Rev Neurol France
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In the past decade, there have been considerable advances in understanding the neuronal bases of sensory and motor map reorganisation in adults and it is now clear that cortical representations are not invariant and stable, but rather, are dynamic and can continuously be modified. In human subjects, substantial advances in this field have been possible because of the spectacular development of non-invasive imaging and brain stimulation techniques. This review addresses specific questions about the capacity of motor maps in adult primates, including man, to change in response to behaviourally relevant experiences or as a result of central or peripheral lesion. ⋯ The mechanisms underlying such a plasticity of cortical maps following peripheral lesions are increasingly well understood. Thirdly, we discuss data showing that a corticospinal system lesion can lead to a complete reorganisation of the area allocated to the hand representation in the primary motor cortex or to a reorganization of the whole network of motor areas responsible for voluntary movements. As a conclusion, therapeutical perspectives that result from a better understanding of those various mechanisms responsible for motor map plasticity are briefly discussed.
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The effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) or the internal pallidum (GPi) on the parkinsonian triad and on levodopa-induced dyskinesias are very similar. The antiakinetic effect of STN DBS seems to be slightly better. On the contrary to pallidal DBS, stimulation of the STN allows to reduce dopaminergic treatment by more than 50 p. 100 on average. ⋯ It is the responsibility of the operating centre to determine the levodopa response, to confirm the diagnosis, to rule out contraindications and to make sure that the medical treatment cannot be further optimised. Severe surgical complications with permanent sequels are relatively rare, about 1 p. 100 per implanted side. The patient selection, the precision of the surgery and the quality of the postoperative follow-up are the three main determinants of success.
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Many coagulation disorders have been associated with cerebral venous thrombosis. These disorders may be primary like protein C and S deficiency, antithrombine III deficiency and activated protein C resistance. Antiphospholipid antibodies represent an acquired disorders of coagulation. A prothrombotic state induced by more common factor including oral contraceptive, pregnancy and puerperium increases the venous thrombosis risk.
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A number of patients admitted to intensive care units for non-neurological disorders develop neuromuscular complications. These patients present with an acute flaccid generalized weakness that may or may not be accompanied by sensory symptoms. There are two main conditions, namely critical illness polyneuropathy and neuromuscular disorder related to the use of neuromuscular blocking agents. ⋯ Critical illness neuropathies often cause difficulty in weaning patients from the respirator. They prolong the stay in the intensive care unit, thereby increasing the risks of complications for the patients. Course of these neuromuscular disorders is usually favorable, however sometimes with sequelae.