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Perretti C, Gales A, Leu-Semenescu S, Dodet P, Bianquis C, Groos E, Puligheddu M, Maranci JB, Arnulf I. Latency To N3 Interruption In Arousal Disorders. Sleep 2024:zsae033. [PMID: 38306685 DOI: 10.1093/sleep/zsae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Indexed: 02/04/2024] Open
Abstract
STUDY OBJECTIVES To help expert witnesses in criminal cases using the "sleepwalking defense", we studied the time of first and last interruptions from stage N3 in patients with arousal disorders, including sexsomnia, as well as their determinants. METHODS The epochs of lights off, sleep onset, first N3 interruption (with and without behaviors), and last N3 interruption were determined by videopolysomnography on two consecutive nights in 163 adults with disorders of arousal, including 46 with and 117 without sexsomnia. RESULTS The first N3 interruption (independently of concomitant behavior) occurred as early as 8 minutes after sleep onset and within 100 minutes of falling asleep in 95% of cases. The first motor arousal from N3 occurred as early as 25 min after lights off time, a timing more variable between participants (between 30 and 60 minutes after lights off time in 25% of participants and within 60 minutes of falling asleep in 50%). These latencies did not differ between the groups with and without sexsomnia. No correlation was found between these latencies and the young age, sex or clinical severity. The latency of motor arousals was shorter when they were associated with a fast-wave EEG profile and were not preceded by another type of N3 arousal. CONCLUSION The first motor arousal may occur early in the night in patients with arousal disorders, with or without sexsomnia, suggesting that abnormal behaviors occurring as early as 25 min after lights off time in clinical and criminal cases can be a parasomnia manifestation.
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Affiliation(s)
- C Perretti
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - A Gales
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - S Leu-Semenescu
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
- Paris Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - P Dodet
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
- Sorbonne University, Paris, France
- Paris Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - C Bianquis
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - E Groos
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - M Puligheddu
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - J B Maranci
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
- Sorbonne University, Paris, France
- Paris Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - I Arnulf
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
- Sorbonne University, Paris, France
- Paris Brain Institute (ICM), INSERM, CNRS, Paris, France
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Jeantin L, Gales A, Berzero G, Leu S, Proust J, Giry M, Valyraki NE, Birzu C, Alentorn A, Vidailhet M, Psimaras D, Arnulf I. Hypersomnia in anti-glutamic acid decarboxylase 65 (GAD65) associated neurological syndromes: A pilot study. Eur J Neurol 2024; 31:e16125. [PMID: 37922501 DOI: 10.1111/ene.16125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND AND PURPOSE Despite their detrimental impact on the quality of life in autoimmune encephalitis, sleep disorders have not been investigated in anti-glutamic acid decarboxylase (GAD65) associated neurological syndromes. METHODS Six consecutive adult patients diagnosed with anti-GAD65-associated neurological syndromes (four with limbic encephalitis and two with stiff-person syndrome) and 12 healthy controls were enrolled. Participants underwent sleep interviews and sleep studies including night-time video-polysomnography, followed by five daytime multiple sleep latency tests (MSLTs, to assess propensity to fall asleep) and an 18 h bed rest polysomnography (to assess excessive sleep need). RESULTS Patients reported the need for daily naps and that their cognition and quality of life were altered by sleepiness, but they had normal scores on the Epworth sleepiness scale. Compared with controls, sleep latencies during the MSLT were shorter in the patient group (median 5.8 min, interquartile range [IQR] 4.5, 6.0 vs. 17.7 min, IQR 16.3, 19.7, p = 0.001), and the arousal index was reduced (2.5/h, IQR 2.3, 3.0 vs. 22.3/h, IQR 13.8, 30.0, p = 0.002), although total sleep time was similar between groups (621 min, IQR 464, 651 vs. 542.5 min, IQR 499, 582, p = 0.51). Remarkably, all six patients had MSLT latencies ≤8 min, indicating severe sleepiness. No parasomnia or sleep-disordered breathing was detected. CONCLUSION Central hypersomnia is a relevant characteristic of anti-GAD65-associated neurological syndromes.
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Affiliation(s)
- Lina Jeantin
- Sleep Disorders Unit, R3S Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Ana Gales
- Sleep Disorders Unit, R3S Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Giulia Berzero
- Neuro-Oncology Unit, Neurology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Smaranda Leu
- Sleep Disorders Unit, R3S Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Jérémy Proust
- Sleep Disorders Unit, R3S Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Marine Giry
- Neuro-Oncology Unit, Neurology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Nefeli Eirini Valyraki
- Neuro-Oncology Unit, Neurology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Cristina Birzu
- Neuro-Oncology Unit, Neurology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Agusti Alentorn
- Neuro-Oncology Unit, Neurology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Marie Vidailhet
- Movement Disorder Unit, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Dimitri Psimaras
- Neuro-Oncology Unit, Neurology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Isabelle Arnulf
- Sleep Disorders Unit, R3S Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
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Brunet de Courssou JB, Testard P, Sallansonnet-Froment M, Brechemier ML, Ricard D, Psimaras D, Ferrand M, Maillet T, Depierre P, Ohlmann C, Capron J, Arnulf I, Gales A. Narcolepsy secondary to anti-Ma2 encephalitis: two case reports. J Clin Sleep Med 2023; 19:837-841. [PMID: 36708258 PMCID: PMC10071386 DOI: 10.5664/jcsm.10448] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 01/29/2023]
Abstract
Recent studies suggest that sleep disorders are present in two-thirds of patients with autoimmune encephalitis. In anti-Ma2 encephalitis, hypersomnia appears to be frequent. However, only few cases of type 1 narcolepsy have been reported to date with anti-Ma2 encephalitis. We report 2 new cases of patients with narcolepsy secondary to anti-Ma2 encephalitis. Patient 1, a 68-year-old man, had narcolepsy type 1, including sleep attacks, cataplexy, abnormal Multiple Sleep Latency Tests and hypocretin-1 deficiency (< 50 ng/L) in the cerebrospinal fluid (CSF), associated with a cerebellar syndrome. Anti-Ma2 antibodies were present in the serum and CSF and antivoltage-gated potassium channel antibodies in the serum. He benefited from a treatment with pitolisant. Patient 2, a 42-year-old man, had narcolepsy type 2, including hypersomnolence, no cataplexy, intermediate CSF levels of hypocretin-1 (138 ng/L), abnormal Multiple Sleep Latency Tests, and a limbic encephalitis presentation. Anti-Ma2 antibodies were present in the serum and CSF, and anti-Ma1 antibodies were in the CSF. For both, repeated polysomnographies were necessary to establish the precise diagnosis of central hypersomnia, emphasizing the importance of carrying out sleep investigations in a tertiary neurology center with sleep medicine expertise in patients with anti-Ma2 encephalitis. CITATION Brunet de Courssou J-B, Testard P, Sallansonnet-Froment M, et al. Narcolepsy secondary to anti-Ma2 encephalitis: two case reports. J Clin Sleep Med. 2023;19(4):837-841.
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Affiliation(s)
| | - Pauline Testard
- Sleep Disorders Unit, Hôpital Pitié-Salpêtrière, Paris, France
| | | | | | - Damien Ricard
- Neurology Department, Hôpital d’Instruction des Armées Percy, Clamart, France
| | - Dimitri Psimaras
- Neurology Department, Onco-Neurology Service, Hôpital Pitié-Salpêtrière, Paris, France
| | - Mickaël Ferrand
- Neurology Department, Hôpital Central - CHRU de Nancy, Nancy, France
| | - Thibault Maillet
- Internal Medicine Department, Centre Hospitalier de Mâcon, Mâcon, France
| | | | - Charlotte Ohlmann
- Radiology Department, Hôpital d’Instruction des Armées Percy, Clamart, France
| | - Jean Capron
- Neurology Department, Hôpital Saint-Antoine, Paris, France
| | - Isabelle Arnulf
- Sleep Disorders Unit, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne University, Paris, France
| | - Ana Gales
- Sleep Disorders Unit, Hôpital Pitié-Salpêtrière, Paris, France
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Rossi J, Gales A, Attali V, Leu-Smenescu S, Dodet P, Groos E, Arnulf I. Do the EEG and behavioral criteria of NREM arousal disorders apply to sexsomnia? Sleep 2023:7068072. [PMID: 36866491 DOI: 10.1093/sleep/zsad056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Indexed: 03/04/2023] Open
Abstract
STUDY OBJECTIVES To establish whether the recent EEG and behavioral criteria of arousal disorders apply to sexsomnia. METHODS EEG and behavioral markers upon N3 sleep interruptions in videopolysomnography were retrospectively compared in 24 participants with sexsomnia, 41 participants with arousals disorders, and 40 healthy controls. The specificity and sensitivity of previously suggested EEG and behavioral cutoffs for supporting arousal disorders diagnosis were measured in the sexsomnia vs. control groups. RESULTS Participants with sexsomnia and arousals disorders showed a higher N3 fragmentation index, slow/mixed N3 arousal index, and number of eye openings during N3 interruptions than healthy controls. Ten (41.7%) participants with sexsomnia (vs. one sleepwalker and no control) displayed an apparently sexual behavior (masturbation, sexual vocalization, pelvic thrusting, and hand within the pajama) during N3 arousal. An N3 sleep fragmentation index ≥ 6.8/h of N3 sleep and two or more N3 arousals associated with eye opening was 95% specific but poorly (46% and 42%) sensitive for diagnosing sexsomnia. An index of slow/mixed N3 arousals ≥ 2.5/h of N3 sleep was 73% specific and 67% sensitive. An N3 arousal with trunk raising, sitting, speaking, showing an expression of fear/surprise, shouting, or exhibiting sexual behavior was 100% specific for a diagnosis of sexsomnia. CONCLUSION In patients with sexsomnia, videopolysomnography based markers of arousal disorders are intermediate between healthy individuals and patients with other arousal disorders, supporting the concept of sexsomnia as a specialized, but less neurophysiologically severe, NREM parasomnia. Previously validated criteria for arousal disorders partially fit in patients with sexsomnia.
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Affiliation(s)
- Jessica Rossi
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Ana Gales
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - Valérie Attali
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France.,INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Smaranda Leu-Smenescu
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France.,Paris Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Pauline Dodet
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France.,Sorbonne University, Paris, France
| | - Elisabeth Groos
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - Isabelle Arnulf
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France.,Paris Brain Institute (ICM), INSERM, CNRS, Paris, France.,Sorbonne University, Paris, France
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5
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Perretti C, Gales A, Leu-Semenescu S, Dodet P, Arnulf I. Short slow wave sleep latency in patients with disorders of arousal. Sleep Med X 2023; 5:100063. [PMID: 36794266 PMCID: PMC9923220 DOI: 10.1016/j.sleepx.2023.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
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6
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Nguyen-Michel VH, Houot M, Delorme C, Sangaré A, Gales A, Frazzini V, Hanin A, Aissani D, Trân T, Oquendo B, Ketz F, Lafuente-Lafuente C, Oasi C, Kinugawa K, Ouvrard G, Ursu R, Degos B, Rohaut B, Demeret S, Lambrecq V, Navarro V, Fournier E, Corvol JC, Borden A. Older patients with COVID-19 and neuropsychiatric conditions: A study of risk factors for mortality. Brain Behav 2022; 12:e2787. [PMID: 36355411 PMCID: PMC9759137 DOI: 10.1002/brb3.2787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/05/2022] [Accepted: 09/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about risk factors for mortality in older patients with COVID-19 and neuropsychiatric conditions. METHODS We conducted a multicentric retrospective observational study at Assistance Publique-Hôpitaux de Paris. We selected inpatients aged 70 years or older, with COVID-19 and preexisting neuropsychiatric comorbidities and/or new neuropsychiatric manifestations. We examined demographics, comorbidities, functional status, and presentation including neuropsychiatric symptoms and disorders, as well as paraclinical data. Cox survival analysis was conducted to determine risk factors for mortality at 40 days after the first symptoms of COVID-19. RESULTS Out of 191 patients included (median age 80 [interquartile range 74-87]), 135 (71%) had neuropsychiatric comorbidities including cognitive impairment (39%), cerebrovascular disease (22%), Parkinsonism (6%), and brain tumors (6%). A total of 152 (79%) patients presented new-onset neuropsychiatric manifestations including sensory symptoms (6%), motor deficit (11%), behavioral (18%) and cognitive (23%) disturbances, gait impairment (11%), and impaired consciousness (18%). The mortality rate at 40 days was 19.4%. A history of brain tumor or Parkinsonism or the occurrence of impaired consciousness were neurological factors associated with a higher risk of mortality. A lower Activities of Daily Living score (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.58-0.82), a neutrophil-to-lymphocyte ratio ≥ 9.9 (HR 5.69, 95% CI 2.69-12.0), and thrombocytopenia (HR 5.70, 95% CI 2.75-11.8) independently increased the risk of mortality (all p < .001). CONCLUSION Understanding mortality risk factors in older inpatients with COVID-19 and neuropsychiatric conditions may be helpful to neurologists and geriatricians who manage these patients in clinical practice.
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Affiliation(s)
- Vi-Huong Nguyen-Michel
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France
| | - Marion Houot
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Institut de la Mémoire et de la maladie d'Alzheimer, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Center of Excellence of Neurodegenerative Disease (CoEN), Paris, France
| | - Cécile Delorme
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France
| | - Aude Sangaré
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Ana Gales
- Sorbonne Université, AP-HP, Pitié Salpêtrière Hospital, Sleep Disorders Unit, Paris, France
| | - Valerio Frazzini
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Aurélie Hanin
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Djamal Aissani
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Department of Radiology, Paris, France
| | - Thanh Trân
- Pierre Bérégovoy Hospital, Neurological Unit, Nevers, France
| | - Bruno Oquendo
- Sorbonne Université, AP-HP, Charles-Foix Hospital, Geriatric Department, Paris, France
| | - Flora Ketz
- Sorbonne Université, AP-HP, Charles-Foix Hospital, Geriatric Department, Paris, France
| | | | - Christel Oasi
- Sorbonne Université, AP-HP, Charles-Foix Hospital, Geriatric Department, Paris, France
| | - Kiyoka Kinugawa
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, CNRS, UMR 8256 Biological Adaption and Aging, Paris, France
| | - Gaëlle Ouvrard
- Sorbonne Université, AP-HP, Rothschild Hospital, Neurological Rehabilitation Unit, Paris, France
| | - Renata Ursu
- Université de Paris, AP-HP Nord, Saint-Louis Hospital, Neurological Unit, Paris, France
| | - Bertrand Degos
- Sorbonne Université Paris Nord, AP-HP, Avicenne Hospital, Department of Neurology, Bobigny, France
| | - Benjamin Rohaut
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Neurological Intensive Care Unit, Paris, France
| | - Sophie Demeret
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Neurological Intensive Care Unit, Paris, France
| | - Virginie Lambrecq
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Vincent Navarro
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Emmanuel Fournier
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France
| | - Alaina Borden
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France
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Nigam M, Hippolyte A, Dodet P, Gales A, Maranci JB, Al-Youssef S, Leu-Semenescu S, Arnulf I. Dormir pendant une pandémie : l’impact des restrictions liées au COVID-19 sur la narcolepsie et l’hypersomnie idiopathique. Médecine du Sommeil 2022. [PMCID: PMC8864981 DOI: 10.1016/j.msom.2022.01.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectif Évaluer l’impact des restrictions liées au COVID-19 sur la narcolepsie de type 1 (NT1), la narcolepsie de type 2 (NT2) et l’hypersomnie idiopathique (HI). Méthodes Enquête en ligne évaluant les caractéristiques clinico-démographiques et professionnelles pendant le premier confinement a été proposée aux patients ayant une NT1, NT2 et HI, suivis dans un hôpital universitaire. Résultats Les 219 personnes ayant répondu à l’enquête ont signalé une augmentation moyenne de 1,2 ± 1,9 h (p < 0,001) du temps de sommeil nocturne et une diminution moyenne de 1,0 ± 3,4 points (p < 0,001) sur l’échelle de somnolence d’Epworth. Les télétravailleurs ont eu une augmentation moyenne de 0,9 ± 1,2 h de leur sommeil nocturne (p < 0,001) et une diminution moyenne du score de somnolence de 1,6 ± 3,1 (p < 0,001). La cataplexie s’est améliorée chez 54,1 % des NT1. La somnolence est corrélée au bien-être psychologique (R = 0,3, p < 0,001). 42,5 % des patients ont apprécié ce premier confinement, grâce à la réaffectation du temps habituellement consacré aux trajets domicile-travail, à un temps de sommeil plus long, aux loisirs et à la famille, et ont apprécié un horaire de sieste plus libre. À l’inverse, 13,2 % des patients ont ressenti un sentiment d’isolement et de détresse psychologique. Conclusion Ces résultats suggèrent que les personnes atteintes d’HI, NT1 et NT2 peuvent bénéficier d’une diminution des contraintes sociales et professionnelles sur les habitudes de sommeil et soulignent l’importance des aménagements des horaires et du lieu de travail dans cette population.
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Leu-Semenescu S, Maranci JB, Lopez R, Drouot X, Dodet P, Gales A, Groos E, Barateau L, Franco P, Lecendreux M, Dauvilliers Y, Arnulf I. Comorbid parasomnias in narcolepsy and idiopathic hypersomnia: more REM than NREM parasomnias. J Clin Sleep Med 2022; 18:1355-1364. [PMID: 34984974 PMCID: PMC9059608 DOI: 10.5664/jcsm.9862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess the frequency, determinants and clinical impact of clinical NREM and REM parasomnias in adult patients with narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH) compared to healthy controls. METHODS Familial and past and current personal parasomnias were assessed by questionnaire and medical interviews in 710 patients (220 NT1, 199 NT2, and 221 IH) and 595 healthy controls. RESULTS Except for sleep-related eating disorder (SRED), current NREM parasomnias were rare in all patient groups and controls. SRED was more frequent in NT1 patients (7.9%, vs. 1.8% in NT2 patients, 2.1% in IH patients and 1% in controls) and associated with disrupted nighttime sleep (odds ratio [OR] = 3.9) and nocturnal eating in full awareness (OR = 6.9) but not with sex. Clinical REM sleep behavior disorder (RBD) was more frequent in NT1 patients (41.4%, half being violent) than in NT2 patients (13.2%) and affected men more often than women (OR = 2.4). It was associated with disrupted nighttime sleep, depressive symptoms and antidepressant use. Frequent (>1/week) nightmares were reported by 39% of patients with NT1, 29% with NT2 and 27.8% with IH (vs. 8.3% in controls) and were associated with depressive symptoms in narcolepsy. No parasomnia (except sleep-related hallucinations) worsened daytime sleepiness. CONCLUSIONS In patients with central disorders of hypersomnolence, comorbid NREM parasomnias (except SRED) are rare and do not worsen sleepiness. In contrast, REM parasomnias are prevalent (especially in NT1) and associated with male sex, disrupted nighttime sleep, depressive symptoms and antidepressant use.
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Affiliation(s)
- Smaranda Leu-Semenescu
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Jean-Baptiste Maranci
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sorbonne University, Paris, France
| | - Regis Lopez
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier.,Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Xavier Drouot
- Clinical Neurophysiology Department, La Miletrie University Hospital, Poitiers, France
| | - Pauline Dodet
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Ana Gales
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Elisabeth Groos
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Lucie Barateau
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier.,Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Patricia Franco
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Pediatric Sleep Unit, Mother-Children Hospital, Hospices Civils de Lyon, University Lyon1, France, Integrative Physiology of Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon 1, Lyon, France
| | - Michel Lecendreux
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Pediatric Sleep Center, Hospital Robert-Debré, AP-HP, Paris, France
| | - Yves Dauvilliers
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier.,Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Isabelle Arnulf
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sorbonne University, Paris, France
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9
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Nigam M, Hippolyte A, Dodet P, Gales A, Maranci JB, Al-Youssef S, Leu-Semenescu S, Arnulf I. Sleeping through a pandemic: impact of COVID-19-related restrictions on narcolepsy and idiopathic hypersomnia. J Clin Sleep Med 2022; 18:255-263. [PMID: 34314345 PMCID: PMC8807898 DOI: 10.5664/jcsm.9556] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To assess the impact of coronavirus disease 2019 (COVID-19)-related restrictions on narcolepsy type 1 (NT2), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH). METHODS Participants with NT1, NT2, and IH followed in a university hospital completed an online 78-question survey assessing demographic, clinical, and occupational features of the population during the first COVID-19-related lockdown. RESULTS A total of 219 of 851 (25.7%) respondents of the survey reported a mean increase of 1.2 ± 1.9 hours (P < .001) in night sleep time and a mean decrease of 1.0 ± 3.4 points (P < .001) on the Epworth Sleepiness Scale during lockdown. Bedtime was delayed by 46.1% of participants and wakeup time was delayed by 59.6%, driven primarily by participants with IH. Teleworkers (but not in-person workers) reported a mean increase of 0.9 ± 1.2 hours in night sleep (P < .001) and a mean decrease in sleepiness score of 1.6 ± 3.1 (P < .001). Cataplexy improved in 54.1% of participants with NT1. Sleepiness correlated with psychological wellness (r = .3, P < .001). As many as 42.5% enjoyed the lockdown, thanks to reallocation of time usually spent commuting toward longer sleep time, hobbies, and family time, and appreciated a freer napping schedule. Conversely, 13.2% disliked the lockdown, feeling isolation and psychological distress. CONCLUSIONS Extended sleep time, circadian delay (in patients with IH), and teleworking resulted in decreased symptoms of central hypersomnias. These findings suggest that people with IH, NT1, and NT2 may benefit from a decrease in social and professional constraints on sleep-wake habits, and support advocacy efforts aimed at facilitating workplace and schedule accommodations for this population. CITATION Nigam M, Hippolyte A, Dodet P, et al. Sleeping through a pandemic: impact of COVID-19-related restrictions on narcolepsy and idiopathic hypersomnia. J Clin Sleep Med. 2022;18(1):255-263.
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Affiliation(s)
- Milan Nigam
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France,Centre for Advanced Research in Sleep Medicine, Sacré-Coeur Hospital, Montreal, Quebec, Canada,Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada,Sorbonne University, Paris, France
| | - Amandine Hippolyte
- Sorbonne University, Paris, France,Faculté des Sciences, Université de Montpellier, Montpellier, France
| | - Pauline Dodet
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France
| | - Ana Gales
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France
| | - Jean-Baptiste Maranci
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France,Sorbonne University, Paris, France
| | - Saba Al-Youssef
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France
| | - Smaranda Leu-Semenescu
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France
| | - Isabelle Arnulf
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France,Sorbonne University, Paris, France,Institut du Cerveau et de la Moelle (Paris Brain Institute), Paris, France,Address correspondence to: Isabelle Arnulf, MD, PhD, Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, 47-83 Bd de l’Hôpital, 75013 Paris; Tel: 33 (0) 1 42 16 77 04; Fax: 33 (0) 1 42 16 77 00;
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10
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Shambrook P, Hesters A, Marois C, Zemba D, Servan J, Gaymard B, Pico F, Delorme C, Lubetzki C, Arnulf I, Psimaras D, Honnorat J, Gales A, Méneret A. Delayed Benefit From Aggressive Immunotherapy in Waxing and Waning Anti-IgLON5 Disease. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/4/e1009. [PMID: 33986128 PMCID: PMC8192057 DOI: 10.1212/nxi.0000000000001009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/10/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Pauline Shambrook
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Adèle Hesters
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Clémence Marois
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Daniel Zemba
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Jérôme Servan
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Bertrand Gaymard
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Fernando Pico
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Cécile Delorme
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Catherine Lubetzki
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Isabelle Arnulf
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Dimitri Psimaras
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Jérôme Honnorat
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Ana Gales
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Aurélie Méneret
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France.
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11
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Nguyen-Michel VH, Herlin B, Gales A, Vaz S, Levy P, Dupont S, Adam C, Navarro V, Frazzini V. Sleep scoring based on video-electroencephalography monitoring in an Epileptology Unit: Comparison with polysomnography. J Sleep Res 2021; 30:e13332. [PMID: 33825252 DOI: 10.1111/jsr.13332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/25/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
The aim of the study was to compare the performance of video- electroencephalography (EEG) monitoring and standard polysomnography for sleep scoring in an Epileptology Unit. We calculated the level of agreement between two methods of sleep scoring, using either 27-electrode video-EEG or polysomnography for 1 night in 22 patients admitted to our Epileptology Unit. Independent experts manually scored sleep using the American Academy of Sleep Medicine 2017 guidelines. We evaluated the number of sleep cycles and their distribution on hypnogram, total sleep time, sleep efficiency, sleep and rapid eye movement sleep-onset latency, wake after sleep-onset, and sleep stages. We then extracted sub-samples of recordings to examine the agreement in microarousal and rapid eye movement scoring. We used Bland and Altman plots and Cohen's kappa test to measure agreement. Bland and Altman plots showed at least 95% agreement for all studied sleep parameters with the exception of wake after sleep onset, where there was an 11 min difference. Cohen's kappa test showed an agreement for the recognition of microarousal (0.89) and of rapid eye movements (0.96) in sub-samples. Video-EEG represents an acceptable alternative tool for sleep architecture study in patients admitted to an Epileptology Unit.
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Affiliation(s)
- Vi-Huong Nguyen-Michel
- Department of Clinical Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France.,Epileptology Unit, DMU Neuroscience 6, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Bastien Herlin
- Epileptology Unit, DMU Neuroscience 6, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France.,Rehabilitation Unit, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France.,Sorbonne Université, Paris, France
| | - Ana Gales
- Epileptology Unit, DMU Neuroscience 6, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France.,Sleep Disorder Unit, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Soraia Vaz
- Epileptology Unit, DMU Neuroscience 6, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Pierre Levy
- Public Health Department and Clinical Neurophysiology Unit, AP-HP, Hôpital Tenon, Paris, France
| | - Sophie Dupont
- Epileptology Unit, DMU Neuroscience 6, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France.,Rehabilitation Unit, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France.,Sorbonne Université, Paris, France
| | - Claude Adam
- Epileptology Unit, DMU Neuroscience 6, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Vincent Navarro
- Department of Clinical Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France.,Epileptology Unit, DMU Neuroscience 6, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France.,Sorbonne Université, Paris, France.,Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Paris, France
| | - Valerio Frazzini
- Department of Clinical Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France.,Epileptology Unit, DMU Neuroscience 6, AP-HP, Hôpital Pitié-Salpêtrière-Charles Foix, Paris, France.,Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Paris, France
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12
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Mainieri G, Maranci JB, Champetier P, Leu-Semenescu S, Gales A, Dodet P, Arnulf I. Are sleep paralysis and false awakenings different from REM sleep and from lucid REM sleep? A spectral EEG analysis. J Clin Sleep Med 2021; 17:719-727. [PMID: 33283752 DOI: 10.5664/jcsm.9056] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine the polysomnography characteristics during sleep paralysis, false awakenings, and lucid dreaming (which are states intermediate to rapid eye movement [REM] sleep and wake but exceptionally observed in sleep laboratory). METHODS In 5 participants, we captured 5 episodes of sleep paralysis (2 time marked with the ocular left-right-left-right code normally used to signal lucid dreaming, 1 time marked by an external noise, and 2 retrospectively reported) and 2 episodes of false awakening. The sleep coding (using 3-second mini-epochs) and spectral electroencephalography analysis were compared during these episodes and normal REM sleep as well as wakefulness in the same 4 of 5 participants and vs lucid REM sleep in 4 other patients with narcolepsy. RESULTS During episodes of sleep paralysis, 70.8% of mini-epochs contained theta electroencephalography rhythm (vs 89.7% in REM sleep and 21.2% in wakefulness), 93.8% contained chin muscle atonia (vs 89.7% in REM sleep and 33.3% in wakefulness), and 6.9% contained rapid eye movements (vs 11.9% in REM sleep and 8.1% in wakefulness). The electroencephalography spectrum during sleep paralysis was intermediate between wakefulness and REM sleep in the alpha, theta, and delta frequencies, whereas the beta frequencies were not different between sleep paralysis and normal REM sleep. The power spectrum during false awakening followed the same profile as in sleep paralysis. CONCLUSIONS The predominant theta electroencephalography rhythm during sleep paralysis and false awakenings (with rare and lower alpha rhythm) suggests that the brain during sleep paralysis is not in an awake but in a dreaming state.
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Affiliation(s)
- Greta Mainieri
- Sleep Disorder Unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France.,Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania Via S. Sofia 78, Italy
| | - Jean-Baptiste Maranci
- Sleep Disorder Unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France.,Sorbonne University, Paris, France.,Paris Brain Institute, Paris, France
| | - Pierre Champetier
- Sleep Disorder Unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France.,Paris Brain Institute, Paris, France.,Ecole Normale Supérieure Paris-Saclay, Université Paris-Saclay, France
| | | | - Ana Gales
- Sleep Disorder Unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Pauline Dodet
- Sleep Disorder Unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Isabelle Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France.,Sorbonne University, Paris, France.,Paris Brain Institute, Paris, France
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13
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Rodrigues-Costa F, Slivinski J, Ióca LP, Bertonha AF, de Felício R, Cunha MGD, da Mata Madeira PV, Cauz ACG, Trindade DM, Freire VF, Ropke CD, Gales A, Brocchi M, Ferreira AG, Gueiros-Filho F, Trivella DBB, Berlinck RGS, Dessen A. Merulinic acid C overcomes gentamicin resistance in Enterococcus faecium. Bioorg Chem 2020; 100:103921. [PMID: 32464403 DOI: 10.1016/j.bioorg.2020.103921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 12/22/2022]
Abstract
Enterococci are gram-positive, widespread nosocomial pathogens that in recent years have developed resistance to various commonly employed antibiotics. Since finding new infection-control agents based on secondary metabolites from organisms has proved successful for decades, natural products are potentially useful sources of compounds with activity against enterococci. Herein are reported the results of a natural product library screening based on a whole-cell assay against a gram-positive model organism, which led to the isolation of a series of anacardic acids identified by analysis of their spectroscopic data and by chemical derivatizations. Merulinic acid C was identified as the most active anacardic acid derivative obtained against antibiotic-resistant enterococci. Fluorescence microscopy analyses showed that merulinic acid C targets the bacterial membrane without affecting the peptidoglycan and causes rapid cellular ATP leakage from cells. Merulinic acid C was shown to be synergistic with gentamicin against Enterococcus faecium, indicating that this compound could inspire the development of new antibiotic combinations effective against drug-resistant pathogens.
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Affiliation(s)
- Fernanda Rodrigues-Costa
- Brazilian Biosciences National Laboratory (LNBio), CNPEM, 13083-970 Campinas, SP, Brazil; Departamento de Genética, Evolução, Microbiologia e Imunologia, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), CEP 13083-970, Campinas, São Paulo, Brazil
| | - Juliano Slivinski
- Instituto de Química de São Carlos, Universidade de São Paulo, CEP 13560-970, São Carlos, SP, Brazil
| | - Laura P Ióca
- Instituto de Química de São Carlos, Universidade de São Paulo, CEP 13560-970, São Carlos, SP, Brazil
| | - Ariane F Bertonha
- Instituto de Química de São Carlos, Universidade de São Paulo, CEP 13560-970, São Carlos, SP, Brazil
| | - Rafael de Felício
- Brazilian Biosciences National Laboratory (LNBio), CNPEM, 13083-970 Campinas, SP, Brazil
| | | | - Paulo Vinicius da Mata Madeira
- Brazilian Biosciences National Laboratory (LNBio), CNPEM, 13083-970 Campinas, SP, Brazil; Departamento de Genética, Evolução, Microbiologia e Imunologia, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), CEP 13083-970, Campinas, São Paulo, Brazil
| | - Ana C G Cauz
- Departamento de Genética, Evolução, Microbiologia e Imunologia, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), CEP 13083-970, Campinas, São Paulo, Brazil
| | | | - Vítor F Freire
- Instituto de Química de São Carlos, Universidade de São Paulo, CEP 13560-970, São Carlos, SP, Brazil
| | | | - Ana Gales
- Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcelo Brocchi
- Departamento de Genética, Evolução, Microbiologia e Imunologia, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), CEP 13083-970, Campinas, São Paulo, Brazil
| | - Antônio G Ferreira
- Departamento de Química, Universidade Federal de São Carlos, CEP 13565-905, São Carlos, SP, Brazil
| | - Frederico Gueiros-Filho
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo (USP), CEP 05508-000, São Paulo, Brazil
| | | | - Roberto G S Berlinck
- Instituto de Química de São Carlos, Universidade de São Paulo, CEP 13560-970, São Carlos, SP, Brazil.
| | - Andréa Dessen
- Brazilian Biosciences National Laboratory (LNBio), CNPEM, 13083-970 Campinas, SP, Brazil; Univ. Grenoble Alpes, CNRS, CEA, Institut de Biologie Structurale (IBS), Grenoble, France.
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14
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Wilcox M, Al-Obeid S, Gales A, Kozlov R, Martínez-Orozco JA, Rossi F, Sidorenko S, Blondeau J. Reporting elevated vancomycin minimum inhibitory concentration in methicillin-resistant Staphylococcus aureus: consensus by an International Working Group. Future Microbiol 2019; 14:345-352. [PMID: 30724113 PMCID: PMC6479275 DOI: 10.2217/fmb-2018-0346] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) remains an important cause of serious infection, for which vancomycin is often recommended as the first-choice antibiotic treatment. Appropriate vancomycin prescribing requires accurate measurement of minimum inhibitory concentrations (MICs) to avoid treatment failure, and yet determination can be challenging due to methodological difficulties associated with susceptibility testing. An International Working Group of infectious disease specialists and clinical/medical microbiologists reached a consensus that empirical MRSA infection therapies should be chosen regardless of the suspected origin of the infecting strain (e.g., community or hospital) due to the complex intermingling epidemiology of MRSA clones in these settings. Also, if an elevated vancomycin MIC in the susceptible range is obtained in routine testing, an alternative second method should be used for confirmation and to aid antibiotic therapy recommendations. There is no absolutely dependable method for the accurate determination of vancomycin MIC, but broth microdilution appears to be the most reliable.
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Affiliation(s)
- Mark Wilcox
- Leeds Teaching Hospitals NHS Trust & University of Leeds, Leeds, UK
| | - Suleiman Al-Obeid
- Microbiology Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ana Gales
- Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Roman Kozlov
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, Smolensk, Russia
| | - José A Martínez-Orozco
- Infectious Diseases & Clinical Microbiology Department, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Flavia Rossi
- Hospital das Clínicas da Faculdade de Medicina, Seção de Microbiologia, Divisão de Laboratório Central LIM03, Universidade de São Paulo, São Paulo, Brazil
| | - Sergey Sidorenko
- Department of Medical Microbiology & Molecular Epidemiology, Pediatric Research & Clinical Center for Infectious Diseases, Department of Medical Microbiology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
| | - Joseph Blondeau
- Department of Clinical Microbiology, Royal University Hospital, Saskatchewan, Canada
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15
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Hadi A, Gales A, Moyo Q, Davies R, Wheeler J. Routine follow up endoscopy in CT proven acute sigmoid diverticulitis. has high resolution imaging replaced endoscopic assessment? Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Nguyen-Michel VH, Solano O, Leu-Semenescu S, Pierre-Justin A, Gales A, Navarro V, Baulac M, Adam C, Dupont S, Arnulf I. Rapid eye movement sleep behavior disorder or epileptic seizure during sleep? A video analysis of motor events. Seizure 2018; 58:1-5. [DOI: 10.1016/j.seizure.2018.03.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 12/31/2022] Open
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17
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Mezouar N, Mochel F, An-Gourfinkel I, Baulac M, Gales A. Focal epilepsy as the revealing symptom of 5,10-methylenetetrahydrofolate reductase deficiency in a young adult. Rev Neurol (Paris) 2018; 174:173-175. [DOI: 10.1016/j.neurol.2017.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/04/2017] [Accepted: 06/15/2017] [Indexed: 12/01/2022]
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18
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Gales A, Masingue M, Millecamps S, Giraudier S, Grosliere L, Adam C, Salim C, Navarro V, Nadjar Y. Adolescence/adult onset MTHFR deficiency may manifest as isolated and treatable distinct neuro-psychiatric syndromes. Orphanet J Rare Dis 2018; 13:29. [PMID: 29391032 PMCID: PMC5796584 DOI: 10.1186/s13023-018-0767-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/12/2018] [Indexed: 12/02/2022] Open
Abstract
5,10-Methylene-tetrahydrofolate reductase (MTHFR) deficiency is a genetic disorder that can occur at any age and can be easily detected by increased homocysteinemia. In adolescence/adult onset forms, the clinical picture is often complex with association of various neurological features and thrombosis. Here we report the cases of two adult siblings who experienced focal epilepsy at 18 years old as a first disease manifestation, without other symptom during several years. Upon diagnosis, both patients received metabolic treatment comprising B9, B12 and betaine which has stopped the occurrence of seizures, allowing discontinuation of anti-epileptic drugs. Among 24 reviewed adolescent/adult onset patients with MTHFR deficiency in the literature, clinical manifestations included gait disorder (96%, from motor central or peripheral origin), cognitive decline (74%), epileptic syndromes (50%), encephalopathy (30%), psychotic symptoms (17%), and thrombotic events (21%). A total of 41% presented a single neurological manifestation that could stay isolated during at least 3 years, delaying achievement of the diagnosis. Brain MRI showed a mostly periventricular white matter changes in 71% of cases. All patients stabilized or improved following metabolic treatment. Despite being rare, adolescence/adult onset MTHFR deficiency can nevertheless be successfully treated. Therefore, homocysteinemia should be tested in various unexplained neuro-psychiatric syndromes like epilepsy or spastic paraparesis, even if isolated, since waiting for completion of the clinical picture is likely to increase the risk of irreversible neurological damage.
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Affiliation(s)
- Ana Gales
- AP-HP, GH Pitié-Salpêtrière-Charles Foix, Epileptology Unit, Paris, France
| | - Marion Masingue
- Neurology Department, Reference Center for Lysosomal Diseases, Neurogenetics and Metabolism Unit, AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Stephanie Millecamps
- Sorbonne Universités UMRS1127, INSERM U1127, CNRS UMR7225, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Stephane Giraudier
- AP-HP, GH Henri Mondor, Laboratoire d'Hématologie, Créteil, France.,UPEC University, Creteil, France.,INSERM U1131, Saint Louis Hospital, Paris, France
| | - Laure Grosliere
- Neurology Department, Reference Center for Lysosomal Diseases, Neurogenetics and Metabolism Unit, AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Claude Adam
- AP-HP, GH Pitié-Salpêtrière-Charles Foix, Epileptology Unit, Paris, France
| | | | - Vincent Navarro
- AP-HP, GH Pitié-Salpêtrière-Charles Foix, Epileptology Unit, Paris, France.,UPMC University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Yann Nadjar
- Neurology Department, Reference Center for Lysosomal Diseases, Neurogenetics and Metabolism Unit, AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France.
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19
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Pfaller MA, Shortridge D, Sader HS, Gales A, Castanheira M, Flamm RK. Ceftolozane-tazobactam activity against drug-resistant Enterobacteriaceae and Pseudomonas aeruginosa causing healthcare-associated infections in Latin America: report from an antimicrobial surveillance program (2013–2015). Braz J Infect Dis 2017; 21:627-637. [PMID: 28941394 PMCID: PMC9425460 DOI: 10.1016/j.bjid.2017.06.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/15/2017] [Accepted: 06/18/2017] [Indexed: 11/29/2022] Open
Abstract
This study evaluated the in vitro activity of ceftolozane-tazobactam and comparator agents tested against Latin American isolates of Enterobacteriaceae and Pseudomonas aeruginosa from patients with health care-associated infections. Ceftolozane-tazobactam is an antipseudomonal cephalosporin combined with a well-established β-lactamase inhibitor. A total of 2415 Gram-negative organisms (537 P. aeruginosa and 1878 Enterobacteriaceae) were consecutively collected in 12 medical centers located in four Latin American countries. The organisms were tested for susceptibility by broth microdilution methods as described by the CLSI M07-A10 document and the results interpreted according to EUCAST and CLSI breakpoint criteria. Results Ceftolozane-tazobactam (MIC50/90, 0.25/32 μg/mL; 84.2% susceptible) and meropenem (MIC50/90, ≤0.06/0.12 μg/mL; 92.6% susceptible) were the most active compounds tested against Enterobacteriaceae. Among the Enterobacteriaceae isolates tested, 6.6% were carbapenem-resistant Enterobacteriaceae and 26.4% exhibited an extended-spectrum β-lactamase non-carbapenem-resistant phenotype. Whereas ceftolozane-tazobactam showed good activity against extended-spectrum beta-lactamase, non-carbapenem-resistant phenotype strains of Enterobacteriaceae (MIC50/90, 0.5/>32 μg/mL), it lacked useful activity against strains with a (MIC50/90, >32/>32 μg/mL; 1.6% S) carbapenem-resistant phenotype. Ceftolozane-tazobactam was the most potent (MIC50//90, 0.5/16 μg/mL) β-lactam agent tested against P. aeruginosa isolates, inhibiting 86.8% at an MIC of ≤4 μg/mL. P. aeruginosa exhibited high rates of resistance to cefepime (16.0%), ceftazidime (23.6%), meropenem (28.3%), and piperacillin-tazobactam (16.4%). Conclusions Ceftolozane-tazobactam was the most active β-lactam agent tested against P. aeruginosa and demonstrated higher in vitro activity than available cephalosporins and piperacillin-tazobactam when tested against Enterobacteriaceae.
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Affiliation(s)
- Michael A Pfaller
- JMI Laboratories, North Liberty, IA, United States; University of Iowa, College of Medicine, Iowa City, IA, United States
| | | | | | - Ana Gales
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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20
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Dupont S, Gales A, Sammey S, Vidailhet M, Lambrecq V. Late-onset Rasmussen Encephalitis: A literature appraisal. Autoimmun Rev 2017; 16:803-810. [DOI: 10.1016/j.autrev.2017.05.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 12/20/2022]
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21
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Gales A, Chaaban B, Husson H, Le Guennec L, Viala K, Maisonobe T, Weiss N. Lidocaine-medicated plaster for treating acute autonomic and sensory neuropathy with erythromelalgia-like presentations. Rev Neurol (Paris) 2016; 172:399-400. [PMID: 27158041 DOI: 10.1016/j.neurol.2016.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/29/2016] [Accepted: 03/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- A Gales
- Neurological Intensive Care Unit, Neurology Department, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris and Pierre and Marie Curie University Paris 6, Paris, France
| | - B Chaaban
- Neurophysiology and Neurology Department, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris and Pierre and Marie Curie University Paris 6, Paris, France
| | - H Husson
- Neurophysiology and Neurology Department, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris and Pierre and Marie Curie University Paris 6, Paris, France
| | - L Le Guennec
- Neurological Intensive Care Unit, Neurology Department, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris and Pierre and Marie Curie University Paris 6, Paris, France
| | - K Viala
- Neurophysiology and Neurology Department, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris and Pierre and Marie Curie University Paris 6, Paris, France
| | - T Maisonobe
- Neurophysiology and Neurology Department, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris and Pierre and Marie Curie University Paris 6, Paris, France
| | - N Weiss
- Neurological Intensive Care Unit, Neurology Department, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris and Pierre and Marie Curie University Paris 6, Paris, France.
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22
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Cousyn L, Gales A, Chassoux F, Bielle F, Petit A, Baulac M, Navarro V. Encéphalite de Rasmussen révélée par une épilepsie frontale pharmacorésistante à l’âge adulte. Rev Neurol (Paris) 2016. [DOI: 10.1016/j.neurol.2016.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Sabben C, Gales A, Demeret S, Bolgert F, Weiss N. Ventilation non invasive et myasthénie, une alternative judicieuse à la ventilation mécanique invasive ? Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Martin-Blondel G, Gales A, Bernad J, Cuzin L, Delobel P, Barange K, Izopet J, Pipy B, Alric L. Low interleukin-10 production by monocytes of patients with a self-limiting hepatitis C virus infection. J Viral Hepat 2009; 16:485-91. [PMID: 19302337 DOI: 10.1111/j.1365-2893.2009.01094.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Host factors seem to be crucial for the spontaneous clearance of hepatitis C virus (HCV). Monocytes play a pivotal role in innate immunity and help regulate adaptive responses. This study assesses the characteristics of monocytes from patients with self-limiting HCV infections. We studied 35 consecutive patients [11 with a self-limiting HCV infection, 16 chronically infected with HCV and sustained virological responders (SVR) following antiviral therapy, and eight chronically infected HCV but untreated] and eight healthy donors (HD). The production of interleukin (IL)-10, tumour necrosis factor-alpha (TNF-alpha) and IL-12p40 by monocytes stimulated with lipopolysaccharides(LPS) or HCV Core protein was measured by enzyme-linked immunoassay. Monocyte surface markers were analysed by flow cytometry. LPS and Core protein triggered IL-10 and TNF-alpha production, but monocytes from self-limiting infection patients produced significantly less IL-10 and TNF-alpha than those of SVR, chronically infected or HD (P < 0.05), while IL-12p40 production was unchanged. This cytokine production profile did not appear to be due to expansion of the CD14(+) CD16(+) monocyte subset or to a classical or alternative activation monocyte profile. Monocytes from self-limiting infection patients had more CCR7 than those from SVR or chronically infected patients (P < 0.05). Monocytes of self-limiting infection patients appear to produce little IL-10 and TNF-alpha in response to viral or unspecific stimulation and to have a higher CCR7 expression. This profile seems to be independent to a particular monocyte subset or activation state. Low IL-10 production may help establish an effective immune response and spontaneous HCV clearance.
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Affiliation(s)
- G Martin-Blondel
- EA2405 UMR3 MD-UM-UPS, Université Paul Sabatier Toulouse III, France
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25
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Zárate MS, Gales A, Jordá-Vargas L, Yahni D, Relloso S, Bonvehi P, Monteiro J, Campos-Pignatari A, Smayevsky J. Contaminación ambiental durante un brote de enterococo resistente a vancomicina en un hospital de Argentina. Enferm Infecc Microbiol Clin 2007; 25:508-12. [PMID: 17915109 DOI: 10.1157/13109987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Vancomycin-resistant enterococci isolates (VRE) have caused numerous outbreaks in intensive care units (ICUs). A contaminated hospital environment, the hands of health care workers (HCW), and carrier patients may play important roles in perpetuating the chain of transmission in these outbreaks. The aims of this study were to report the first VRE outbreak in our center and assess the role of environmental contamination and HCW hands in the spread of new cases of enterococcal infection. MATERIAL AND METHOD Between August and December 2003, surveillance cultures were performed with samples from all patients (n = 113) admitted to the ICU, as well as cultures of samples from the environment (n = 69) and HCW hands (n = 23). RESULTS Eighteen clinical samples from 8 patients and 7 environmental samples yielded Enterococcus faecium (24 strains) and E. avium (1 strain). VRE was not detected on HCW hands. All the VRE isolates belonged to a single clone and carried the vanA gene. CONCLUSION Environmental contamination provides an important reservoir for future outbreaks of VRE, perpetuating transmission of the microorganism in the hospital setting.
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Affiliation(s)
- Mariela Soledad Zárate
- Laboratorio de Bacteriología, Micología y Parasitología. Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC). Capital Federal. Buenos Aires. Argentina.
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26
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Gales A, Jones R, Janechek M, Sader H. P1637 Evaluation of the in vitro activity of levofioxacin and moxifioxacin tested against Stenotrophomonas maltophilia: can moxifloxacin activity be predicted by levofioxacin MIC results? Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71476-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Several Etest (AB BIODISK, Solna, Sweden) gradient formats were developed for detection of metallo-beta-lactamases based on the reduction of imipenem (IP) or ceftazidime (TZ) MICs in the presence of EDTA or 2-mercaptopropionic acid (MPA). The Etest metallo-beta-lactamase (Etest MBL) strips consisted of a double-sided seven-dilution range of IP or TZ (4 to 256 microg/ml) and IP or TZ (1 to 64 microg/ml) overlaid with a constant concentration of EDTA or MPA. The prototype strips were evaluated on several agar media (brain heart infusion agar, Isosensitest agar, nutrient agar, and Mueller-Hinton agar for aerobes and brucella blood agar for anaerobes) with 138 challenge strains: Acinetobacter spp. (n = 9), Aeromonas spp. (n = 8), Chryseobacterium spp. (n = 28), Escherichia coli (n = 1), Klebsiella pneumoniae (n = 4), Pseudomonas aeruginosa (n = 14), Proteus mirabilis (n = 3), Serratia spp. (n = 10), Stenotrophomonas maltophilia (n = 43), Sphingobacterium spp. (n = 3), and Bacteroides fragilis group (n = 15). PCR analysis using specific primers for IMP-1, L1, CcrA, and bla(B/C) confirmed the presence of the metallo-beta-lactamase genes. Enzyme assays were also performed with IP as an indicator substrate followed by EDTA inhibition profiles. EDTA was found to be a better inhibitor of metallo-beta-lactamases, especially for anaerobes. IP was a better than TZ. Mueller-Hinton agar was the preferred medium, particularly when compared to Isosensitest agar, which frequently produced falsely low MICs for IP. Etest IP plus IP-EDTA with Mueller-Hinton agar had a sensitivity of 94% (79 of 84) and specificity of 95% (124 of 130). The Etest MBL strip appears to be an acceptable diagnostic reagent to detect metallo-beta-lactamase phenotypes in the clinical microbiology laboratory.
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Gales A, Sader H, Jones RN. Activities of BMS 284756 (T-3811) against Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae isolates from SENTRY antimicrobial surveillance program medical centers in Latin America (1999). Antimicrob Agents Chemother 2001; 45:1463-6. [PMID: 11302811 PMCID: PMC90489 DOI: 10.1128/aac.45.5.1463-1466.2001] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The antimicrobial activity of BMS 284756, a novel des-F(6)-quinolone, was comparatively evaluated against 257 Streptococcus pneumoniae, 198 Haemophilus influenzae, and 88 Moraxella catarrhalis strains isolated in Latin America between July and September of 1999 as part of the SENTRY Antimicrobial Surveillance Program. Nearly 28.0% of S. pneumoniae strains were nonsusceptible to penicillin. The rank order of quinolone potency versus S. pneumoniae was BMS 284756 (MIC at which 90% of isolates were inhibited [MIC(90)], 0.12 microg/ml) > trovafloxacin (MIC(90), 0.25 microg/ml) > gatifloxacin (MIC(90), 0.5 microg/ml) > levofloxacin and ciprofloxacin (MIC(90), 1 to 2 microg/ml). All S. pneumoniae strains that were not susceptible to other quinolones were inhibited by BMS 284756 at < or = 2 microg/ml. The overall prevalence of beta-lactamase production was 15.2% in H. influenzae and 98.9% in M. catarrhalis. BMS 284756 showed excellent potency and spectrum against this group of pathogens, inhibiting all isolates at < or = 0.12 microg/ml. BMS 284756 exhibited activity similar to those displayed by the new fluoroquinolones, such as levofloxacin, trovafloxacin, or gatifloxacin, and could be a therapeutic option for empirical treatment of community-acquired respiratory tract infections.
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Affiliation(s)
- A Gales
- University of Iowa College of Medicine, Iowa City, Iowa, USA
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Acébal E, Subirá S, Spatz J, Faleni R, Merzbacher B, Gales A, Moizeszowicz J. A double blind comparative trial of nomifensin and desimipramine in depression. Relationship between treatment and phenylethylamine excretion. Eur J Clin Pharmacol 1976; 10:109-13. [PMID: 786670 DOI: 10.1007/bf00609468] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The effect of nomifensin (Hoechst 36984), a synthetic psychotropic drug whose structure differs from MAO inhibitors and tricyclics, was studied in a double blind comparative trial with desimipramine in patients with various depressive syndromes. Forty-three patients (23 in the nomifensin group and 20 in the desimipramine group) were studied for 6 weeks. Clinical follow-up was done with the Wittenborn scale (WPRS), Hamilton's rating scale for depression (HRS), Zung's scale (SDS), and the PEN inventory. The average daily dose was nomifensin 84 mg and desimipramine 76 mg. Changes in HRS, WPRS and SDS showed statistically significant improvement with both treatments. A moderate anxiolytic effect was found in the nomifensin group, whereas medication had to be discontinued in two desimipramine-treated patients because of its drive-enhancing effect. Urinary phenylethylamine excretion rose in 2 out of 8 patients after 5 weeks of treatment with nomifensin.
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