Personality dimensions of patients can change during the course of parkinson's disease.

BACKGROUND: Studies assessing personality dimensions by the "Temperament and Character Inventory" (TCI) have previously found an association between Parkinson's disease (PD) and lower Novelty Seeking and higher Harm Avoidance scores. Here, we aimed to describe personality dimensions of PD patients with motor fluctuations and compare them to a normative population and other PD populations. METHODS: All PD patients awaiting Deep Brain Stimulation (DBS) answered the TCI before neurosurgery. Their results were compared to those of historical cohorts (a French normative population, a de novo PD population, and a PD population with motor fluctuations). RESULTS: Most personality dimensions of our 333 included PD patients with motor fluctuations who are candidates for DBS were different from those of the normative population and some were also different from those of the De Novo PD population, whereas they were similar to those of another population of PD patients with motor fluctuations. CONCLUSIONS: During the course of PD, personality dimensions can change in parallel with the development of motor fluctuations, either due to the evolution of the disease and/or dopaminergic treatments.

Personality Dimensions Are Associated with Quality of Life in Fluctuating Parkinson's Disease Patients (PSYCHO-STIM).

BACKGROUND: Parkinson's disease (PD) negatively affects patients' Quality of Life (QoL) which depends on both objective criteria such as physical health and subjective ones such as worries and norms according to personal believes. Therefore, QoL could be also associated to personality dimensions in chronic neurological diseases such as PD. OBJECTIVE: Our objective was thus to study the potential association between personality dimensions and QoL in PD patients with motor fluctuations before Deep Brain Stimulation of the Sub-Thalamic Nucleus (DBS-STN). METHODS: Data were obtained from the French multicentric cohort study Predi-Stim. All PD patients awaiting DBS-STN and responding to the inclusion criteria at the time of the study were included. All participants answered the "Temperament and Character Inventory" (TCI) and the PDQ-39 before surgery. Analyses were made using adjusted univariate generalized linear regression models to evaluate a potential association between TCI dimensions and PDQ-39 scores. RESULTS: Three hundred thirty-three consecutive patients were included. The temperament Harm Avoidance was negatively associated with QoL (p = 1e-4, R2= 0.33), whereas the character Self-Directedness was positively associated with mental component of QoL (p = 2e-4, R2= 0.33) in PD patients with motor fluctuations awaiting DBS-STN. CONCLUSIONS: PD patients with motor fluctuations, with lower Harm Avoidance and higher Self-Directedness scores have the best QoL mainly at an emotional and social level. Therapeutic education of these PD patients focusing on their personal resources may thus be important to improve their well-being.

Leucine-Rich Glioma-Inactivated 1 Encephalitis: Broadening the Sphere.

Background: Leucine-rich glioma-inactivated 1 (LGI1) encephalitis is a rare entity. Its typical features are seizures, faciobrachial dystonic seizures (FBDS), cognitive impairment, and personality changes. Case report: We report the case of a 66-year-old man with an unusual presentation, consisting of two types of FBDS, one starting in the foot and the other consisting of asynchronous myoclonic and dystonic jerks of the face triggered by noise and chin stimulation. The patient displayed no personality changes or cognitive impairment. Discussion: LGI1 encephalitis is a heterogeneous disease. Many different forms of FBDS may be observed, and these seizures can be the only symptom. This type of encephalitis should be suspected in presenting very frequent episodic events with dystonic features, regardless of the part of the body affected.

Dopamine transporter imaging for the diagnosis of multiple system atrophy cerebellar type.

INTRODUCTION: The added value of dopamine transporter SPECT (DAT-SPECT) for the diagnosis of "possible" multiple system atrophy of the cerebellar type (MSA-C) remains unknown. METHODS: We reviewed retrospectively the charts of 128 consecutive patients with a clinical diagnosis of MSA-C who were seen between 2007 and 2016 at the French Reference Center for MSA. The main objective was to evaluate the proportion of patients for whom the diagnosis of "possible" MSA-C was made because of a positive DAT-SPECT. RESULTS: Seventy-eight MSA-C patients had at least one DAT-SPECT. Fifty-nine of them were considered for the final analysis. In these, 22 had "possible" MSA-C and 23 "probable" MSA-C before DAT-SPECT, while 14 did not reach diagnosis criteria at that time. In those with "possible" MSA-C, DAT-SPECT was positive in 64%. In patients with "probable" MSA-C, 83% showed nigrostriatal denervation. Six out of 14 (43%) received a diagnosis of "possible" MSA-C because of positive DAT-SPECT. These patients had mean disease duration of 2.3 years at the time of DAT-SPECT compared to 3.5 years of the entire cohort of MSA-C patients with DAT-SPECT. Of the eight remaining, one had positive DAT-SPECT but also pons atrophy on magnetic resonance imaging, and seven progressed to "probable" MSA based on clinical features. CONCLUSION: Our results suggest that DAT-SPECT significantly contributes to the diagnosis of "possible" MSA-C (43% of patients not reaching consensus diagnosis criteria before DAT-SPECT). DAT-SPECT seems especially useful in patients with shorter disease duration, while a negative result does not exclude a diagnosis of MSA.

Combined cardiovascular and sweating autonomic testing to differentiate multiple system atrophy from Parkinson's disease.

OBJECTIVES: It can be difficult to differentiate multiple system atrophy (MSA) with predominant parkinsonism (MSA-P), a very disabling but rare disease, from Parkinson's disease (PD). Autonomic dysfunction, particularly cardiovascular autonomic neuropathy (CAN), is classically more pronounced in MSA. We investigated whether testing for CAN combined with sweat function assessment was helpful to differentiate patients with MSA from those with PD. METHODS: In this retrospective study, 62 patients with MSA-P and 96 with PD, comparable in age, BMI and sex ratio with disease duration of 4.3±2.5 years for MSA vs. 11.5±6 years for PD (P<0.0001) were tested for CAN using heart rate changes with deep breathing (HR-DB), stand test (HR-ST) and Valsalva maneuver (HR-VM) and blood pressure changes during stand test (BPs-ST and BPd-ST), Valsalva maneuver (BPs-VM-II and IV), hand grip (BPd-HG) and the total "Ewing" score tests (EwS), and for sweating function using electrochemical skin conductance for hands and feet (HESC and FESC). RESULTS: In MSA-P abnormal EwS, HR-DB, BP-ST and ESC were more frequent compared to PD, despite longer disease duration for PD. Using a model adjusted for sex, BMI, age, disease duration and treatment, the Odds Ratio for having MSA-P vs. PD based on EwS was 2.71, on HR-DB 2.36, on BP-ST 2.87 and on ESC 4.94 while it was 11.68 (2.17-62.79) for the combination of the three last tests. CONCLUSION: Assessment of HR-DB, BP-ST and ESC, that is, rapid and non-invasive could be helpful in combination as a first simple screening to differentiate MSA-P from PD.

[Other care in Parkinson's disease: Psychological, rehabilitation, therapeutic education and new technologies]. / Autres prises en charge dans la maladie de Parkinson : psychologique, rééducative, éducation thérapeutique et nouvelles technologies.

Diagnosis of Parkinson's disease (PD) is often traumatic. It is then important to organize this announcement in order to support the patient in this major step of his care course. Anxiety and depression are present in about 50% of PD patients. Besides pharmacological treatment, cognitive-behavioral therapy induces improvement in anxio-depressive symptoms. We have to promote physical activity for PD patients, from the beginning of the disease, because it prevents from deconditioning, improves motor and non-motor symptoms, quality of life, and decreases loneliness. Rehabilitation may be also proposed (physiotherapy, speech therapy, occupational therapy). But there is no specific recommendation in PD, and usual activities can be proposed. Therapeutic education is an answer for PD patients who need to know and understand their disease and treatment. Organization of therapeutic education is different depending of the teams: group workshop and/or individual sessions, conduct by doctors or paramedical staff (nurse, physiotherapist, psychologist…). Therapeutic education programs are always evolving. It will soon be proposed therapeutic education for care partners, and some patients may join therapeutic education staff.