forty-eight drug-naive PD patients were included. The primary outcome was not reached, with a surprisingly high placebo effect on apathy (60%). There was no significant difference in the change of depression at 6 months between rotigotine and placebo. Trait-anxiety was significantly improved by rotigotine compared to placebo (p = 0.04). Compared to placebo, low dose rotigotine significantly improved trait anxiety, but not apathy and depression. The major placebo effect on apathy points towards the importance of a multidisciplinary and tight follow-up in the management of neuropsychiatric symptoms.

[Syndrome of transient epileptic amnesia and epileptic amnesic syndrome: the same entity?]. / Le syndrome of transient epileptic amnesia et l'epileptic amnesic syndrome sont-ils une même entité ?

A chronic subjective cognitive impairment can be symptomatic of temporal lobe epilepsy (TLE); it is thereby frequently reversible with the use of antiepileptic monotherapy. In this field, two distinct syndromes have been described: the Epileptic Amnesic Syndrome (EAS) and the Syndrome of Transient Epileptic Amnesia. Their diagnostic criteria have much in common but identification of STEA is based only on transient amnesic attacks. On the contrary, EAS takes into account subtle temporal lobe seizures. Here, we report a case where chronic cognitive disturbances were combined with very limited temporal lobe seizures while amnesic attacks were lacking. Antiepileptic drug treatment led to normalization of cognitive function. The criteria of STEA were not applicable because of the lack of transient amnesia in the patients' medical history. Considering brief episodes of flashbacks and abdominal pain as possibly seizure-related, the criteria of EAS were more operative: they allowed proper investigation to confirm TLE in our patient.

[Reduced emotional reactivity to negative stimuli in multiple sclerosis, preliminary results]. / Moindre réactivité émotionnelle aux stimuli négatifs dans la sclérose en plaques, résultats préliminaires.

BACKGROUND: Charcot first described emotional deficits in multiple sclerosis (MS) in the XIXth century. Despite this early description, there are very few studies about emotions and MS. OBJECTIVES: This study aimed at better understanding the emotional process in MS and more specifically recognition of facial emotions and emotional experience. METHODS: Thirteen women with remittent MS (R-MS), with a mean EDSS score of 2, were compared with thirteen healthy control subjects, matched for age (mean age of 42±2), sex and educational level. The Beck Depression Inventory (BDI), the Hamilton Anxiety Scale and the brief repeatable battery of neuropsychological tests for MS (BCcogSEP) were administered. Recognition of faces and facial expression of emotion were assessed by the Benton facial recognition test and recognition of facial emotions was assessed by Ekman's facial expression test. We have also presented 12 different sounds and pictures from the International Affective Digitized Sounds and Picture System (IADS and IAPS) in order to study the emotional experience by using criteria of valence and arousal. RESULTS: No deficit of facial emotion recognition was found in MS in this small population. Nevertheless, patients who had difficulty recognizing faces were the least able to recognize facial expressions. No significant difference was observed between the patient and control group for the experience of emotional valence. However, independently of their mood and cognitive status, the self-assessment of the MS patient population suggested that the patients were less reactive to negative sounds (P=0.005) and negative pictures (P=0.002) as compared with the control group, pointing to lesser sensitivity towards aversive stimuli. CONCLUSION: These data suggest disorders in emotional processes in R-MS, mainly a poor reactivity to negative stimuli which may have an impact on everyday life. A larger population should be studied to confirm these modifications of emotion.