Neuropsychological assessment in pediatric epilepsy surgery: A French procedure consensus

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

Revisiting emotion recognition in different types of temporal lobe epilepsy: The influence of facial expression intensity

Temporal lobe epilepsy (TLE) can induce various difficulties in recognizing emotional facial expressions (EFE), particularly for negative valence emotions. However, these difficulties have not been systematically examined according to the localization of the epileptic focus. For this purpose, we used a forced-choice recognition task in which faces expressing fear, sadness, anger, disgust, surprise, or happiness were presented in different intensity levels from moderate to high intensity. The first objective of our study was to evaluate the impact of emotional intensity on the recognition of different categories of EFE in TLE patients compared to control participants. The second objective was to assess the effect of localizationof epileptic focus on the recognition of EFE in patients with medial temporal lobe epilepsy (MTLE) associated or not with hippocampal sclerosis (HS), or lateral temporal lobe epilepsy (LTLE). The results showed that the 272 TLE patients and the 68 control participants were not differently affected by the intensity of EFE. However, we obtained group differences within the clinical population when we took into account the localization of the temporal lobe epileptic focus. As predicted, TLE patients were impaired in recognizing fear and disgust relative to controls. Moreover, the scores of these patients varied according to the localization of the epileptic focus, but not according to the cerebral lateralization of TLE. The facial expression of fear was less well recognized by MTLE patients, with or without HS, and the expression of disgust was less well recognized by LTLE as well as MTLE without HS patients. Moreover, emotional intensity modulated differently the recognition of disgust and surprise of the three patient groups underlying the relevance of using moderate emotional intensity to distinguish the effect of epileptic focus localization. These findings should be taken into account for interpreting the emotional behaviors and deserve to befurther investigated before considering TLE surgical treatment or social cognition interventions in TLE patients.

Colchicine for community-treated patients with COVID-19 (COLCORONA): a phase 3, randomised, double-blinded, adaptive, placebo-controlled, multicentre trial

BACKGROUND

Evidence suggests a role for excessive inflammation in COVID-19 complications. Colchicine is an oral anti-inflammatory medication beneficial in gout, pericarditis, and coronary disease. We aimed to investigate the effect of colchicine on the composite of COVID-19-related death or hospital admission.

METHODS

The present study is a phase 3, randomised, double-blind, adaptive, placebo-controlled, multicentre trial. The study was done in Brazil, Canada, Greece, South Africa, Spain, and the USA, and was led by the Montreal Heart Institute. Patients with COVID-19 diagnosed by PCR testing or clinical criteria who were not being treated in hospital were eligible if they were at least 40 years old and had at least one high-risk characteristic. The randomisation list was computer-generated by an unmasked biostatistician, and masked randomisation was centralised and done electronically through an automated interactive web-response system. The allocation sequence was unstratified and used a 1:1 ratio with a blocking schema and block sizes of six. Patients were randomly assigned to receive orally administered colchicine (0·5 mg twice per day for 3 days and then once per day for 27 days thereafter) or matching placebo. The primary efficacy endpoint was the composite of death or hospital admission for COVID-19. Vital status at the end of the study was available for 97·9% of patients. The analyses were done according to the intention-to-treat principle. The COLCORONA trial is registered with ClinicalTrials.gov (NCT04322682) and is now closed to new participants.

FINDINGS

Trial enrolment began in March 23, 2020, and was completed in Dec 22, 2020. A total of 4488 patients (53·9% women; median age 54·0 years, IQR 47·0-61·0) were enrolled and 2235 patients were randomly assigned to colchicine and 2253 to placebo. The primary endpoint occurred in 104 (4·7%) of 2235 patients in the colchicine group and 131 (5·8%) of 2253 patients in the placebo group (odds ratio [OR] 0·79, 95·1% CI 0·61-1·03; p=0·081). Among the 4159 patients with PCR-confirmed COVID-19, the primary endpoint occurred in 96 (4·6%) of 2075 patients in the colchicine group and 126 (6·0%) of 2084 patients in the placebo group (OR 0·75, 0·57-0·99; p=0·042). Serious adverse events were reported in 108 (4·9%) of 2195 patients in the colchicine group and 139 (6·3%) of 2217 patients in the placebo group (p=0·051); pneumonia occurred in 63 (2·9%) of 2195 patients in the colchicine group and 92 (4·1%) of 2217 patients in the placebo group (p=0·021). Diarrhoea was reported in 300 (13·7%) of 2195 patients in the colchicine group and 161 (7·3%) of 2217 patients in the placebo group (p<0·0001).

INTERPRETATION

In community-treated patients including those without a mandatory diagnostic test, the effect of colchicine on COVID-19-related clinical events was not statistically significant. Among patients with PCR-confirmed COVID-19, colchicine led to a lower rate of the composite of death or hospital admission than placebo. Given the absence of orally administered therapies to prevent COVID-19 complications in community-treated patients and the benefit of colchicine in patients with PCR-proven COVID-19, this safe and inexpensive anti-inflammatory agent could be considered for use in those at risk of complications. Notwithstanding these considerations, replication in other studies of PCR-positive community-treated patients is recommended.

FUNDING

The Government of Quebec, the Bill & Melinda Gates Foundation, the National Heart, Lung, and Blood Institute of the US National Institutes of Health, the Montreal Heart Institute Foundation, the NYU Grossman School of Medicine, the Rudin Family Foundation, and philanthropist Sophie Desmarais.

French neuropsychological procedure consensus in epilepsy surgery

INTRODUCTION

Neuropsychological assessment is an integral component of the surgical procedure in patients with epilepsy. As no French consensus for neuropsychological assessment was available, the main goal of this work was to define French neuropsychological procedure consensus in regard to literature review.

METHOD

A panel of expert in neuropsychology was created within the framework of the French League Against Epilepsy. A systematic search of publications from 1950 to 2017 listed in PubMed database was conducted leading to a classification of articles according to their level of scientific evidence. French neuropsychological procedure consensus was then carried out with an expert panel of expert.

RESULTS

Low scientific evidence of neuropsychological data was reported. A panel of expert proposed a comprehensive neuropsychological assessment procedure including the exploration of intellectual efficiency, long-term memory, short-term and working memory, attention, executive functions, processing speed and motor skills, language, visual processing, praxis, psychobehavioral, and social cognition.

DISCUSSION

A common procedure for assessing cognitive and psychobehavioral function is now available in patients with epilepsy undergoing surgical evaluation have been established, they may help to improve the quality of care and the patient experience. This work highlights the need of furthers investigations and the necessity to develop specific tools with normative data.

Ten things every neurologist needs to know about neuropsychological assessments and interventions in people with epilepsy

This paper describes 10 core features of a neuropsychological assessment with the aim of helping neurologists understand the unique contribution the evaluation can make within the wider context of diagnostic methods in epilepsy. The possibilities, limitations and cautions associated with the investigation are discussed under the following headings. (1) A neuropsychological assessment is a collaborative investigation. (2) Assessment prior to treatment allows for the accurate assessment of treatment effects. (3) The nature of an underlying lesion and its neurodevelopmental context play an important role in shaping the associated neuropsychological deficit. (4) Cognitive and behavioural impairments result from the essential comorbidities of epilepsy which can be considered as much a disorder of cognition and behaviour as of seizures. (5) Patients' subjective complaints can help us understand objective cognitive impairments and their underlying neuroanatomy, resulting in improved patient care. At other times, patient complaints reflect other factors and require careful interpretation. (6) The results from a neuropsychological assessment can be used to maximize the educational and occupational potentials of people with epilepsy. (7) Not all patients are able to engage with a neuropsychological assessment. (8) There are limitations in assessments conducted in a second language with tests that have been standardized on different populations from that of the patient. (9) Adequate intervals between assessments maximize sensitivity to meaningful change. (10) Patients should be fully informed about the purpose of the assessment and have realistic expectations of the outcome prior to referral.

Abstract P5-07-13: Conceptual model of transdisciplinary science - Advocacy collaboration for the physical sciences and oncology: A case study focusing on breast density, biomarker discovery, and emerging therapeutics

BACKGROUND: What happens when you mix the foundations of tissue mechanics with advocacy? In a shared quest for exciting scientific frontiers, Bay Area physical scientists, clinical researchers, and advocates work in dynamic symbiotic relationships to integrate concepts drawn from their respective fields. Focusing on the mechanobiology of tumor progression in breast cancer, researchers and advocates are co-creating system change interventions for revamping convergent research processes.

METHODS:As vital catalysts of transdisciplinary innovation, advocates affiliated with the National Cancer Institute (NCI) Physical Sciences and Oncology Network (PS-ON) applied core principles that synergize with the evolving disciplines of Implementation Science (IS) and the Science of Team Science (STS). Diverse methodologies to describe the intersections of physical sciences, breast density, biomarker discovery, emerging therapeutics and advocacy are presented. Additionally, we introduce a theoretical framework and conceptual puzzle illustrating multimethod science advocacy engagement strategies, a typology of contextual factors influencing collaboration, as well as the antecedents, processes, strategic priorities, and overall potential impacts of collaborative transdisciplinary science advocacy exchanges.

RESULTS:Through proactive participation in four areas: 1) research and programmatic support, 2) education and outreach, 3) policy and strategy, and 4) representation and advisory, advocates, representing patient/consumer perspectives, worked toward a common set of goals with researchers and clinicians in determining how tumor microenvironments regulate cancer initiation and behavior through interactions among cell types (e.g., initiated cells, activated stromal cells, and components of the extracellular matrix). Applying NCI Office of Advocacy Relations (OAR) and NCI PS-ON Advocacy Working Group goals for strategic innovation, collaborative execution, and ethical codes of conduct, researchers and advocates codeveloped guiding conceptual frameworks based on organizational foundations, systems readiness, leadership commitment to change, and transdisciplinary levers to promote shared governance, bidirectional collaboration, advocacy inclusion, and the prioritization of research addressing questions of importance to patients.

DISCUSSION: Embedding advocate patient/consumer evidentiary and experiential insights/perspectives regarding mechanics-directed research priorities and clinical interventions in the early phase of convergent research efforts contributes to our understanding of the important role of the physical organization in cell-to-cell contacts, tissue architecture, tumor microenviroments, and mechanical properties in response to therapy. Notably, catalyzing and leveraging advocate engagement across the research continuum provides novel opportunities for advancing institutional changes, spurring unique training/mentoring exchanges, and fostering innovative research and translational opportunities.

Citation Format: Samson S, Northey JJ, Baas C, Weaver VM. Conceptual model of transdisciplinary science - Advocacy collaboration for the physical sciences and oncology: A case study focusing on breast density, biomarker discovery, and emerging therapeutics [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-07-13.

Identification and characterisation of the epididymal proteins in the lizard, Eutropis carinata (Reptilia, Squamata) (Schneider, 1801)

Lizards are seasonal breeders. Cyclic reproductive nature makes lizard as a useful model for the study of the reproductively active protein secretions in the epididymis. During breeding season, the epididymides of the lizard secret proteins that mixes with the spermatozoa and create a favourable environment for sperm maturation. In this spectrum, the aim of this study is to identify and characterize proteins which are present in the lumen of the epididymis of the lizard, E. carinata during the active phase of reproduction. The identification and analysis of the proteins are done through the proteomic approaches. The epididymal luminal fluid sample was taken from the reproductively active and inactive phase and these are subjected to the size exclusion chromatography. Two major peaks (peak 1 and peak 2) were obtained in the epididymal luminal fluid sample taken during the reproductively active phase. On the other hand, the sample from the reproductively inactive phase showed one peak (peak 1) whereas, peak 2 is not present during this phase. The peak 2 belong to reproductively active phase was later subjected to the proteomic analysis. Appropriate gel electrophoresis separation and purification methods are combined with LC-MS/MS in order to identify and characterize the proteins that are presented during the reproductively active phase. Further, in this work, nine proteins are identified including three enzymes and three heat shock proteins. Among the identified proteins, bioinformatics analysis predicts that majority of them are localized in the cytoplasm. In addition to this, an observation is made in the endoplasmic reticulum where it is seen that a close protein-protein interaction network of three molecular chaperones are involved in protein processing. Overall, this paper opens up a new dimension search for epididymal markers for the first time in reptiles, particularly lizards.

Seasonal changes in the protein profile and enzyme activity of the epididymal luminal fluid in the lizard, Eutropis carinata (Schneider, 1801)

The epididymis of the male reproductive system is known to be involved in sperm maturation via the production of polypeptides, glycoproteins, surface proteins, enzymes and other factors. During the annual reproductive cycle, the epididymis of the lizard Eutropis carinata undergoes dramatic changes, both morphologically and biochemically, that occur in a well-organized sequence. The present study reveals the sequential changes that occur in the production and concentration of proteins in the epididymal luminal fluid throughout the annual reproductive cycle. A one-dimensional electrophoretic profile of the epididymal luminal proteins revealed a total of 18 bands in the regenerative phase, 22 bands during breeding and 17 bands in the post-breeding as well as regressed phases of the reproductive cycle. By two-dimensional electrophoresis, the protein complexes that are unique to the breeding phase were further resolved based on their pI and the molecular weight of each protein of the protein complex was determined. This is the first study to observe that proteins that are present during the reproductively inactive phase disappear during the reproductively active phase. The Periodic Acid Schiff (PAS) test for protein profiles revealed the presence of proteins with a carbohydrate moiety. Certain enzymes, such as acid phosphatase, alkaline phosphatase, and α-glucosidase, are highly sensitive to seasonal changes and their activity parallels the production of the epididymal proteins. This study provides evidence for androgen-dependent cyclical changes in the pattern of protein profiles and enzyme activity of the epididymal lumen in the lizard E. carinata.

Care pathways and healthcare use of stroke survivors six months after admission to an acute-care hospital in France in 2012

INTRODUCTION

Care pathways and healthcare management are not well described for patients hospitalized for stroke.

METHODS

Among the 51 million beneficiaries of the French national health insurance general scheme (77% of the French population), patients hospitalized for a first stroke in 2012 and still alive six months after discharge were included using data from the national health insurance information system (Sniiram). Patient characteristics were described by discharge destination-home or rehabilitation center (for < 3 months)-and were followed during their first three months back home.

RESULTS

A total of 61,055 patients had a first admission to a public or private hospital for stroke (mean age; 72 years, 52% female), 13% died during their stay and 37% were admitted to a stroke management unit. Overall, 40,981 patients were still alive at six months: 33% of them were admitted to a rehabilitation center (mean age: 73 years) and 54% were discharged directly to their home (mean age 67 years). For each group, 45 and 62% had been previously admitted to a stroke unit. Patients discharged to rehabilitation centers had more often comorbidities, 39% were highly physically dependent and 44% were managed in specialized neurology centers. For patients with a cerebral infarction who were directly discharged to their home 76% received at least one antihypertensive drug, 96% an antithrombotic drug and 76% a lipid-lowering drug during the following month. For those with a cerebral hemorrhage, these frequencies were respectively 46, 33 and 28%. For those admitted to a rehabilitation center, more than half had at least one visit with a physiotherapist or a nurse, 15% a speech therapist, 10% a neurologist or a cardiologist and 15% a psychiatrist during the following three months back home (average numbers of visits for those with at least one visit: 23 for physiotherapists and 100 for nurses). Patients who returned directly back home had fewer physiotherapist (30%) or nurse (47%) visits but more medical consultations. The 3-month re-hospitalization rate for patients who were discharged directly to their home was 23% for those who had been admitted to a stroke unit and 25% for the others. In rehabilitation centers, this rate was 10% for patients who stayed < 3 months.

CONCLUSIONS

These results illustrate the value of administrative databases to study stroke management, care pathways and ambulatory care. These data should be used to improve care pathways, organization, discharge planning and treatments.

[Health care use by free complementary health insurance coverage beneficiaries in France in 2012]

BACKGROUND

The objective was to investigate healthcare use among people covered by one of the two complementary healthcare insurance schemes available for people with low annual income: CMUC (universal complementary healthcare insurance) and, for people whose income exceeds the CMUC ceiling, ACS (aid for complementary healthcare insurance). Comparisons were made between CMUC and ACS beneficiaries versus CMUC and ACS non-beneficiaries and between CMUC beneficiaries and ACS beneficiaries.

METHODS

Using the national health insurance information system (SNIIRAM), people less than 60 years old covered by the general national health insurance (86% of the 66 million inhabitants) and with ACS or CMUC coverage in 2012 were selected. Diseases were identified using hospital diagnosis, drugs refunds and long-term chronic disease status. Hospital related diagnoses were categorized in major hospital activity groups. Sex- and age-standardized relative risk (RR) were calculated.

RESULTS

There were 4.4 million (9.6%) CMUC beneficiaries and 732,000 (1.6%) ACS beneficiaries (56% and 54% women; mean age: 24 years and 29 years respectively versus 52% and 30 years for CMUC or ACS non-beneficiaries). CMUC or ACS beneficiaries had more often cardiovascular diseases (RR=1.4;2.1) and diabetes (RR=2.2;2.4). Their sex- and age-standardized hospitalisation rates for all diagnosis were higher (18%; 17%, RR=1.3;1.4) than CMUC or ACS non-beneficiaries (13%). This was especially the case for the following major groups: toxicology, intoxications, alcohol major group (RR=3.8;4.0); psychiatry (RR=2.8;4.1); respiratory disease (RR=1.9;2.3); infectious disease (RR=1.9;2.7). Compared with CMUC beneficiaries, ACS beneficiaries had more often cancer (RR=1.5), cardiovascular disease (RR=1.5), neurological disease (RR=2.7), psychiatric illness (RR=2.6), end-stage renal disease (RR=2.8), hemophilia (RR=1.4) or cystic fibrosis (RR=1.6) and they received also more often disability allowance (20%, 4%).

CONCLUSION

The disease and hospitalisation rates of ACS beneficiaries are similar or higher than those of CMUC beneficiaries, especially for disabling diseases. Both CMUC and ACS beneficiaries received healthcare for chronic diseases that can be targeted by prevention and screening programs for more optimal healthcare.

Cohorte d’adultes débutant un traitement antidépresseur en 2011 : premières analyses à 12 mois

Introduction

Des études ont montré un usage non optimal des antidépresseurs en France [1,2]. Une cohorte d’adultes ayant débuté un traitement antidépresseur a été mise en place pour suivre leur devenir.

Méthode

La cohorte inclut les adultes du régime général d’assurance maladie, ayant eu ≥ 1 délivrance d’antidépresseurs en 2011. Ont été exclus les patients « prévalents » (≥ 1 délivrance en 2009/2010 d’antidépresseur/antipsychotique/thymorégulateur/médicament de la dépendance/stimulant ; hospitalisés avec motif psychiatrique (F04–F99) en MCO/RIMP/SSR (2006–2010) ; en ALD, arrêt de travail ≥ 6 mois, invalidité, pour motif psychiatrique).

Résultats

Près de 950 000 adultes (2,5 %) ont débuté un traitement antidépresseur en 2011 (âge moyen 50 ans, 2/3 de femmes). Un médecin généraliste était premier prescripteur pour 90 %. Le délai entre le début de traitement et la consultation suivante (généraliste/psychiatre) était de 23 jours pour les patients avec ≥ 3 délivrances. Dans l’année suivant l’initiation du traitement, 12 % des patients avaient eu une consultation en psychiatrie libérale. Les molécules les plus fréquemment prescrites étaient escitalopram (33 %), paroxetine (15 %), amitriptyline (11 %) fluoxetine (7 %), venlafaxine (7 %). La médiane de traitement était de 28 jours (< 6 mois : 83 %), 40 % n’avaient eu qu’une délivrance sur l’année, 13 % deux, 47 % ≥ trois. La part des personnes socialement défavorisées était un peu plus élevée parmi celles n’ayant eu qu’une ou deux délivrances. Le taux d’instauration variait du simple au double entre départements. Plus ce taux était élevé, plus l’arrêt de traitement était fréquent après un mois ou deux (r = −0,34, p = 0,0005).

Discussion

Un traitement antidépresseur est débuté annuellement chez 2,5 % des adultes mais interrompu avant 6 mois dans 4 cas sur 5, et suivi d’une consultation dans les 15 jours dans moins du tiers des cas. Les disparités sociales et géographiques de recours et suivi du traitement sont importantes. Les facteurs de chronicité (traitement au long cours, rechutes, hospitalisations, invalidité…) et la qualité du suivi seront analysés.

Une cohorte de personnes ayant un premier arrêt maladie de longue durée (plus de 6 mois) pour dépression en 2011

Introduction

Au cours d’un épisode dépressif, un arrêt maladie peut permettre de gérer les situations de stress. Cependant, la prolongation excessive de l’arrêt peut aggraver l’anxiété et entraîner une désocialisation, mais aussi témoigner de la gravité de la maladie. Notre objectif est de décrire les patients avec arrêt de longue durée pour dépression, analyser leur recours aux soins, identifier des facteurs prédictifs des arrêts, et suivre leur devenir.

Méthodes

Les bases de l’assurance maladie (SNIIRAM/PMSI) ont été utilisées pour constituer une cohorte de bénéficiaires du régime général, âgés de 20–69 ans, débutant en 2011 un arrêt maladie > 6 mois pour dépression et sans antécédent d’arrêt long en 2010 pour ce motif.

Résultats

En 2011, 84 000 personnes (2,6 pour 1000) étaient en arrêt maladie long pour dépression. Parmi celles-ci, 34 000 (1,1 pour 1000) l’avaient débuté en 2011 et constituent la cohorte (âge moyen 46 ans, femmes 66 %). L’arrêt était prescrit dans 75 % des cas par un médecin généraliste, 10 % un psychiatre libéral et 12 % un médecin salarié. Dans l’année précédant l’arrêt, 27 % avaient consulté un psychiatre libéral, et 57 % dans l’année précédant ou suivant le début de l’arrêt. L’année précédente, 43 % des patients avaient eu ≥ 3 délivrances d’antidépresseur et 83 % l’année suivante. Pour 39 % on retrouvait : ≥ 1 comorbidité somatique identifiée par une ALD ou une hospitalisation (23 %), une ALD psychiatrique (21 % dont 89 % pour dépression), une hospitalisation en MCO à ± 3 jours de l’arrêt (5,5 % dont 6 % pour tentative de suicide et 14 % pour pathologie psychiatrique).

Discussion

Un recours au psychiatre libéral est observé dans les 2 ans (avant/après) pour environ la moitié des 34 000 patients ayant débuté un arrêt maladie de longue durée pour dépression en 2011. Les analyses sont en cours pour déterminer quels facteurs influencent le recours à ces arrêts et quelle en est l’évolution (invalidité éventuelle).

Elderly patients with colorectal cancer: treatment modalities and survival in France. National data from the ThInDiT cohort study

BACKGROUND

Few data exist on how elderly patients with colorectal cancer (CRC) are actually treated in real-life practice. Based on a national cohort, we analysed routine treatment modalities of the elderly who were diagnosed with CRC in France in 2009.

PATIENTS AND METHODS

The characteristics of patients and tumours and the cancer treatments received during the first year of all national incident cases of CRC diagnosed between 1st April and 31st December 2009, were compared between a 'younger group' (YG), under 75 years of age (N = 18,410 patients), and an 'older group' (OG), aged 75 and over (N = 13,255 patients). In the OG with metastases at baseline, we analysed two-year overall survival (OS) according to the treatment received (e.g. chemotherapy, surgery) and well-known prognostic factors.

RESULTS

Among patients with localised CRC (N = 25,353), surgery was equally performed in both groups in more than 80% of the cases (p=0.52); time to surgery was shorter in the OG (8 versus 23 days) because there was more emergency surgery for occlusion among the OG. Adjuvant chemotherapy was performed in 15% of the OG (versus 29% in the YG) and consisted of 5-fluorouracil (5FU) monotherapy in more than 50% of OG patients. Among patients with metastatic CRC (N = 6,312), palliative chemotherapy was given to 48% of the OG versus 85% of the YG. Chemotherapy regimens included 30% monotherapy with 5FU, 30% oxaliplatin combination and 20% bevacizumab combination in the OG; compared to 10%, 34% and 35%, respectively, in the YG. The median OS for the OG was 8.4 months (versus 22.3 months in the YG) and 17.1 months among elderly patients who received chemotherapy.

CONCLUSION

CRC is more frequently complicated at diagnosis among elderly patients. Adjuvant and palliative chemotherapy is less frequently prescribed among elderly patients. This could be explained by the fact that unfit elderly patients do not deserve chemotherapy, but certainly also reflect the fact that some fit elderly patients are undertreated.

Abstract P5-10-01: A systems approach to combine genomics and emerging therapeutics to discover new treatments for TNBC

Genomic analyses of patient tumors have unearthed an overwhelming number of recurrent somatic alterations in genes that undoubtedly have dramatic effects on breast tumor biology, clinical outcomes and responses to therapeutics. In triple negative breast cancer (TNBC), there is an urgent need to translate this emerging patient genomic data into new therapeutic paradigms. To develop genotype-specific therapies, we have established an isogenic cell-line drug screen that measures the impact of gene activation on a panel of emerging, clinically relevant compounds targeting a variety of cancer pathways. We seek to uncover genotype-dependent sensitivity to drugs, synthetic lethal relationships, and validate in breast cancer cells and in vivo mouse models. We focused on emerging compounds that are already approved or in testing for human use and we expect that this work will serve as a prelude to one or more clinical trials in TNBC.

RESULTS: We have developed a synthetic-lethal interaction mapping strategy to uncover the impact of gene activation on responses to a panel of emerging therapeutics. We believe that this approach can identify core synthetic lethal interactions which underlie drug sensitivity and can be used as a foundation to identify patient populations that will selectively respond to drug treatments. We have developed a high-throughput screening platform that can rapidly and accurately assess the proliferative capacity of cell lines in response to a panel of inhibitors. We have generated a panel of isogenic cell lines which closely mimic the impact of recurrent gene mutations and overexpression common in breast cancer. We have currently generated 23 cell lines expressing wild-type and/or mutant forms of these genes. To date we have screened 12 known oncogenes against our panel of 94 emerging therapeutic compounds. Using this systems approach, the resulting interaction map highlights both known and novel connections between oncogene activation and drug responses and provides a modular roadmap for the exploration of synthetic lethal relationships.

Based on the coordinate activity of multiple drugs targeting the same pathway, we identified oncogenes that can drive resistance to EGFR inhibitors and PI3K/AKT inhibitors. We also recapitulated a known synthetic lethal relationship between MYC and CDK inhibition which we have previously described and we are now evaluating in a clinical trial. Therefore, our approach identified both resistance and synthetic lethal relationships that have been independently described, indicating that this platform is a good model for predicting synthetic lethality in vivo. Several novel and previously uncharacterized connections were also uncovered, including novel connections between MYC activity and several promising drugs in clinical development. Synthetic-lethal interactions discovered using this chemical-genetic systems approach and their mechanistic validation will be described in the presentation. Furthermore, the important role of patient advocacy in developing this project will be described.

CONCLUSION: A novel systems biology approach that uses chemical-genetic maps of oncogenes and emerging therapeutics can define synthetic-lethal interactions and actionable therapeutics for breast cancer.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-10-01.

Une prise en charge fréquente de la population adulte pour troubles psychiatriques ou traitements psychotropes, à travers les données de l’Assurance Maladie

Introduction.

Utiliser les bases de l’Assurance Maladie (Sniiram et PMSI) pour estimer la fréquence des prises en charge liées à la psychiatrie chez l’adulte en France.

Méthodes.

Parmi les bénéficiaires du régime général en 2010 de plus de 18 ans (45 millions), ceux ayant une prise en charge liée à la psychiatrie ont été identifiés à partir :

– des diagnostics liés aux hospitalisations (PMSI-MCO, RIM-P, SSR), aux affections de longue durée, aux arrêts de travail ou invalidité ;

– du remboursement de consultation avec un psychiatre ou à des soins ambulatoires psychiatriques ;

– d’au moins trois remboursements de médicaments de la dépendance ou neuroleptiques, antidépresseurs, anxiolytiques, hypnotiques [1].

Résultats.

Près de 8,2 millions des adultes (18 %) ont reçu des soins liés à la psychiatrie, dont 5,6 millions (69 %) ont eu uniquement des délivrances médicamenteuses sans diagnostic identifié dans les bases. Les pathologies les plus fréquemment retrouvées étaient les épisodes dépressifs/troubles de l’humeur (889 000), les troubles anxieux (464 000), les addictions (383 000), les troubles de la personnalité et du comportement (340 000). Schizophrénie, autres troubles psychotiques, troubles bipolaires et anorexie mentale étaient retrouvés chez respectivement 181 000, 224 000, 164 000 et 23 000 adultes. L’âge moyen variait de 42 (anorexie mentale) à 58 ans (patients identifiés seulement par les médicaments). Le pourcentage de femmes (65 %) s’élevait de 28 % (addictions) à 68 % (épisodes dépressifs/troubles de l’humeur, ou patients identifiés seulement par psychotropes) et 87 % (anorexie mentale). Le pourcentage de bénéficiaires de la CMU-C (11,5 %) variait de 11 % (troubles bipolaires) à 26 % (addictions).

Discussion.

Dix-huit pour cent de la population adulte a eu recours à des soins liés à la psychiatrie en 2010. Un diagnostic spécifique est retrouvé dans les bases chez plus d’un quart de ces patients, avec une forte proportion d’épisodes dépressifs et autres troubles de l’humeur.

L’association fréquente des pathologies somatiques aux troubles psychiatriques en population adulte, à travers les données de l’Assurance Maladie

Introduction.

Les fréquences des pathologies somatiques chez les adultes atteints de maladies psychiatriques sont peu documentées.

Méthodes.

Les bénéficiaires du régime général de l’Assurance Maladie en 2010, âgés d’au moins 18 ans, pris en charge pour troubles psychiatriques ont été identifiés dans le SNIIRAM à partir des diagnostics liés aux :

– affections de longue durée ;

– hospitalisations (PMSI-MCO, SSR, RIM-P) ;

– arrêts de travail et invalidité [1].

Les maladies somatiques ont été déterminées à partir des diagnostics liés aux affections de longue durée et aux hospitalisations [1]. Les prévalences ont été standardisées sur âge et sexe pour comparaison à celles observées en population générale.

Résultats.

En 2010, près de 2,1 millions d’adultes (5 %) avaient un trouble psychiatrique retrouvé dans le SNIIRAM, et 44 % d’entre eux avaient également une pathologie somatique retrouvée. Les pathologies somatiques les plus fréquemment retrouvées étaient les maladies cardiovasculaires (15 %), les affections respiratoires (11 %), le diabète (10 %) et les cancers (9,3 %). Par rapport à la population générale, une maladie cardiovasculaire était moins fréquemment retrouvée en cas de schizophrénie (fréquence brute : 5 %, ratio standardisé : 0,9), mais plus souvent en cas d’autres pathologies psychiatriques (16 %, ratio : 1,8 en cas d’épisode dépressif ou troubles de l’humeur). Un cancer était également moins souvent retrouvé que dans la population générale en cas de schizophrénie (3,3 %, ratio : 0,8), mais plus souvent en cas d’addictions (10,7 %, ratio : 2,1) ou de troubles anxieux (12 %, ratio : 1,6).

Discussion.

Par rapport à la population générale, certaines pathologies somatiques sont plus fréquemment retrouvées en présence de troubles psychiatriques, sauf en cas de schizophrénie. La connaissance de ces associations peut permettre aux soignants d’améliorer la prise en charge des pathologies somatiques comme des pathologies psychiatriques.

Seasonal influenza vaccination coverage in France during two influenza seasons (2007 and 2008) and during a context of pandemic influenza A(H1N1) in 2009

OBJECTIVES

To measure the seasonal influenza vaccination coverage rate (VCR) in France in 2009, year of the A(H1N1) influenza pandemic, by age and target disease and compare it with the VCR for the 2007 and 2008 influenza seasons.

METHOD

At the beginning of each annual seasonal vaccination campaign, the National Health Insurance, covering 86% of the French population, sends free influenza vaccination vouchers to at-risk beneficiaries aged under 65 suffering from diverse chronic diseases and to all individuals aged 65 and over (around 11 million). Vaccination is estimated from refund claims registered in the National Health Insurance Information System.

RESULTS

The global VCR for the target population was 51% in 2007, 55.8% in 2008 and 56.9% in 2009. In 2009, the VCR for children under 10 years old was 24.3%, 28.1% in the 10-19 age range, 39.2% in the 20-64 age range and 63.3% for individuals aged 65 and over, of which 72.3% with a targeted chronic disease and 56.9% without. The inclusion of asthma as a target disease, lowered the global VCR for children under 10 years old (30.6% without asthma) but VCR increased proportionally with the number of annual refunds for drugs against asthma and chronic obstructive pulmonary disease. The 2009 vaccine uptake rates in target group children, adolescents, young adults and to a lesser extent the population aged 65 and over suffering from a chronic disease (particularly chronic respiratory disease), could have been positively impacted by the A(H1N1) influenza context.

CONCLUSION

The influenza VCR varies considerably according to age and target disease but globally remains inferior to the recommended 75% coverage rate. These results permit the detailed analysis of VCR distribution by disease and target group and highlights areas for reflection and action. Specific studies should be conducted in order to understand why the VCR is lower in certain target groups.

[In search of the musical brain]

The emotional power of music opens novel prospects in the field of affective neurosciences. To clarify the neurobiological substrate of emotions brought by music, we adopted an integrative approach, which combines neuropsychology, brain imaging and electrophysiology (intracranial depth electrode recordings). The results of a series of studies carried out in patients with focal brain lesions allow to describe the involvement of different temporal lobe regions and, in particular, of the amygdala in these emotional judgments before discussing the therapeutic benefits of music to handle Alzheimer's disease.

Different spatial memory systems are involved in small- and large-scale environments: evidence from patients with temporal lobe epilepsy

Recent reports show that humans and animals do not acquire information about routes and object locations in the same way. In spatial memory, a specific sub-system is hypothesized to be involved in encoding, storing and recalling navigational information, and it is segregated from the sub-system devoted to small-scale environment. We assessed this hypothesis in a sample of patients treated surgically for intractable temporal lobe epilepsy. We found double dissociations between learning and recall of spatial positions in large space versus small space. These results strongly support the hypothesis that two segregate systems process navigational memory for large-scale environments and spatial memory in small-scale environments.

[Epilepsy: role of neuropsychological evaluation]

Cognitive deficits are frequent in epileptic patients and can be considered epileptic behavioural markers. They are assessed by neuropsychological exploration, which requires the use of standardized psychometric tests. The neuropsychological data obtained complement the information provided by other perisurgical investigations. In addition to the indications concerning lateralization and the extent of the cerebral dysfunction, neuropsychological findings can assist in anticipating the possible cognitive risks resulting from surgical treatment. Finally, these results are indispensable to implementing neuropsychological rehabilitation, which should be proposed before and/or after surgery, when necessary, to patients involved in a surgical program for epilepsy.

Vermian metastasis causing truncal ataxia and hydrocephalus as initial presentation of carcinoma stomach

The common presentation of carcinoma stomach includes haematemesis, malaena and gastric outlet obstruction. Symptoms due to metastases to the liver and lung as part of the disease progression are usually preceded by the detection of a primary in the stomach. Carcinoma stomach, where the primary is silent, and which presents with truncal ataxia and features of hydrocephalus due to isolated metastatic deposit in the cerebellar vermis is exceptionally rare. The prognosis of such patients is poor and the treatment is palliative.

Is anterior temporal lobectomy a precipitating factor for transient global amnesia?

Little is known about the pathophysiology of transient global amnesia (TGA) and how it is related to epilepsy. We report here five typical episodes of TGA, each occurring several years after surgery for epilepsy. In all cases, patients were seizure-free after a surgery consisting of anterior temporal lobectomy for refractory medial temporal lobe epilepsy associated with hippocampal sclerosis (n = 4) or linked with a dysembryoplastic neuroepithelial tumour (n = 1). Investigations, including MRI or CT scan, angio-MRI or echocardiogram or vascular echo Doppler, excluded a vascular origin. Using accepted criteria to distinguish between TGA and epileptic amnesic attacks--the typical clinical presentation, the long duration of the episode, the absence of other symptoms associated with seizures and the absence of recurrence--it is evident that these patients suffered a TGA. These studies suggest that hippocampal resection carried out therapeutically in some epileptic patients may be a precipitating factor for TGA.

How emotional auditory stimuli modulate time perception

Emotional and neutral sounds rated for valence and arousal were used to investigate the influence of emotions on timing in reproduction and verbal estimation tasks with durations from 2 s to 6 s. Results revealed an effect of emotion on temporal judgment, with emotional stimuli judged to be longer than neutral ones for a similar arousal level. Within scalar expectancy theory (J. Gibbon, R. Church, & W. Meck, 1984), this suggests that emotion-induced activation generates an increase in pacemaker rate, leading to a longer perceived duration. A further exploration of self-assessed emotional dimensions showed an effect of valence and arousal. Negative sounds were judged to be longer than positive ones, indicating that negative stimuli generate a greater increase of activation. High-arousing stimuli were perceived to be shorter than low-arousing ones. Consistent with attentional models of timing, this seems to reflect a decrease of attention devoted to time, leading to a shorter perceived duration. These effects, robust across the 2 tasks, are limited to short intervals and overall suggest that both activation and attentional processes modulate the timing of emotional events.

Autobiographical memory after temporal lobe resection: neuropsychological and MRI volumetric findings

This study examined the contribution of medial temporal lobe (MTL) structures in autobiographical memory. While some investigators have reported a temporal gradient in memory performance, characterized by retrieval difficulties limited to recent periods of life [Squire and Alvarez (Retrograde amnesia and memory consolidation: a neurobiological perspective. Curr Opin Neurobiol 1995; 5: 169-77)], others have suggested that this impairment involves all life-time periods [Nadel and Moscovitch (Memory consolidation, retrograde amnesia and the hippocampal complex. Curr Opin Neurobiol 1997; 7: 217-27)]. In this study, autobiographical memory was assessed in 22 patients who had undergone a left (n = 12) or a right (n = 10) MTL resection for the relief of epileptic seizures and in 22 normal control participants. For this purpose, we used an autobiographical memory task (TEMPau, Piolino et al., 2003) across four time periods covering the subjects' entire lifespan. For each period, an overall autobiographical memory score (AM score) was obtained, from which a strictly episodic score (SE score), characterized by specificity and richness of details, was computed. For all events recalled, Remember responses justified by specificity of factual, spatial and temporal contents (jR responses) were measured using the Remember/Know paradigm. MRI volumetric analyses performed on the medial (i.e. hippocampus, temporopolar, entorhinal, perirhinal and parahippocampal cortices) and lateral temporal (i.e. superior, middle and inferior temporal gyri) lobe structures stated that the resection mainly included MTL structures. AM and SE scores were impaired in patients with right and left MTL resections as compared to normal controls across all time periods, reflecting the patients' particular difficulty in producing specific and detailed memories across all periods. This impairment was associated with poor autonoetic consciousness, revealed by the small number of jR responses across all periods. Results of correlation analysis between MRI volume measures of temporal lobe structures and autobiographical memory scores suggest that the right MTL structures are particularly responsive in reliving the encoding context regardless of remoteness. Our results support the bilateral MTL contribution to episodic autobiographical memory covering the entire lifespan, which is consistent with the multiple trace theory of MTL function [Moscovitch et al. (Functional neuroanatomy of remote episodic, semantic and spatial memory: a unified account based on multiple trace theory. J Anat 2005; 207: 35-66.)].