D Parain

Assistance Publique – Hôpitaux de Paris, Lutetia Parisorum, Île-de-France, France

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Publications (59)38.19 Total impact

  • Source
    D. Parain, N. Chastan
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    ABSTRACT: Objectif Les symptômes neurologiques fonctionnels (SNF) sont fréquemment rencontrés en pratique neurologique et difficile à traiter. Les symptômes sont multiples et peuvent être associés ou se succéder chez un même patient. Peu d’études ont analysé l’efficacité de la stimulation magnétique transcrânienne répétitive (rTMS) focale dans les SNF. Cette stimulation induit un courant très focal, vertical par rapport au cortex. Les résultats sont contradictoires, probablement parce qu’il est difficile d’identifier une cible corticale limitée qui pourrait être l’origine des ces troubles. Nous avons voulu évaluer l’efficacité d’un autre type de rTMS, la stimulation à large champ à l’aide d’une bobine circulaire qui permet de stimuler une surface de cortex environ 20 fois supérieure et qui induit un courant circulaire tangentiel au cortex. Études déjà publiées Nous avons rapporté et analysé deux études concernant l’effet de la rTMS à large champ dans les paralysies fonctionnelles et dans les mouvements anormaux fonctionnels. Dans ces deux études, l’efficacité a été très importante. Études personnelles non publiées Nous rapportons plusieurs séries en ouvert concernant des patients avec des déficits sensitifs fonctionnels, des déficits visuels fonctionnels ou des crises non épileptiques. Méthode Une ou plusieurs sessions de 60 stimulations sont effectuées avec un protocole différent selon les symptômes. Résultats L’efficacité s’est montrée importante dans tous les SNF étudiés. Les hypothèses sur les mécanismes sous-jacents sont discutées: effet placebo; effet cognitivo-comportemental ou effet de neuromodulation. Conclusion La rTMS à large champ pourrait être un nouveau type de traitement pour les patients avec des SNF. Cependant, des études contrôlées sont nécessaires.
    Neurophysiologie Clinique/Clinical Neurophysiology 01/2014; · 2.55 Impact Factor
  • Neurochirurgie. 01/2013; 59(6):233.
  • Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2010; 17(6):129-129.
  • P Hubert, D Parain, L Vallée
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    ABSTRACT: Convulsive status epilepticus in childhood is a life threatening condition with serious risk of neurological sequelae which constitutes a medical emergency. Clinical and experimental data suggest that prolonged seizures can have immediate and long-term adverse consequences on the immature and developing brain. So the child who presents with a continuous generalized convulsive seizure lasting greater than five minutes should be promptly treated. The outcome is mainly determined by the underlying etiology, age and duration of status epilepticus. In children the mortality from status epilepticus ranges from 3 to 5% and the morbidity is two-fold higher. Mortality and morbidity are highest with status epilepticus associated with central nervous system infections, which is the most important cause of status epilepticus. There are few evidence-based data to guide management decisions for the child with status epilepticus. Immediate goals are stabilization of airways, breathing and circulation and termination of seizures. Benzodiazepines remain the first-line drugs recommended for prompt termination of seizures. As intravenous lorazepam is not available in France, we suggest clonazepam as the best choice for initial therapy. Rectal diazepam or buccal midazolam remain important options. Intravenous phenytoin/fosphenytoin and phenobarbital are the second-line drugs. Phenytoin is being increasingly substituted by fosphenytoin, but pediatric data are scarce and fosphenytoin is not authorized for use in France below five years old. In children, phenytoin is often preferred to phenobarbital, even though no comparative studies have demonstrated a better efficacy. To manage status epilepticus refractory to a benzodiazepine and administration of phenytoin and/or phenobarbital, many pediatricians today prefer high-dose midazolam infusion rather than thiopental to minimize serious side effects from barbiturate anesthesia. There is no benefit/risk ratio to support the use of propofol for children with refractory status epilepticus.
    Revue Neurologique 04/2009; 165(4):390-7. · 0.51 Impact Factor
  • P. Hubert, D. Parain, L. Vallée
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    ABSTRACT: Convulsive status epilepticus in childhood is a life threatening condition with serious risk of neurological sequelae which constitutes a medical emergency. Clinical and experimental data suggest that prolonged seizures can have immediate and long-term adverse consequences on the immature and developing brain. So the child who presents with a continuous generalized convulsive seizure lasting greater than five minutes should be promptly treated. The outcome is mainly determined by the underlying etiology, age and duration of status epilepticus. In children the mortality from status epilepticus ranges from 3 to 5% and the morbidity is two-fold higher. Mortality and morbidity are highest with status epilepticus associated with central nervous system infections, which is the most important cause of status epilepticus. There are few evidence-based data to guide management decisions for the child with status epilepticus. Immediate goals are stabilization of airways, breathing and circulation and termination of seizures. Benzodiazepines remain the first-line drugs recommended for prompt termination of seizures. As intravenous lorazepam is not available in France, we suggest clonazepam as the best choice for initial therapy. Rectal diazepam or buccal midazolam remain important options. Intravenous phenytoin/fosphenytoin and phenobarbital are the second-line drugs. Phenytoin is being increasingly substituted by fosphenytoin, but pediatric data are scarce and fosphenytoin is not authorized for use in France below five years old. In children, phenytoin is often preferred to phenobarbital, even though no comparative studies have demonstrated a better efficacy. To manage status epilepticus refractory to a benzodiazepine and administration of phenytoin and/or phenobarbital, many pediatricians today prefer high-dose midazolam infusion rather than thiopental to minimize serious side effects from barbiturate anesthesia. There is no benefit/risk ratio to support the use of propofol for children with refractory status epilepticus.
    Revue Neurologique 04/2009; 165(4):390–397. · 0.51 Impact Factor
  • Journal of neurology, neurosurgery, and psychiatry 02/2009; 80(1):94. · 4.87 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the concordance between clinical diagnosis and the International Classification of Headache Disorders, 2nd edn (ICHD-II) in children and adolescents with primary headaches. This 6-month prospective multicentre study of 486 patients (mean 9.8 +/- 3.1 years; 52.6% girls) assessed the headache features through a structured questionnaire. In 398 patients with a single type of headache, headaches were bilateral (78.1%), frontal (62.4%), pulsatile (56.1%), with associated symptoms in 84.4%. The most frequently assigned diagnoses were migraine without aura (50.8%), probable migraine (14.1%), migraine with aura (11.1%) and frequent episodic tension-type headache (7.5%). For most of the diagnostic categories, the consistency of the investigator's diagnosis with the ICHD-II criteria was good (kappa > 0.6 and < or = 0.8) or excellent (kappa > 0.8). We conclude that migraine was predominant with regard to headache diagnoses repartition and that the ICHD-II seems usable in practice for evaluation of primary headache in French children and adolescents.
    Cephalalgia 11/2008; 28(11):1145-53. · 3.49 Impact Factor
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    ABSTRACT: We studied four members of a family suffering from typical attacks of familial hemiplegic migraine (FHM) caused by a new mutation, R548C, of ATP1A2 gene in exon 12. One individual had also childhood absence epilepsy and generalized tonic-clonic seizures (GTCS). GTCS were followed by a severe attack of hemiplegic migraine at four times. Sodium valproate enabled control of both the epileptic seizures and the most severe FHM attacks. This association of FHM and epileptic seizures and their control with the same treatment suggest similar pathophysiological mechanisms.
    Cephalalgia 08/2008; 28(7):774-7. · 3.49 Impact Factor
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    ABSTRACT: The aim of this study was to describe the abnormalities associated with migraine aura lasting 1-24 h in children as shown by EEG, trancranial Doppler (TCD) and single photon emission computed tomography (SPECT). In this retrospective study, 11 patients each underwent EEG, TCD and brain SPECT on the day of admission and the day thereafter. On the day of admission, the migrainous hemisphere of all patients showed that the mean velocities were decreased in the middle cerebral artery by TCD, slow-wave abnormalities were recorded after several hours of aura by EEG and the SPECT showed hypoperfusion. On the day after, in the same hemisphere, slow waves were recorded only in the occipital area by EEG, and SPECT showed slight hyperperfusion. In these patients, there was a clear sequence of EEG, TCD and SPECT abnormalities.
    Cephalalgia 10/2007; 27(9):1043-9. · 3.49 Impact Factor
  • Revue Neurologique - REV NEUROL. 01/2007; 163(4):113-113.
  • Revue Neurologique - REV NEUROL. 01/2007; 163(4):136-136.
  • Source
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    ABSTRACT: This is an open-label, retrospective, multicenter study to determine the outcome of intermittent stimulation of the left vagal nerve in children with tuberous sclerosis complex and medically refractory epilepsy. The records of all children treated with vagal nerve stimulation were reviewed in five pediatric epilepsy centers to locate those with tuberous sclerosis complex who had been treated with vagal nerve stimulation for at least 6 months. These patients were compared with (1) a series of patients obtained from the literature, (2) 10 similar control patients with epilepsy obtained from a registry of patients receiving vagal nerve stimulation, and (3) four published series of tuberous sclerosis complex patients whose epilepsy was surgically managed. Ten tuberous sclerosis complex patients with medically refractory epilepsy treated with vagal nerve stimulation were found. Nine experienced at least a 50% reduction in seizure frequency, and half had a 90% or greater reduction in seizure frequency. No adverse events were encountered. Comparison with published and registry patients revealed improved seizure control in the tuberous sclerosis complex patients. Comparison with the group undergoing seizure surgery demonstrated improved outcomes after surgery. Vagal nerve stimulation appears to be an effective and well-tolerated adjunctive therapy in patients with tuberous sclerosis complex and seizures refractory to medical therapy. Resective surgery has a better prospect for improved seizure control.
    Pediatric Neurology 10/2001; 25(3):213-6. · 1.42 Impact Factor
  • D Parain
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    ABSTRACT: Photosensitivity is defined by a pattern of occipital or more diffuse spikes and waves. Several techniques are needed for exploration: intermittent light stimulation (ILS), patterns, TV-screen, video games. Photosensitivity is a genetic characteristic. Only diffuse spikes and waves induced by ILS are correlated with epilepsy. Pure photogenic epilepsy is characterized by seizures induced by visual stimuli alone, usually by TV-screen. Video games may also have a triggering effect due to the slow-moving patterns or intense brightness. Several epileptic syndromes are associated with photosensitivity with or without visually-induced seizures. These syndromes are most often generalized and idiopathic.
    Revue Neurologique 12/1998; 154(11):757-61. · 0.51 Impact Factor
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    ABSTRACT: Stroke is a rare cause of neonatal seizures. During a 5-year period, eight full-term infants were admitted to hospital for seizures due to a stroke. Seizures began shortly after birth and were always one-sided. Early CT scans showed cerebral infarctions. Motor disabilities such as hemiparesis were found in three out of seven cases; language difficulties were observed in the same proportion; however all the children had not reached school age. Neonatal localized seizures may be symptomatic of a stroke and therefore justify a computerized tomography (CT) scan. Motor and cognitive sequelae require early management.
    Archives de Pédiatrie 05/1998; 5(4):404-8. · 0.36 Impact Factor
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    ABSTRACT: Background Stroke is a rare cause of neonatal seizures. Case reports During a 5-year period, eight full-term infants were admitted to hospital for seizures due to a stroke. Seizures began shortly after birth and were always one-sided. Early CT scans showed cerebral infarctions. Motor disabilities such as hemiparesis were found in three out of seven cases; language difficulties were observed in the same proportion; however all the children had not reached school age. Conclusion Neonatal localized seizures may be symptomatic of a stroke and therefore justify a computerized tomography (CT) scan. Motor and cognitive sequelae require early management.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/1998; 5(4):404-408.
  • Neurophysiologie Clinique-clinical Neurophysiology - NEUROPHYSIOL CLIN. 01/1998; 28(4):376-376.
  • Archives de Pédiatrie 01/1998; 5(4). · 0.36 Impact Factor
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    ABSTRACT: Palinopsia (visual perseveration) and palinacousis (auditory perseveration) are reported in a 51-year-old woman with a left temporo parietal astrocytoma. EEG showed a left temporal delta-focus with sharp waves. EEG was not modified during neither palinacousis nor palinopsia. The relationship between the two hallucinatory phenomena and epilepsy is discussed.
    Revue Neurologique 12/1997; 153(11):687-9. · 0.51 Impact Factor
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    ABSTRACT: In a prospective study of 417 premature neonates born before 33 weeks' gestational age, neonatal tracings were reviewed to evaluate the use of EEG in prognosis of neurological injuries. The population was divided into two groups: Group 1, infants who died before the age of 1, and Group 2, survivors in which two categories of motor development were considered. Category A, were abnormal, and Category B, were always normal. Positive rolandic sharp waves (PRSW), which reflect white matter injury, occurred equally in both groups, indicating a similar incidence of white matter damage in Groups 1 and 2. In Group 2, there was a significant correlation of PRSW with developmental motor sequelae (Category A). A frequency of PRSW above 2/min (suggesting more severe periventricular white matter injury) and seizures were significantly more prevalent in Group 1 than in Group 2 and in Category A of Group 2 than in Category B. Background abnormalities occurred equally in both subgroups of extremely premature infants (< or = 28 weeks' gestation) they were significantly more numerous in the subgroup of very premature infants (between 28 and 33 weeks' gestation) who died, than in the subgroup of very premature infants who survived. This study shows the potential utility of using neonatal EEG in association with transfontanellar ultrasonography in anticipating the neurological development of very (> 28 weeks' gestation) and extremely (< or = 28 weeks' gestation) premature newborns.
    Electroencephalography and Clinical Neurophysiology 03/1997; 102(3):178-85.
  • Neurophysiologie Clinique-clinical Neurophysiology - NEUROPHYSIOL CLIN. 01/1997; 27(2):168-169.

Publication Stats

209 Citations
38.19 Total Impact Points

Institutions

  • 2009
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2008
    • Hôpital Lariboisière - Fernand-Widal (Hôpitaux Universitaires Sant-Louis, Lariboisière, Fernand-Widal)
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Régional Universitaire de Lille
      Lille, Nord-Pas-de-Calais, France
  • 1981–2008
    • Centre Hospitalier Universitaire Rouen
      • Service de Pédiatrie Médicale
      Rouen, Upper Normandy, France
  • 1988–1989
    • Hôpital Charles-Nicolle
      Tunis-Ville, Tūnis, Tunisia