Jean-Paul Nguyen

Jean-Paul Nguyen
Centre Hospitalier Universitaire de Nantes | CHU Nantes · 44000

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145
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Publications

Publications (145)
Article
Full-text available
Background: Deep brain stimulation (DBS) is an effective technique to treat patients with advanced Parkinson's disease. The surgical procedure of DBS implantation is generally performed under local anesthesia due to the need for intraoperative clinical testing. However, this procedure is long (5-7 h on average) and, therefore, the objective that t...
Article
Objective To assess the long-term effects of multi-site repetitive transcranial magnetic stimulation combined with cognitive training (NeuroAD procedure) on cognitive symptoms and apathy in patients with Alzheimer's disease (AD) as part of a 4-year chart review. Methods The study included the 30 AD patients who underwent NeuroAD treatment between...
Article
Transcranial magnetic stimulation (TMS) is a powerful tool to probe in vivo brain circuits, as it allows to assess several cortical properties such as excitability, plasticity and connectivity in humans. In the last 20 years, TMS has been applied to patients with dementia, enabling the identification of potential markers of the pathophysiology and...
Article
Nitrous oxide (N2O) is an odorless and colorless gas routinely used as an adjuvant of anesthesia and for short duration analgesia in various clinical settings mostly in the form of a N2O/O2 50%-50% equimolar mixture (EMONO). Experimental studies have suggested that EMONO could also induce long lasting analgesic effects related to the blockade of NM...
Article
Background Occipital nerve stimulation (ONS) is shown to be effective in treating various forms of headache. Most studies describe the treatment of occipital neuralgia (ON), but in many patients, the clinical description could also correspond to cervicogenic headache (CGH) or occipital migraine (OM). These different entities (ON, CGH, and OM) may b...
Article
Full-text available
A group of European experts reappraised the guidelines on the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) previously published in 2014 [Lefaucheur et al., Clin Neurophysiol 2014;125:2150-206]. These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently rev...
Article
High-frequency repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex has a good level of evidence of efficacy as a method for providing analgesic effects in patients with chronic pain. However, there is still no consensus regarding the parameters of stimulation to use and the detailed protocol to apply for therapeutic prac...
Article
Full-text available
AimChronic pain associated with knee osteoarthritis may develop in connection with a maladaptive process of pain sensitization in the central nervous system. Repetitive transcranial magnetic stimulation (rTMS) has been proposed to treat various pain syndromes related to central sensitization phenomenon, but was never applied in the context of knee...
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Full-text available
Aim: To show the value of low-frequency repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) to treat bladder pain syndrome (BPS), characterized by suprapubic pain, urgency and increased micturition frequency. Methods: A 68-year-old woman with BPS underwent 16 sessions of high-intensity, low-frequency (1...
Article
This pilot study aimed at assessing the effect of transcutaneous electrical nerve stimulation (TENS) of the occipital nerve (ON) to treat chronic refractory headache secondary to intracranial endovascular procedures (iEVP) in 4 patients. The duration of ON-TENS therapy was only 1 month (n=2) or longer than 4 months (n=2). Overall, pain intensity de...
Article
Objective: To assess the efficacy of a combination of cognitive training (COG) and repetitive transcranial magnetic stimulation (rTMS), on cognitive performance, locomotor activity, apathy, caregiver burden and dependence of patients with Alzheimer's disease (AD). Methods: A combination of COG and rTMS was performed in 10 patients with AD (Neuro...
Article
Corresponding author. Centre anti-douleur, clinique Bretéché, rue de la Béraudière, 44000 Nantes, France.
Article
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Le cortex cérébral est la cible qui a été la plus récemment évaluée pour le traitement des douleurs neuropathiques par neuromodulation. Au début des années 1990, les premiers succès de la stimulation épidurale du cortex moteur implantée chirurgicalement (EMCS) ont été publiés. Quelques années plus tard a été développée la stimulation magnétique tra...
Article
Occipital nerve stimulation (ONS) is a surgical approach to treat patients with medically intractable chronic headache disorders. However, no preoperative test has been yet validated to allow candidates to be selected for implantation. In this study, the analgesic efficacy of transcutaneous electrical nerve stimulation (TENS) was tested for 1 to 3...
Chapter
Les lombalgies chroniques touchent environ 25 % de la population générale et leurs coûts directs et indirects en font un problème majeur de santé publique. Les lombalgies chroniques réfractaires se définissent par leur caractère rebelle à une prise en charge pluridisciplinaire, comprenant plusieurs lignes de traitements, incluant des opioïdes forts...
Chapter
Les douleurs neuropathiques secondaires à une lésion encéphalique — douleurs dites centrales — ou à une lésion du nerf trijumeau — douleurs faciales neuropathiques — sont généralement difficiles à traiter. Les traitements médicamenteux sont le plus souvent peu efficaces et les techniques de stimulation médullaires sont inadaptées et sans effet. La...
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Full-text available
Patients with Parkinson's disease frequently complain of sleep disturbances and loss of muscle atonia during rapid-eye-movement (REM) sleep is not rare. The orexin-A (hypocretin-1) hypothalamic system plays a central role in controlling REM sleep. Loss of orexin neurons results in narcolepsy-cataplexy, a condition characterized by diurnal sleepines...
Article
In some patients, with refractory chronic pelvic and perineal pain, pain and quality of life are barely alleviated despite optimal medical treatment, infiltrations and surgical release of the pudendal nerve. The management of these patients is complex, especially after failure of neuromodulation techniques (spinal cord stimulation. S3 nerve root st...
Article
Full-text available
Drug-refractory pain is an indication for neurostimulation therapy, which can be either non-invasive [mainly transcutaneous electrical nerve stimulation (TENS), repetitive Transcranial Magnetic Stimulation (rTMS), and transcranial direct current stimulation (tDCS)] or invasive which requires the intervention of a surgeon to implant electrodes and a...
Article
Full-text available
Neurostimulation therapy is indicated for neuropathic pain that is refractory to medical treatment, and includes stimulation of the dorsal spinal cord, deep brain structures, and the precentral motor cortex. Spinal cord stimulation is validated in the treatment of selected types of chronic pain syndromes, such as failed back surgery syndrome. Deep...
Article
Unlabelled: This study was designed to assess the value of repetitive transcranial magnetic stimulation (rTMS) to predict the efficacy of epidural motor cortex stimulation (EMCS) to treat neuropathic pain. We have included 59 patients treated by EMCS for more than 1 year and in whom active and sham 10Hz-rTMS sessions were performed as preoperative...
Article
Surgical options of multiple sclerosis (MS) tremor treatment are limited and narrowed to thalamotomy or deep brain stimulation of the thalamic nucleus ventralis intermedius. Lack of qualification protocol frequently results in poor outcome. To determine prospectively the efficacy and safety of unilateral ventralis intermedius deep brain stimulation...
Article
Chronic, drug-resistant neuropathic pain can be treated by surgically implanted motor cortex stimulation (MCS). The leads used for MCS have not been specifically designed for this application. To study the value of a new 8-contact lead for MCS therapy in a series of 6 patients with refractory central poststroke pain. The study comprised a 1-month r...
Article
Despite good clinical results, the mechanisms of action of spinal cord stimulation (SCS) for the treatment of chronic refractory neuropathic pain have not yet been elucidated. In the present study, the effects of SCS were assessed on various neurophysiological parameters in a series of 20 patients, successfully treated by SCS for mostly unilateral,...
Article
To assess the modulation of acute provoked pain by repetitive transcranial magnetic stimulation (rTMS) of the motor cortex in patients with chronic neuropathic pain. In 32 patients with chronic neuropathic pain affecting one upper limb, laser-evoked potentials (LEPs) (N2 and P2 components) were recorded in response to laser stimulation of the painf...
Article
Accurate evaluation of the electrode position in subthalamic nucleus (STN) after deep-brain stimulation (DBS) has rarely been verified before. We superimposed the postoperative thin-sliced computed tomography (CT) on the preoperative magnetic resonance imaging (MRI), and the positional information of the implanted electrodes with electrophysiologic...
Article
Epidural motor cortex stimulation (EMCS) is a therapeutic option for chronic, drug-resistant neuropathic pain, but its mechanisms of action remain poorly understood. In two patients with refractory hand pain successfully treated by EMCS, the presence of implanted epidural cervical electrodes for spinal cord stimulation permitted to study the descen...
Article
The neurosurgical procedures currently available for the treatment of trigeminal neuralgia can induce trigeminal neuropathic pain. Severe forms of trigeminal neuropathic pain correspond to the classical facial anesthesia dolorosa, whose treatment is known to be very difficult. Chronic stimulation of the ventral posterolateral nucleus (VPL) of the t...
Article
Epidural motor cortex stimulation (MCS) has been proposed as a treatment for chronic, drug-resistant neuropathic pain of various origins. Regarding pain syndromes due to peripheral nerve lesion, only case series have previously been reported. We present the results of the first randomized controlled trial using chronic MCS in this indication. Sixte...
Article
Neurostimulation of neuropathic pain is based on surgical implantation of devices for several types of neuromodulatory treatment (stimulation of the spinal cord, cortex, deep brain or thalamus, or occiput). Spinal cord stimulation is a recognized treatment, with a high level of proof. It is effective in 70 or 80% of appropriately selected cases. Co...
Article
Full-text available
A higher than expected frequency of suicide has been reported among patients undergoing subthalamic nucleus deep brain stimulation (STN DBS) for advanced Parkinson's disease (PD). We conducted a retrospective survey of 200 patients with PD who underwent STN DBS. Two patients (1%) committed suicide and four (2%) attempted suicide, despite clear moto...
Article
Full-text available
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) gained general acceptance in the treatment of Parkinson's disease (PD). To study the clinical outcome and the predicting factors of efficacy of chronic STN stimulation, while DBS electrodes were implanted under local or general anaesthesia with intra-operative electrophysiological guidan...
Article
We studied the involvement of the electrophysiological localization of the subthalamic nucleus (NST) using a multi-unit recording technique by means of semi-microelectrode in a set of thirty Parkinson's patients who benefited from a bilateral stimulation of the NST and who were operated on under local or general anesthesia. The multi-unit recording...
Article
Neurostimulation of neuropathic pain is based on surgical implantation of devices for several types of neuromodulatory treatment (stimulation of the spinal cord, cortex, deep brain or thalamus, or occiput). Spinal cord stimulation is a recognized treatment, with a high level of proof. It is effective in 70 or 80% of appropriately selected cases. Co...
Article
Chronic motor cortex stimulation (MCS) with surgically implanted epidural electrodes has been proposed as a treatment for neuropathic pain refractory compared with medical treatment. However, no prospective controlled trial has been published to provide convincing evidence of MCS analgesic efficacy. To compare MCS analgesic efficacy between "ON"- a...
Article
Improvement in sensory detection thresholds was found to be associated with neuropathic pain relief produced by epidural motor cortex stimulation with surgically implanted electrodes. To determine the ability of repetitive transcranial magnetic stimulation (rTMS) of the motor cortex to produce similar sensory changes. In 46 patients with chronic ne...
Article
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is increasingly used to treat advanced Parkinson's disease (PD). The optimal method for targeting the STN before implanting the definitive DBS electrode is still a matter of debates. Beside methods of direct visualization of the nucleus based on stereotactic magnetic resonance imaging (M...
Article
To explore the significance of intra-operative motor evoked potentials (MEPs) obtained by monopolar and bipolar stimulation in determining the location of the electrode(s) giving most pain relief in chronic motor cortex stimulation (MCS). Eight patients with chronic refractory neuropathic pain were implanted epidurally with two parallel leads of fo...
Article
The conditions of motor cortex stimulation (MCS) applied with epidural electrodes, in particular monopolar (cathodal or anodal) and bipolar stimulation, are discussed. The results of theoretical studies, animal experiments and clinical studies lead to similar conclusions. Basically, cortical nerve fibres pointing at the epidural electrode and those...
Article
Motor cortex repetitive transcranial magnetic stimulation (rTMS) was found to relieve chronic neuropathic pain, but the optimal parameters of stimulation remain to be determined, including the site of stimulation. To determine the relationship between cortical stimulation site and pain site regarding the analgesic efficacy of rTMS of motor cortex i...
Article
To assess cortical excitability changes in patients with chronic neuropathic pain at baseline and after repetitive transcranial magnetic stimulation (rTMS) of the motor cortex. In 22 patients with unilateral hand pain of various neurologic origins and 22 age-matched healthy controls, we studied the following parameters of cortical excitability: mot...
Article
Tinnitus - the perception of sound in one or both ears or in the head when no external sound is present - can be disabling and is especially difficult to treat. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique for activating or inactivating specific areas of the cortex. The aim of this study was to assess the feasibili...
Article
Objective Tinnitus - the perception of sound in one or both ears or in the head when no external sound is present - can be disabling and is especially difficult to treat. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique for activating or inactivating specific areas of the cortex. The aim of this study was to assess the...
Article
Aim. In MCS motor evoked potentials (MEPs) are recorded to identify the pain-related somatotopic region(s) of the motor cortex. Since stimuli are applied bipolarly, MEPs may originate near the negative pole (cathode), the positive one (anode), or both. The aim is to identify the stimulus polarity effective in inducing MEPs and in relieving pain. Ma...
Chapter
Colloid cysts represent approximately 1% of all intracranial neoplasms [6, 12, 54, 173]. The preferential localization of these lesions to the anterior part of the third ventricle explains why these lesions appear primarily with obstructive biventricular hydrocephalus, the obstruction sitting on the level of the foramina of Monro. The natural histo...
Article
To assess the effects of focal motor cortex stimulation on motor performance and cortical excitability in patients with Parkinson's disease (PD). Repetitive transcranial magnetic stimulation (rTMS) was performed on the left motor cortical area corresponding to the right hand in 12 'off-drug' patients with PD. The effects of subthreshold rTMS applie...
Article
Full-text available
Huntington's disease (HD) is a monogenic neurodegenerative disease that affects the efferent neurons of the striatum. The protracted evolution of the pathology over 15 to 20 years, after clinical onset in adulthood, underscores the potential of therapeutic tools that would aim at protecting striatal neurons. Proteins with neuroprotective effects in...
Article
Dystonia is associated with excessive corticospinal motor output. Motor cortex excitability may be reduced by low-frequency repetitive transcranial magnetic stimulation (rTMS) of premotor cortical areas. We report the effects of 1 Hz rTMS applied at 90% of resting motor threshold over the left premotor cortex in an open pilot study of three patient...
Article
Background and purpose Spinal cord stimulation is a well-known treatment of rigorously selected failed-back surgery syndrome patients. Efficacy levels over 50 % of pain relief have been reported in long-term studies. The objective of this multicenter prospective evaluation was to analyze the cost to benefit ratio of spinal cord stimulation treatmen...
Article
Neuropathic pain can be controlled by motor cortex stimulation using surgically-implanted electrodes in a majority of selected patients. Analgesic effects were also found to result from repetitive transcranial magnetic stimulation (rTMS) of the cortex. We report the case of a woman, in whom drug-resistant peripheral pain was controlled for 16 month...
Article
Full-text available
Drug resistant neurogenic pain can be relieved by repetitive transcranial magnetic stimulation (rTMS) of the motor cortex. This study was designed to assess the influence of pain origin, pain site, and sensory loss on rTMS efficacy. Sixty right handed patients were included, suffering from intractable pain secondary to one of the following types of...
Article
Full-text available
Huntington's disease is a hereditary disease in which degeneration of neurons in the striatum leads to motor and cognitive deficits. Foetal striatal allografts reverse these deficits in phenotypic models of Huntington's disease developed in primates. A recent open-label pilot study has shown some clinical improvement or stabilization in three out o...
Article
The origins of excessive daytime sleepiness in Parkinson disease (PD) are unclear. The authors hypothesize that orexin neurons, a recently identified wake promoting system, could contribute to its pathophysiology. They measured orexin-A/hypocretin-1 concentration in ventricular CSF in 19 parkinsonian patients and compared it with neurologic control...
Article
An erratum for this article appears in the January, 2004 issue of Movement Disorders (Mov Disord 2004;12:119). We compared the striatal uptake of [18F]fluorodopa with [76Br]-FE-CBT, a positron emission tomography (PET) ligand of the dopamine transporter (DAT), which estimates the density of dopamine nerve terminals, in 6 patients with Parkinson's d...
Article
Full-text available
Epidural motor cortex stimulation (MCS) could achieve good pain control in patients with drug-resistant chronic neurogenic pain. In the search for parameters associated with the favourable outcome of this surgical procedure, quantitative sensory testing was performed in a series of 31 patients treated by MCS for chronic pain. Non-nociceptive and no...
Article
Full-text available
Measuring progression of Parkinson disease (PD) using positron emission tomography may help demonstrate the efficacy of neuroprotective treatments. To date, (18)F-dopa has been the gold standard to measure presynaptic dopaminergic function in PD, but this tracer might overestimate the rate of neuronal death in PD because its uptake also depends on...
Article
MRI and electrophysiological techniques to localize the primary motor cortex (MC) were performed on patients considered for MC stimulation for the treatment of deafferentation pain. The representation and trajectory of the rolandic fissure (RF) were accurately localized by external cranial landmarks and radiopaque fiducials superimposed on oblique...
Article
Hydrocephalus associated with Chiari I malformation is a rare entity related to an obstruction in the flow of cerebrospinal fluid (CSF) in the foramen of Magendie. Like all forms of noncommunicating hydrocephalus. it can be treated by endoscopic third ventriculostomy (ETV). The object of this study is to report a series of five cases of hydrocephal...
Article
Chronic electrical stimulation of the precentral (motor) cortex using surgically implanted electrodes is performed to treat medication-resistant neurogenic pain. The goal of this placebo-controlled study was to obtain such antalgic effects by means of a non-invasive cortical stimulation using repetitive transcranial magnetic stimulation (rTMS). Eig...