Thierry Moulin

University of Franche-Comté, Becoinson, Franche-Comté, France

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Publications (164)701.67 Total impact

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    ABSTRACT: Background: Primary leptomeningeal gliomatosis (PLG) is a poorly recognized tumor of the central nervous system. Objective: To describe the histopathological, immunohistochemical, and molecular features of PLG. Methods: Results of our multicentric retrospective study of 6 PLG cases (3 pediatric and 3 adult) were compared with literature data. Results: The mean age was 54.7 years for adults and 8.7 years for children, with 3 males and 3 females. Clinical symptoms were nonspecific. Cerebrospinal fluid analyses showed a high protein level often associated with pleocytosis but without neoplastic cells. On neuroimaging, diffuse leptomeningeal enhancement and hydrocephalus were observed, except in 1 case. PLG was mostly misinterpreted as infectious or tumoral meningitis. The first biopsy was negative in 50% of cases. Histopathologically, PLG cases corresponded to 1 oligodendroglioma without 1p19q codeletion and 5 astrocytomas without expression of p53. No immunostaining for IDH1R132H and no mutations of IDH1/2 and H3F3A genes were found. Overall survival was highly variable (2-82 months) but seems to be increased in children treated with chemotherapy. Conclusion: This study shows the difficulties of PLG diagnosis. The challenge is to achieve an early biopsy to establish a diagnosis and to begin a treatment, but the prognosis remains poor. PLG seems to have a different molecular and immunohistochemical pattern compared with intraparenchymal malignant gliomas. Abbreviations: OS, overall survivalPLG, primary leptomeningeal gliomatosis.
    Neurosurgery 09/2015; DOI:10.1227/NEU.0000000000001028 · 3.62 Impact Factor

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    ABSTRACT: The specific role of the amygdala remains controversial even though the development of functional imaging techniques has established its implication in the emotional process. The aim of this study was to highlight the sensitivity of the amygdala to emotional intensity (arousal). We conducted an analysis of the modulation of amygdala activation according to variation in emotional intensity via an fMRI event-related protocol. Monitoring of electrodermal activity, a marker of psychophysiological emotional perception and a reflection of the activation of the autonomic nervous system, was carried out concurrently. Eighteen subjects (10 men; aged from 22 to 29 years) looked at emotionally positive photographs. We demonstrated that the left and right amygdalae were sensitive to changes in emotional intensity, activating more in response to stimuli with higher intensity. Furthermore, electrodermal responses were more frequent for the most intense stimuli, demonstrating the concomitant activation of the autonomic nervous system. These results highlight the sensitivity of the amygdala to the intensity of positively valenced visual stimuli, and in conjunction with results in the literature on negative emotions, reinforce the role of the amygdala in the perception of intensity.
    Frontiers in Behavioral Neuroscience 07/2015; 9:178. DOI:10.3389/fnbeh.2015.00178 · 3.27 Impact Factor
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    ABSTRACT: Assessment of awareness in patients with disorders of consciousness such as patients in a vegetative state (unresponsive wakefulness syndrome, UWS) and patients in a minimally conscious state (MCS) remains difficult, with a high rate of misdiagnosis (around 40%). While patients with UWS have no awareness, patients with MCS have partial preservation of conscious awareness. To improve the assessment of awareness in these patients, recent functional neuroimaging protocols have been developed. However, does the complexity of realizing and interpreting these functional magnetic resonance imaging (fMRI) investigation protocols, which are currently carried out by only a few specialist teams, permit generalizable use in clinical routine?
    Neuroscience 05/2015; 300. DOI:10.1016/j.neuroscience.2015.05.059 · 3.36 Impact Factor
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    ABSTRACT: Episodic memory disorders are frequent in patients with temporal lesion. Verbal or visuo-spatial memory disorders depend on the location and the lateralization of the lesion. These disorders are well described in temporal epilepsy but rarely in population with cerebral tumor and especially not specifically focus on temporal glioma. The purpose of this study was to describe neuropsychological examination in patient with temporal glioma in the database of the regional memory centre of Besançon. Four patients were identified (all right-handed and with a left temporal glioma). Verbal episodic memory impairment and auditory-verbal short-term memory impairment were observed. One patient had also visual memory disorders. Therefore, further investigations showed an associated Alzheimer's disease. This finding modified the clinical management of this patient. Extensive neuropsychological assessment should be systematic initially to seek an associated pathology, especially in elderly patients, if the cognitive profile is unusual, during the follow-up to better understand cognitive evolution and the effect of therapies on cognition.
    Revue Neurologique 04/2015; 171(4). DOI:10.1016/j.neurol.2015.02.009 · 0.66 Impact Factor
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    ABSTRACT: Recent studies have evidenced serious difficulties in detecting covert awareness with electroencephalography-based techniques both in unresponsive patients and in healthy control subjects. This work reproduces the protocol design in two recent mental imagery studies with a larger group comprising 20 healthy volunteers. The main goal is assessing if modifications in the signal extraction techniques, training-testing/cross-validation routines, and hypotheses evoked in the statistical analysis, can provide solutions to the serious difficulties documented in the literature. The lack of robustness in the results advises for further search of alternative protocols more suitable for machine learning classification and of better performing signal treatment techniques. Specific recommendations are made using the findings in this work. © EEG and Clinical Neuroscience Society (ECNS) 2014.
    Clinical EEG and neuroscience: official journal of the EEG and Clinical Neuroscience Society (ENCS) 12/2014; DOI:10.1177/1550059414560397 · 2.22 Impact Factor
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    ABSTRACT: Almost 1 person in 1000 suffers from stroke annually in France. Health-related quality of life (HRQoL) measurement with specific questionnaires is useful to study the consequences of stroke on patient's daily lives. To validate the French version of the Stroke Impact Scale (SIS) questionnaire, as no disease-specific questionnaire was validated in French heretofore. Two hundred eighty eight patients with stroke were classified in 2 groups (158 acute, 130 chronic). Rate of item completion, test-retest reliability, as well as construct validity, convergent validity and discriminant validity of the questionnaire, and also sensitivity to change were assessed. Acute group patients were recruited during the first month post stroke and followed for 3 months. Chronic group patients (stroke dating from >1 year) were recruited from outpatient consultations. The first 100 chronic patients were called back 15 days after inclusion for test-retest. Barthel index, Hospital Anxiety and Depression Scale (HADS) and Duke Health Profile questionnaires were administered. The French version of the SIS was well accepted by all patients. It had good reproducibility. Cronbach's alpha was >89% for all scales. A ceiling effect was noted in the majority of scales. Physical domains were significantly correlated to other measures of physical capacity (Barthel Index and Duke Health Profile, Spearman coefficients were between 0.5 and 0.73), while the emotional and social domains were significantly correlated to almost all domains of the Duke questionnaire. Psychometric properties were similar to the US version. Responsiveness was good for physical and emotional domains. The French SIS version presents good psychometric properties, except for ceiling effect. This is the first stroke-specific questionnaire evaluating perceived health after stroke to be validated in France, and could be useful for further investigations of HRQoL after stroke. © 2014 American Physical Therapy Association.
    Physical Therapy 12/2014; 95(5). DOI:10.2522/ptj.20130012 · 2.53 Impact Factor

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    ABSTRACT: Background: This study aimed to evaluate the clinical symptoms of Angelman syndrome (AS) in adults and to identify the neurological pathways affected in this disease. AS is a neurogenetic disorder resulting due to the deletion or inactivation of the ubiquitin-protein-ligase E3A gene on maternal chromosome 15. Summary: A retrospective analysis of data from six adults patients with clinical, electroencephalographic and genetic confirmation of AS was performed. Movement disorders of the hands and mouth, laughing spells, severe expressive speech disorders, a happy nature, hyposomnia and anxiety are the major neurological characteristics of AS in adulthood. Cerebellar ataxia, muscle hypotonia and tremor, though constant in childhood, tend to be attenuated in adulthood. Epilepsy, one of the most frequent symptoms in childhood and in adulthood, is characterised by specific electroencephalographic patterns. Key Messages: These clinical characteristics are important to improve the clinical awareness and genetic diagnosis of AS. Clinicians must be better informed concerning the adult phenotype as it is not well described in the literature. We stress the importance of AS as one of the main causes of intractable epilepsy. The authors suggest frontal and cerebellar dysfunction. Further functional cerebral imaging studies are necessary.
    European Neurology 11/2014; 73(1-2):119-125. DOI:10.1159/000369454 · 1.36 Impact Factor
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    ABSTRACT: Background In gradient echo magnetic resonance imaging (MRI), intravascular thrombi (IT) can appear as vascular susceptibility artifacts, linked to local presence of intra-arterial deoxyhaemoglobin, and called susceptibility vessel signs (SVS).AimsOur objectives were to evaluate the sensitivity of susceptibility-weighted sequences, such as T2* weighted angiography (SWAN) in the visualization of SVS compared with T2*, to consider whether it enabled a better understanding of the importance of SVS, and to compare cerebral circulation regulation profiles according to the localization of the SVS (i.e. proximal or distal).Methods We prospectively studied the clinical and imaging data of 78 consecutive patients admitted for acute cerebral ischemia to the stroke unit of Besançon University Hospital between 1 April 2009 and 31 January 2010.ResultsAn SVS was visualized in 44/78 (56%) patients using SWAN and in 13/78 (16%) patients using T2*. All the SVS visible using T2* were also visible on the SWAN. The inter-observer kappa score was 0·72 [CI (0·53–0·91)] for T2*, 0·72 [CI (0·57–0·87)] for SWAN, and weighted kappa was 0·77 [CI (0·61–0·92)] for both T2* and SWAN. When an MCA occlusion was visible on MRA imaging (22/78 patients), a SVS was visualized in 7/22 cases (31·8%) using T2* and in 20/22 cases (91%) using SWAN. When the occlusion was visible in the M1 or M2 segments (17/78 patients), an SVS was visualized in 6/17 cases (35·3%) using T2* and in 15/17 cases (88·2%) using SWAN. When the occlusion was visible in the M3 segment (5/78 patients), an SVS was visualized in 1/5 cases (20%) using T2* and in 5/5 cases (100%) using SWAN. Presence of SVS was not associated with cardioembolic etiology of the stroke.ConclusionsSWAN was more sensitive than T2* in the visualization of SVS in the intracranial arteries during the acute phase of ischemic stroke. Our study shows that the low number of SVS visualized using T2* in previous studies is probably related to a lack of sensitivity of the sequence, rather than to the nature or age of the thrombus. The greater sensitivity of SWAN seems to be linked to the visualization of SVS in cases of small thrombi.
    International Journal of Stroke 11/2014; 9(8). DOI:10.1111/ijs.12373 · 3.83 Impact Factor
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    ABSTRACT: Flavors guide consumers' choice of foodstuffs, preferring those that they like and meet their needs, and dismissing those for which they have a conditioned aversion. Flavor affects the learning and consumption of foods and drinks; what is already well-known is favored and what is new is apprehended. The flavor of foodstuffs is also crucial in explaining some eating behaviors such as overconsumption. The "blind" taste test of wine is a good model for assessing the ability of people to convert mouth feelings into flavor. To determine the relative importance of memory and sensory capabilities, we present the results of an fMRI neuro-imaging study involving 10 experts and 10 matched control subjects using wine as a stimulus in a blind taste test, focusing primarily on the assessment of flavor integration. The results revealed activations in the brain areas involved in sensory integration, both in experts and control subjects (insula, frontal operculum, orbitofrontal cortex, amygdala). However, experts were mainly characterized by a more immediate and targeted sensory reaction to wine stimulation with an economic mechanism reducing effort than control subjects. Wine experts showed brainstem and left-hemispheric activations in the hippocampal and parahippocampal formations and the temporal pole, whereas control subjects showed activations in different associative cortices, predominantly in the right hemisphere. These results also confirm that wine experts work simultaneously on sensory quality assessment and on label recognition of wine.
    Frontiers in Behavioral Neuroscience 10/2014; 8:358. DOI:10.3389/fnbeh.2014.00358 · 3.27 Impact Factor
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    ABSTRACT: The logopenic variant of primary progressive aphasia is a syndrome with neuropsychological and linguistic specificities, including phonological loop impairment for which diagnosis is currently mainly based on the exclusion of the two other variants, semantic and nonfluent/agrammatic primary progressive aphasia. The syndrome may be underdiagnosed due (1) to mild language difficulties during the early stages of the disease or (2) to being mistaken for mild cognitive impairment or Alzheimer's disease when the evaluation of episodic memory is based on verbal material and (3) finally, it is not uncommon that the disorders are attributed to psychiatric co-morbidities such as, for example, anxiety. Moreover, compared to other variants of primary progressive aphasia, brain abnormalities are different. The left temporoparietal junction is initially affected. Neuropathology and biomarkers (cerebrospinal fluid, molecular amyloid nuclear imaging) frequently reveal Alzheimer's disease. Consequently this variant of primary progressive aphasia does not fall under the traditional concept of frontotemporal lobar degeneration. These distinctive features highlight the utility of correct diagnosis, classification, and use of biomarkers to show the neuropathological processes underlying logopenic primary progressive aphasia. The logopenic variant of primary progressive aphasia is a specific form of Alzheimer's disease frequently presenting a rapid decline; specific linguistic therapies are needed. Further investigation of this syndrome is needed to refine screening, improve diagnostic criteria and better understand the epidemiology and the biological mechanisms involved. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Revue Neurologique 10/2014; 171(1). DOI:10.1016/j.neurol.2014.08.004 · 0.66 Impact Factor
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    ABSTRACT: Hysteria has generated the most heated debates among physicians, from antiquity to the present day. It has been long confused with neuroses and neurological pathologies such as Parkinson's disease and epilepsy, principally associated with women and sexual disorders. The clinical manifestations must first be seen in their historical context, as interpretation varies according to the time period. Recently, the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association marked a break in the consensus that previously seemed to apply to the concept of hysteria and approach to the clinical manifestations. The clinical manifestations of hysteria are numerous and multifaceted, comprising 3 main classifications: paroxysms, attacks, and acute manifestations; long-lasting functional syndromes, and visceral events. Each main classification can be subdivided into several subgroups. The first main group of paroxysms, attacks, and acute manifestations includes major hysterical attacks, such as prodrome, trance and epileptic states, minor hysterical attacks such as syncope and tetany, twilight states, paroxysmal amnesia, and cataleptic attacks. The second group includes focal hysterical symptoms, paralyses, contractures and spasms, anesthesia, and sensory disorders. Visceral manifestations can be subdivided into spasms, pain, and general and trophic disorders. The diversity of the symptoms of hysteria and its changing clinical presentation calls into question the same hysterical attacks and the same symptoms, which have had only a few differences for over 2,000 years. A new definition of hysteria should be proposed, in that it is a phenomenon that is not pathological, but physiological and expressional. © 2014 S. Karger AG, Basel.
    Frontiers of neurology and neuroscience 10/2014; 35:28-43. DOI:10.1159/000360436
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    ABSTRACT: Background and Purpose-We aimed at comparing the long-term benefit-risk balance of carotid stenting versus endarterectomy for symptomatic carotid stenosis. Methods-Long-term follow-up study of patients included in Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S), a randomized, controlled trial of carotid stenting versus endarterectomy in 527 patients with recently symptomatic severe carotid stenosis, conducted in 30 centers in France. The main end point was a composite of any ipsilateral stroke after randomization or any procedural stroke or death. Results-During a median follow-up of 7.1 years (interquartile range, 5.1-8.8 years; maximum 12.4 years), the primary end point occurred in 30 patients in the stenting group compared with 18 patients in the endarterectomy group. Cumulative probabilities of this outcome were 11.0% (95% confidence interval, 7.9-15.2) versus 6.3% (4.0-9.8) in the endarterectomy group at the 5-year follow-up (hazard ratio, 1.85; 1.00-3.40; P=0.04) and 11.5% (8.2-15.9) versus 7.6% (4.9-11.8; hazard ratio, 1.70; 0.95-3.06; P=0.07) at the 10-year follow-up. No difference was observed between treatment groups in the rates of ipsilateral stroke beyond the procedural period, severe carotid restenosis (>= 70%) or occlusion, death, myocardial infarction, and revascularization procedures. Conclusions-The long-term benefit-risk balance of carotid stenting versus endarterectomy for symptomatic carotid stenosis favored endarterectomy, a difference driven by a lower risk of procedural stroke after endarterectomy. Both techniques were associated with low and similar long-term risks of recurrent ipsilateral stroke beyond the procedural period.
    Stroke 07/2014; 45(9). DOI:10.1161/STROKEAHA.114.005671 · 5.72 Impact Factor

  • Revue Neurologique 04/2014; 170:A198. DOI:10.1016/j.neurol.2014.01.528 · 0.66 Impact Factor

  • Revue Neurologique 04/2014; 170:A88. DOI:10.1016/j.neurol.2014.01.646 · 0.66 Impact Factor
  • E. Medeiros De Bustos · B. Bouamra · T. Moulin ·

    Revue Neurologique 04/2014; 170:A199. DOI:10.1016/j.neurol.2014.01.530 · 0.66 Impact Factor

  • Revue Neurologique 04/2014; 170:A51-A52. DOI:10.1016/j.neurol.2014.01.111 · 0.66 Impact Factor
  • T. Moulin · E. Medeiros ·

    Revue Neurologique 04/2014; 170:A187. DOI:10.1016/j.neurol.2014.01.500 · 0.66 Impact Factor
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    ABSTRACT: Background The clinical benefit of preventive eradication of unruptured brain arteriovenous malformations remains uncertain. A Randomised trial of Unruptured Brain Arteriovenous malformations (ARUBA) aims to compare the risk of death and symptomatic stroke in patients with an unruptured brain arteriovenous malformation who are allocated to either medical management alone or medical management with interventional therapy. Methods Adult patients (≥18 years) with an unruptured brain arteriovenous malformation were enrolled into this trial at 39 clinical sites in nine countries. Patients were randomised (by web-based system, in a 1:1 ratio, with random permuted block design [block size 2, 4, or 6], stratified by clinical site) to medical management with interventional therapy (ie, neurosurgery, embolisation, or stereotactic radiotherapy, alone or in combination) or medical management alone (ie, pharmacological therapy for neurological symptoms as needed). Patients, clinicians, and investigators are aware of treatment assignment. The primary outcome is time to the composite endpoint of death or symptomatic stroke; the primary analysis is by intention to treat. This trial is registered with, number NCT00389181. Findings Randomisation was started on April 4, 2007, and was stopped on April 15, 2013, when a data and safety monitoring board appointed by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health recommended halting randomisation because of superiority of the medical management group (log-rank Z statistic of 4·10, exceeding the prespecified stopping boundary value of 2·87). At this point, outcome data were available for 223 patients (mean follow-up 33·3 months [SD 19·7]), 114 assigned to interventional therapy and 109 to medical management. The primary endpoint had been reached by 11 (10·1%) patients in the medical management group compared with 35 (30·7%) in the interventional therapy group. The risk of death or stroke was significantly lower in the medical management group than in the interventional therapy group (hazard ratio 0·27, 95% CI 0·14–0·54). No harms were identified, other than a higher number of strokes (45 vs 12, p<0·0001) and neurological deficits unrelated to stroke (14 vs 1, p=0·0008) in patients allocated to interventional therapy compared with medical management. Interpretation The ARUBA trial showed that medical management alone is superior to medical management with interventional therapy for the prevention of death or stroke in patients with unruptured brain arteriovenous malformations followed up for 33 months. The trial is continuing its observational phase to establish whether the disparities will persist over an additional 5 years of follow-up. Funding National Institutes of Health, National Institute of Neurological Disorders and Stroke.
    The Lancet 01/2014; 383(9917):614–621. · 45.22 Impact Factor

Publication Stats

4k Citations
701.67 Total Impact Points


  • 2008-2015
    • University of Franche-Comté
      • Laboratoire de Neurosciences Intégratives et Cliniques
      Becoinson, Franche-Comté, France
  • 2014
    • Centre Hospitalier Universitaire de Nancy
      Laxou, Lorraine, France
  • 1997-2012
    • Centre Hospitalier Régional et Universitaire de Besançon
      Becoinson, Franche-Comté, France
  • 2007
    • Centre Hospitalier Universitaire de Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France
    • Société Française de Cardiologie
      Lutetia Parisorum, Île-de-France, France
  • 1999
    • Centre Hospitalier Régional Universitaire de Lille
      Lille, Nord-Pas-de-Calais, France
  • 1988
    • CHRU de Strasbourg
      Strasburg, Alsace, France