Expression pattern of synaptic vesicle protein 2 (SV2) isoforms in patients with temporal lobe epilepsy and hippocampal sclerosis.

AIMS: Synaptic vesicle proteins 2 (SV2) are neuronal vesicles membrane glycoproteins that appear as important targets in the treatment of partial and generalized epilepsies. Therefore, we analysed the expression of SV2 isoforms in the hippocampus of patients with temporal lobe epilepsy (TLE). METHODS: SV2A, SV2B and SV2C immunostaining and QuantiGene branched DNA assay were performed on biopsies from 31 consecutive TLE patients with mesial temporal sclerosis (MTS) and compared with 10 autopsy controls. SV2 expression was further compared with Timm's staining, and synaptophysin, Zinc transporter 3 (ZnT3), dynorphin, vesicular glutamate transporter 1 (VGLUT1) and vesicular GABA transporter (VGAT) expression. RESULTS: In TLE patients, SV2A and SV2B expression was decreased in areas of synaptic loss. SV2C, which is weakly expressed or absent in the hippocampus of controls, was overexpressed in 10/11 cases with classical MTS1A and mossy fibre sprouting but not in cases with other types of MTS. SV2C staining was located in the inner molecular layer of the dentate gyrus and colocalized with dynorphin, ZnT3 and VGLUT1, suggesting selective expression in presynaptic glutamatergic Zn(2+) -rich terminals of abnormal sprouting fibres. SV2 expression patterns correlated with histological subtypes of MTS, but not with clinical features or therapeutic regimens in this patient cohort. CONCLUSION: In classical MTS1A, the expression of SV2 isoforms is altered with a marked decrease of SV2A and SV2B paralleling synaptic loss and a selective increase of SV2C in sprouting mossy fibres. These findings suggest a different physiology of sprouting synapses and the possibility to target them with SV2C-specific strategies.

[Treatment compliance in epileptic patients. A frequent and complex problem]. / Le défaut d'observance thérapeutique du patient souffrant d'epilepsie. Un problème fréquent et complexe.

Epilepsy is a chronic disease, requiring a medical treatment which is essentially preventive (avoiding further seizure). Because of these characteristics, 30 to 50% of epileptic patients do not always comply with their treatment. In this paper, we review the different factors of poor compliance. Some are specific to this medical condition, while others are more general, like treatment complexity. We list some suggestions to improve the compliance of the epileptic patient in routine medical practice.

[Diagnostic exercise for the medical school student: how to analyze an abnormality of eye movements?]. / La vignette diagnostique de l'étudiant. Comment raisonner une anomalie des mouvements oculaires?

Eye movements abnormalities are common symptoms in neurology. We report a clinical observation of ischemic unilateral internuclear ophtalmoplegia to illustrate how much anatomical diagnosis is based on 1) a detailed neurological examination and 2) a deep knowledge and understanding of the anatomy and physiology of ocular movements. We also take this opportunity to review ocular symptoms and signs encountered in neurological practice.

[Time is brain]. / Prise en charge de l'accident vasculaire cérébral ischémique à la phase aiguë.

Ischemic stroke exacts a heavy toll in death and disability. Important progress have been made in terms of secondary prevention. Care of patients with acute stroke can also be improved. In 1996, the FDA approved Alteplase or rt-PA as a safe and effective treatment for stroke when given within 3 hours of the onset of neurological deficit. More than 10 years later, this treatment is still underused, mostly because of poor knowledge in the general population regarding stroke symptoms and implications, and inefficient emergency care and organisation. Organisation of primary stroke centers results in optimization in the care of patients with acute stroke, and improvement in outcomes, with reduction in death, dependency and need for institutional care.

[When HIV gets into the brain]. / Lorsque le VIH atteint le système nerveux central.

Besides opportunistic infections, direct or indirect HIV-mediated lesions of cerebral vascular or neural cells can also occur during the natural course of HIV infection. The main non-infectious complications of HIV are cerebral lymphomas, cerebrovascular disorders, HIV dementia and myelitis.

[Neuroborreliosis]. / La neuroborréliose: quand la tique a piqué.

Borrelia burgdorferi infection is a frequent disease in our country. The neurological complications of this infection are found essentially in the early dissemination stage and in the late stage of the disease. Neuroborreliosis symptoms are most often characterized by radiculalgia resisting to treatment, sometimes associated to a cranial neuropathy, predominantly facial. The evolution is satisfactory under adapted antibiotherapy. This antiobiotherapy remains necessary despite the fact that most neuroborreliosis complications resolve spontaneously. Treatment permits to avoid the appearance of late complications or of possible extraneurological symptoms.

[HIV-related infections of the brain]. / Les infections encéphaliques liées au VIH.

During the natural course of human immunodeficiency virus infection, central nervous system insults are very common. They can consist of infectious complications, consequently to the collapse of the patient's immune system. Alternatively, direct or indirect HIV-mediated lesions of cerebral vascular or neural cells can also occur. It is crucial to detect HIV-related infectious complications since their prognosis will depend on early and accurate treatments. The diagnosis is generally made by means of magnetic resonance imaging and lumbar puncture.

[Therapeutic armamentarium in neurology: the birth of a new era]. / L'arsenal thérapeutique en neurologie: une nouvelle ère voit le jour.

The field of neurology was long infamous for a lack of therapeutic options. How many of you have once thought: "Neurologists don't cure the disease, they admire it". But those days have passed into history, and the field is now vibrant with new treatments and hope even for patients with the worst neurodegenerative diseases. We summarized in the present review the latest major advances in therapeutic principles and practice for some of the most frequent chronic neurological disorders such as headaches, epilepsy, multiple sclerosis, dementias, Parkinson's disease, sleep/wake disturbances and peripheral neuropathies. We cannot cure or prevent, but we can now halt or control symptoms and disease progression to provide physical and psychological relief, and a better quality of life for patients who suffer from these otherwise devastating neurological conditions.

[How do you investigate an elevated calcitonin level?]. / Comment j'explore.... Une valeur elevée de calcitonine?

This article describes a case of lung cancer with associated hypercalcitoninemia in a man with a goitre. The case raises the problem of the differential diagnosis between medullary thyroid carcinoma and a neuroendocrine neoplasm with ectopic calcitonin secretion. The article first reviews the physiology of calcitonin, then outlines the diagnostic tests that are required to investigate hypercalcitoninemia and finally discusses the interpretation of test results.