C Fischer

French Institute of Health and Medical Research, Lutetia Parisorum, Île-de-France, France

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Publications (146)303.6 Total impact

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    ABSTRACT: We prospectively studied early bedside standard EEG characteristics in 61 acute postanoxic coma patients. Five simple EEG features, namely, isoelectric, discontinuous, nonreactive to intense auditory and nociceptive stimuli, dominant delta frequency, and occurrence of paroxysms were classified yes or no. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) of each of these variables for predicting an unfavorable outcome, defined as death, persistent vegetative state, minimally conscious state, or severe neurological disability, as assessed 1 year after coma onset were computed as well as Synek's score. The outcome was unfavorable in 56 (91.8%) patients. Sensitivity, specificity, PPV, NPV, and AUC of nonreactive EEG for predicting an unfavorable outcome were 84%, 80%, 98%, 31%, and 0.82, respectively; and were all very close to the ones of Synek score >3, which were 82%, 80%, 98%, 29%, and 0.81, respectively. Specificities for predicting an unfavorable outcome were 100% for isoelectric, discontinuous, or dominant delta activity EEG. These 3 last features were constantly associated to unfavorable outcome. Absent EEG reactivity strongly predicted an unfavorable outcome in postanoxic coma, and performed as accurate as a Synek score >3. Analyzing characteristics of some simple EEG features may easily help nonneurophysiologist physicians to investigate prognostic issue of postanoxic coma patient. In this study (a) discontinuous, isoelectric, or delta-dominant EEG were constantly associated with unfavorable outcome and (b) nonreactive EEG performed prognostic as accurate as a Synek score >3.
    Clinical EEG and neuroscience: official journal of the EEG and Clinical Neuroscience Society (ENCS) 11/2015; DOI:10.1177/1550059415612375 · 2.22 Impact Factor
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    ABSTRACT: Introduction L’objectif de cette étude monocentrique était d’explorer le devenir à long terme de patients victimes d’un traumatisme crânien grave et de rechercher des marqueurs pronostiques. Méthodologie Le devenir des patients victimes d’un TC sévère a été évalué au moins 2 ans après le traumatisme. Ces patients ont tous bénéficié d’une évaluation standardisée, comprenant des paramètres cliniques, radiologiques et électrophysiologiques recueillis à la phase aiguë, au cours des années 2007 et 2008. Selon la disponibilité et le niveau de communication de chaque patient, l’évaluation à distance comportait des échelles mesurant la dépendance, les fonctions cognitives, le comportement, l’humeur et la qualité de vie. Résultats Parmi les dix-huit patients inclus, dix étaient autonomes pour les gestes de la vie quotidienne lors de l’évaluation tardive. La plainte mnésique, les troubles attentionnels, l’anxiété et l’irritabilité étaient au premier plan des séquelles à distance du TC. L’analyse de corrélation a montré que la durée du coma, la durée de l’amnésie post-traumatique, l’onde N100 des PEA étaient corrélées au niveau de la dépendance à la MIF. Discussion Les résultats confirment la singularité de chaque cas quant aux conséquences du TC à long terme et le caractère multi-déterminé du pronostic.
    Annals of Physical and Rehabilitation Medicine 08/2014; 57(6-7). DOI:10.1016/j.rehab.2014.06.001
  • Irena Holeckova · Catherine Fischer · Dominique Morlet ·

    Clinical Neurophysiology 05/2014; 125(5):e22. DOI:10.1016/j.clinph.2013.12.032 · 3.10 Impact Factor
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    Dominique Morlet · Catherine Fischer ·
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    ABSTRACT: In recent decades, there has been a growing interest in the assessment of patients in altered states of consciousness. There is a need for accurate and early prediction of awakening and recovery from coma. Neurophysiological assessment of coma was once restricted to brainstem auditory and primary cortex somatosensory evoked potentials elicited in the 30 ms range, which have both shown good predictive value for poor coma outcome only. In this paper, we review how passive auditory oddball paradigms including deviant and novel sounds have proved their efficiency in assessing brain function at a higher level, without requiring the patient's active involvement, thus providing an enhanced tool for the prediction of coma outcome. The presence of an MMN in response to deviant stimuli highlights preserved automatic sensory memory processes. Recorded during coma, MMN has shown high specificity as a predictor of recovery of consciousness. The presence of a novelty P3 in response to the subject's own first name presented as a novel (rare) stimulus has shown a good correlation with coma awakening. There is now a growing interest in the search for markers of consciousness, if there are any, in unresponsive patients (chronic vegetative or minimally conscious states). We discuss the different ERP patterns observed in these patients. The presence of novelty P3, including parietal components and possibly followed by a late parietal positivity, raises the possibility that some awareness processes are at work in these unresponsive patients.
    Brain Topography 11/2013; 27(4). DOI:10.1007/s10548-013-0335-5 · 3.47 Impact Factor
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    ABSTRACT: To investigate automatic event-related potentials (ERPs) to an auditory change in migraine patients. Auditory ERPs were recorded in 22 female patients suffering from menstrually-related migraine and in 20 age-matched control subjects, in three sessions: in the middle of the menstrual cycle, before and during menses. In each session, 200 trains of tone-bursts each including two duration deviants were presented in a passive listening condition. In all sessions, duration deviance elicited a mismatch negativity (MMN) showing no difference between the two groups. However, migraine patients showed an increased N1 orienting component to all incoming stimuli and a prolonged N2b to deviance. They also presented a different modulation of P3a amplitude along the menstrual cycle, which tended to normalise during migraine attacks. None of the studied ERP components showed a default of habituation. This passive paradigm highlighted increased automatic attention orienting to auditory changes but normal auditory sensory processing in migraineurs. Our observations suggest normal auditory processing up to attention triggering but enhanced activation of attention-related frontal networks in migraineurs.
    Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 11/2013; 125(3). DOI:10.1016/j.clinph.2013.05.032 · 3.10 Impact Factor
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    ABSTRACT: Transcranial electric stimulation elicited muscle motor evoked potentials (TESmMEPs) is one of the best methods for corticospinal tract's function monitoring during spine and spinal cord surgeries. A train of multipulse electric stimulation is required for eliciting TESmMEPs under general anaesthesia. Here, we investigated the best stimulation parameters for eliciting and recording tibialis anterior's TESmMEPs during paediatric scoliosis surgery. Numbers of pulses (NOP), inter-stimulus intervals (ISI) and current intensities allowing the best size tibialis anterior muscle's TESmMEPs under general anaesthesia, were tested and collected during 77 paediatric scoliosis surgery monitoring procedures in our hospital. Individual pulse duration was kept at 0.5ms and stimulating electrodes were positioned at C1 and C2 (International 10-20-EEG-System) during all the tests. The NOP used for eliciting the best tibialis anterior TESmMEPs response was 5, 6, and 7 respectively in 21 (27%), 47 (61%) and 9 (12%) out of the 77 patients. The ISI was 2, 3 and 4 ms respectively in 13 (17%), 55 (71%) and 9 (12%) of them. The current intensity used varied from 300 to 700V (mean: 448±136 V). Most patients had 6 as best NOP (61%) and 3ms as best ISI (71%). These findings support that a NOP of 6 and an ISI of 3 ms should be preferentially used as optimal stimulation settings for intraoperative tibialis anterior muscle's TESmMEPs eliciting and recording during paediatric scoliosis surgery.
    Neurophysiologie Clinique/Clinical Neurophysiology 10/2013; 43(4):243-250. DOI:10.1016/j.neucli.2013.08.001 · 1.24 Impact Factor
  • N. André-Obadia · C. Fischer ·

    Revue Neurologique 04/2013; 169:A219-A220. DOI:10.1016/j.neurol.2013.01.536 · 0.66 Impact Factor

  • Archives of Disease in Childhood 10/2012; 97(Suppl 2):A66-A67. DOI:10.1136/archdischild-2012-302724.0230 · 2.90 Impact Factor
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    G. P. Kalamangalam · J. Teo · N. K. Sethi · J. Luaute · C. Fischer ·

    Neurology: Clinical Practice (Print) 06/2012; 2(2):91-93. DOI:10.1212/CPJ.0b013e31825ab82d
  • C. Fischer · J. Luaute · D. Morlet ·

    Neurophysiologie Clinique/Clinical Neurophysiology 06/2012; 42(4):253. DOI:10.1016/j.neucli.2012.04.014 · 1.24 Impact Factor

  • Neurophysiologie Clinique/Clinical Neurophysiology 06/2012; 42(4):253. DOI:10.1016/j.neucli.2012.04.016 · 1.24 Impact Factor
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    ABSTRACT: It is now firmly established that bilateral abolition of somatosensory evoked potentials (SEPs) after a nontraumatic coma has 100% specificity for nonawakening. In traumatic coma, a bilateral absence of the N20 components of SEPs does not implicate nonawareness. Comatose brain-injured patients should be systematically explored with auditory evoked potentials to check the functional integrity of another sensory pathway and the mesencephalic tegmento-tectal region on cerebral MRI should be carefully examined. Repeated evaluations during follow-up are also mandatory.
    Neurology: Clinical Practice (Print) 03/2012; 2(1):24-32. DOI:10.1212/CPJ.0b013e31824c6cab
  • C. Fischer · J. Luaute · M. Kandel · F. Dailler · D. Mrlet ·

    Clinical Neurophysiology 06/2011; 122. DOI:10.1016/S1388-2457(11)60051-5 · 3.10 Impact Factor
  • D. Morlet · A. Caclin · F. Brudon · C. Fischer · G. Demarquay ·

    Clinical Neurophysiology 06/2011; 122. DOI:10.1016/S1388-2457(11)60158-2 · 3.10 Impact Factor
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    ABSTRACT: To investigate long-term (LTH) and short-term (STH) habituation of auditory event-related potentials (ERPs) during a migraine cycle, using a classic habituation paradigm. In 22 patients suffering from menstrually-related migraine and in 20 age-matched control subjects, auditory ERPs were recorded in 3 sessions: in the middle of the menstrual cycle, before menses, and during menses. In 12 patients, a migraine attack occurred during one of the peri-menses sessions. In each session, 200 trains of stimuli were presented, with an average of 10 stimuli per train. In response to the first stimuli of the trains, migraineurs exhibited in all sessions a larger orienting component of N1 than matched controls and a larger P3a in the interictal session, which normalized during attacks. They also showed a residual orienting component in response to the subsequent stimuli inside the trains. In contrast, the sensory component of N1 showed no difference between the two groups, with similar STH and LTH. Migraineurs show an exacerbated attention orienting to auditory stimulation, without any habituation deficit. Previous migraine studies reported interictal habituation deficits of ERPs, but demonstrated in the auditory modality only in paradigms testing intensity dependence. Previous and current results can be interpreted as an increased attention orienting, possibly relying on an abnormal involvement of frontal cortex in auditory processing.
    Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 03/2011; 122(9):1755-63. DOI:10.1016/j.clinph.2011.02.013 · 3.10 Impact Factor
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    Irena Holeckova · Catherine Fischer · Dominique Morlet · Nicolas Coste ·
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    ABSTRACT: Background / Purpose: Define the degree and extent of possible residual cognitive function in persistent vegetative state (PVS) patients. Main conclusion: This report identifies the evidence of alteration of neuro-metabolic coupling in PVS between event-related potentials (ERPs) and positron emission tomography (PET).
    Clinical Neurophysiology 10/2010; 121(5). DOI:10.1016/S1388-2457(10)60514-7 · 3.10 Impact Factor
  • C. Fischer · J. Luaute · D. Morlet ·

    Clinical Neurophysiology 10/2010; 121. DOI:10.1016/S1388-2457(10)60114-9 · 3.10 Impact Factor
  • J Luauté · D Maucort-Boulch · L Tell · F Quelard · T Sarraf · J Iwaz · D Boisson · C Fischer ·
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    ABSTRACT: The present retrospective cohort study compares the long-term functional outcome, improvement or deterioration, of patients considered in a vegetative state (VS) or a minimally conscious state (MCS) 1 year after coma onset, then yearly for up to 5 years. We reviewed the clinical courses of 12 patients in VS and 39 in MCS. The outcomes were assessed at 2, 3, 4, and 5 years after injury using the 5 categories of the Glasgow Outcome Scale plus an additional category for patients in MCS. A logistic regression analysis investigated the relationships between each outcome and 10 predictor variables. Four of these variables were auditory evoked potentials recorded at the early stage of coma. None of the patients in VS improved during the follow-up period: 1 was lost to follow-up, 9 died, and 2 remained in VS. Among patients in MCS, 3 were lost to follow-up, 14 died, 9 remained in MCS, and 13 emerged from MCS with severe disabilities. VS, age >39 years, and bilateral absence of cortical components of middle-latency auditory evoked potentials were significantly associated with deterioration. In contrast to patients in VS, a third of patients in MCS improved more than 1 year after coma onset. This emphasizes the need to define reliable boundaries between VS and MCS using repeated clinical evaluations and all imaging and neurophysiologic tools available today.
    Neurology 07/2010; 75(3):246-52. DOI:10.1212/WNL.0b013e3181e8e8df · 8.29 Impact Factor
  • Catherine Fischer · Jacques Luaute · Dominique Morlet ·
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    ABSTRACT: To assess markers of cognition, if any, in patients in a permanent vegetative state (PVS). Event-related potential (ERP) mapping was performed on 27 patients in permanent (4-261 months after coma onset) vegetative (PVS, n=16) or minimally conscious states (MCS, n=11) due to anoxia (n=18) or other aetiologies (n=9). Mismatch negativity (MMN) to duration-deviant tones and novelty P3 (nP3) to the subject's own name were recorded according to a paradigm previously validated in healthy volunteers and comatose patients. SEPs, MLAEPs and BAEPs were also recorded. MMN was present in 5/27 and nP3 in 7/27 patients. ERPs were not related to the time from coma onset and not different in MCS and in PVS. Normal SEPs and MLAEPs, and present nP3s were less frequent in anoxia than in other aetiologies. Irrespective of their clinical assessment, a few patients are likely to process sound deviance (MMN) or novelty (nP3), mainly when their state is not due to anoxia. Some PVS patients may be able to put certain awareness marker processes to work. The diagnostic criteria for PVS or MCS, currently based on mere behaviour, should also include functional brain investigations, such as ERPs, related to the aetiology.
    Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 03/2010; 121(7):1032-42. DOI:10.1016/j.clinph.2010.02.005 · 3.10 Impact Factor

Publication Stats

4k Citations
303.60 Total Impact Points


  • 2013
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2004-2013
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
  • 2011
    • Lyon Neuroscience Research Center
      Lyons, Rhône-Alpes, France
  • 2001-2009
    • University of Lyon
      Lyons, Rhône-Alpes, France
  • 1989-2009
    • CHU de Lyon - Hôpital Neurologique et Neurochirurgical Pierre Wertheimer
      Lyons, Rhône-Alpes, France
  • 2002-2005
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2002-2004
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France
  • 1996
    • Vojna akademija Beograd
      Beograd, Central Serbia, Serbia