Marc Vérin

• Professor
• Professor (Full) at University of Orléans

The link between subthalamic nucleus deep brain stimulation (STN‐DBS) and apathy in patients with Parkinson's disease (PD) remains a controversial topic. The literature is mixed and the most supported explanation is the reduction of dopaminergic treatment. Yet a body of clinical and experimental evidences suggest that STN‐DBS itself can also promot...

Introduction. Recently, studies have suggested a role of motor symptom asymmetry on impaired emotional recognition abilities in Parkinson’s disease with a greater vulnerability in patients with a predominance of left-sided symptoms. However, none of them explored the interaction between motor symptom asymmetry and dopamine replacement therapy in di...

Neurodegenerative diseases such as Parkinson's (PD) and Alzheimer's (AD) exhibit considerable heterogeneity of functional brain features within patient populations, complicating diagnosis, treatment, prognosis, and drug discovery. Here, we use electroencephalography (EEG) and normative modeling to investigate neurophysiological oscillatory mechanis...

Neuroscience research has shown that specific brain patterns can relate to creativity during multiple tasks but also at rest. Nevertheless, the electrophysiological correlates of a highly creative brain remain largely unexplored. This study aims to uncover resting-state networks related to creative behavior using high-density electroencephalography...

Multidimensional, chronic, progressive and incurable, Parkinson's disease is, by definition, a palliative disease, and this from the moment of diagnosis. This vision, relatively new to neurology, calls for a paradigm shift, as well as a dual medical-paramedical and home-hospital alliance. This approach allows us to better understand the specificiti...

Anxiety is a common non-motor symptom in Parkinson’s disease (PD) occurring in up to 31% of the patients and affecting their quality of life. Despite the high prevalence, anxiety symptoms in PD are often underdiagnosed and, therefore, undertreated. To date, functional and structural neuroimaging studies have contributed to our understanding of the...

Background There are currently no recommendations on the therapeutic management of Parkinson’s disease (PD) patients at the end of life. Objective To describe a cohort of patients with PD who benefited from continuous subcutaneous apomorphine infusion (CSAI) initiation at the end of their life as comfort care. Methods This real-life cohort includ...

The standard of care is a term that refers to the level of care, skill, and treatment that a healthcare provider should offer to a patient based on the current scientific evidence and the level of medical knowledge available in the field. For Parkinson’s disease (PD), the standard care is mostly considered to be oral treatment with dopaminergic dru...

Neuroscience research has shown that specific functional brain patterns can be related to creativity during multiple tasks but also at rest. Nevertheless, the electrophysiological correlates of a highly creative brain remain largely unexplored. This study aims to uncover resting-state networks related to real-life creativity using high-density elec...

Device-aided therapies (DAT), which include deep brain stimulation and pump-based continuous dopaminergic stimulation with either levodopa or apomorphine, are among the major advances in the clinical management of Parkinson’s disease (PD). Although DAT are being increasingly offered earlier in the disease course, their classical indication remains...

Background: Parkinson's disease (PD) patients present with a heterogeneous clinical phenotype, including motor, cognitive, sleep, and affective disruptions. However, this heterogeneity is often either ignored or assessed using only clinical assessments. Objectives: We aimed to identify different PD sub-phenotypes in a longitudinal follow-up anal...

Dopaminergic therapies dominate the treatment of the motor and non-motor symptoms of Parkinson’s disease (PD) but there have been no major advances in therapy in many decades. Two of the oldest drugs used appear more effective than others—levodopa and apomorphine—but the reasons for this are seldom discussed and this may be one cause for a lack of...

Anxiety is a common non-motor symptom in Parkinson's disease (PD) occurring in up to 31% of the patients and affecting their quality of life. Despite the high prevalence, anxiety symptoms in PD are often underdiagnosed and, therefore, undertreated. To date, functional and structural neuroimaging studies have contributed to our understanding of the...

Continuous subcutaneous apomorphine infusion (CSAI) is used to treat patients with Parkinson's disease (PD) who are experiencing motor fluctuations. However, the need to initiate this treatment during a hospital stay may restrict patients' access to it. To assess the feasibility and benefits of initiating CSAI in the patient's own home. A French pr...

Introduction: Risk factors (e.g., motor symptom asymmetry) for short- and long-term cognitive and neuropsychiatric symptoms following deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinson's disease have yet to be fully identified. The objectives of the present study were to determine whether motor symptom asymmet...

Introduction Apathy, as defined as a deficit in goal-directed behaviors, is a critical clinical dimension in depression associated with chronic impairment. Little is known about its cerebral perfusion specificities in depression. To explore neurovascular mechanisms underpinning apathy in depression by pseudo-continuous arterial spin labeling (pCASL...

Background: Continuous subcutaneous apomorphine infusion (CSAI) is increasingly being used to treat patients with Parkinson’s disease who are experiencing motor fluctuations. However, the need to initiate this treatment during a hospital stay, more often than not in a specialist center, may restrict patients’ access to it. Objective: To assess the...

Introduction There is a growing interest in personality evaluation in Parkinson's disease (PD), following observations of specific temperaments in PD patients. Therefore, our objective was to evaluate personality dimensions from the Temperament and Character Inventory (TCI) in a cohort of fluctuating PD patients considered for deep brain stimulatio...

Among the cognitive symptoms that are associated with Parkinson's disease (PD), alterations in cognitive action control (CAC) are commonly reported in patients. CAC enables the suppression of an automatic action, in favor of a goal-directed one. The implementation of CAC is time-resolved and arguably associated with dynamic changes in functional br...

Emerging evidence showed that major depressive disorder (MDD) is associated with disruptions of brain structural and functional networks, rather than impairment of isolated brain region. Thus, connectome-based models capable of predicting the depression severity at the individual level can be clinically useful. Here, we applied a machine-learning a...

There is growing evidence that both the basal ganglia and the cerebellum play functional roles in emotion processing, either directly or indirectly, through their connections with cortical and subcortical structures. However, the lateralization of this complex processing in emotion recognition remains unclear. To address this issue, we investigated...

Background: Tracking longitudinal functional brain dysconnectivity in Parkinson's disease (PD) is a key element to decoding the underlying physiopathology and understanding PD progression. Objectives: The objectives of this follow-up study were to explore, for the first time, the longitudinal changes in the functional brain networks of PD patien...

Introduction La prise en charge thérapeutique des patients atteints de maladie de Parkinson (MP) au stade terminal ne fait aujourd’hui l’objet d’aucune recommandation. Objectifs Décrire le bénéfice de la pompe à apomorphine et du suivi conjoint neurologique et palliatif chez 7 patients MP au stade terminal. Patients et méthodes Les données cliniq...

Introduction Les pénuries de médicaments posent un problème majeur de santé publique et concernent aussi bien des médicaments d’usage quotidien que ceux d’intérêt vital, comme le Sinemet® (six mois en 2018–2019). Objectifs Les objectifs de ce travail étaient de déterminer : (i) comment les informations concernant cette rupture ont été relayées aux...

Risk factors for long-term non-motor symptoms and quality of life following subthalamic nucleus deep brain stimulation (STN DBS) have not yet been fully identified. In the present study, we investigated the impact of motor symptom asymmetry in Parkinson’s disease. Data were extracted for 52 patients with Parkinson’s disease (half with predominantly...

Among the cognitive symptoms that are associated with Parkinson’s disease (PD), alterations in cognitive action control (CAC) are commonly reported in patients. CAC enables the suppression of an automatic action, in favor of a goal-directed one. The implementation of CAC is time-resolved and arguably associated with dynamic changes in functional br...

Despite clinical evidence of poor oral health and hygiene in Parkinson’s disease (PD) patients, the mouth is often overlooked by both patients and the medical community, who generally focus on motor or psychiatric disorders considered more burdensome. Yet, oral health is in a two-way relationship with overall health—a weakened status triggering a d...

Risk factors for long-term non-motor disorders and quality of life following subthalamic nucleus deep-brain stimulation (STN DBS) have not yet been fully identified. In the present study, we investigated the impact of motor symptom asymmetry in Parkinson’s disease. Data were extracted for 52 patients with Parkinson’s disease (half with left-sided m...

Emerging evidence showed that major depressive disorder (MDD) is associated with disruptions of brain structural and functional networks, rather than impairment of isolated brain region. Thus, connectome-based models capable of predicting the depression severity at the individual level can be clinically useful. Here, we applied a machine-learning a...

OBJECTIVES To test for cerebellar involvement in motor and nonmotor impairments in Parkinson’s disease (PD), and to determine patterns of metabolic correlations with supratentorial brain structures, we correlated clinical motor, cognitive and psychiatric scales with cerebellar metabolism. METHODS We included 90 patients with PD. Motor, cognitive a...

Background: There are no effective treatments for multiple system atrophy (MSA). Objective: The objective of this study was to assess the efficacy and safety of the serotonin reuptake inhibitor fluoxetine (40 mg/d) for the symptomatic treatment of MSA. Methods: This was a double-blind, parallel-group, placebo-controlled, randomized trial in pa...

Introduction: Internal globus pallidus (GPi) deep brain stimulation (DBS) is a safe and effective alternative treatment in Parkinson's disease (PD) for patients with cognitive impairment. However, no study has yet investigated metabolic changes within a large series of patients undergoing GPi stimulation. Objective: We assessed motor, cognitive...

Background Neurophobia is a chronic disease of medical students and junior doctors. Early detection is needed to facilitate prevention and management as this fear can negatively impact patient care. Methods We conducted a two-part mono-centric study at the faculty of Medicine, Sorbonne University, in Paris. Part one: a cross-sectional study to val...

Introduction The main objective is to validate a French translation of the Alcohol Urge Questionnaire (AUQ) that measures craving in patients with alcohol dependence entering a detoxification program. Methods: All patients aged >18 years who were hospitalized for alcohol detoxification from February to May 2019 in the alcohol unit of the Rennes u...

In addition to the subthalamic nucleus’ (STN) role in motor control, STN deep brain stimulation (DBS) for Parkinson’s disease (PD) has also uncovered its involvement in cognitive and limbic processing. STN neural oscillations analyzed through local field potential (LFP) recordings have been shown to contribute to emotional (mostly in the alpha band...

The subthalamic nucleus (STN) is involved in different aspects of emotional processes and more specifically in emotional prosody recognition. Recent studies on the behavioral effects of deep brain stimulation (DBS) in patients with Parkinson's disease (PD) have uncovered an asymmetry in vocal emotion decoding in PD, with left-onset PD patients show...

Apathy is frequently reported in Parkinson's disease (PD) patients under subthalamic nucleus deep brain stimulation (STN-DBS). The prevailing clinical view for apathy following STN-DBS is the reduction of dopaminergic medication. However, few clinical reports and recent experimental data suggested the pathogenicity of bilateral STN-DBS on motivatio...

Studies of the phenotype and population distribution of rare genetic forms of parkinsonism are required, now that gene‐targeting approaches for Parkinson's disease have reached the clinical trial stage. We evaluated the frequencies of PRKN , PINK1 , and DJ‐1 mutations in a cohort of 1587 cases. Mutations were found in 14.1% of patients: 27.6% were...

The objective of this study was to explore the brain modifications associated with vocal emotion (i.e., emotional prosody) processing deficits in patients with Parkinson’s disease after deep brain stimulation of the subthalamic nucleus, and the impact of motor asymmetry on these deficits. We therefore conducted 18-fluorodeoxyglucose positron emissi...

This chapter focuses on apomorphine therapy, a device-aided strategy in Parkinson's disease. Apomorphine is a nonnarcotic and nonspecific dopaminergic agonist (D1-like and D2-like receptors) indicated in the case of suboptimal therapeutic response to oral antiparkinsonian medication. Two approaches are possible—either as a rescue therapy with acute...

Introduction Patients with Parkinson’s disease sometimes report postural instability and gait disorders (PIGD) after subthalamic nucleus deep brain stimulation (STN-DBS). Whether this is the direct consequence of DBS or the result of natural disease progression is still subject to debate. Objective To compare changes in brain metabolism during STN...

Cognitive action control depends on cortical-subcortical circuits, involving notably the subthalamic nucleus (STN), as evidenced by local field potentials recordings (LFPs) studies. The STN consistently shows an increase in theta oscillations power during conflict resolution. Some studies have shown that cognitive action control in Parkinson's dise...

Background: Within the heterogeneity of schizophrenia, apathy constitutes an independent cluster of negative symptoms associated with poor outcomes. Attempts to identify an emotional deficit in patients who have schizophrenia with negative symptoms have yielded mixed results, and studies that focus on the relationship between apathy and emotional d...

Apomorphine is a 150-year old nonspecific dopaminergic agonist, currently indicated for treating motor fluctuations in Parkinson's disease. At the era of drug repurposing, its pleiotropic biological functions suggest other possible uses. To further explore new therapeutic and diagnostic applications, the available literature up to July 2018 was rev...

Cognitive action control depends on cortical-subcortical circuits, involving notably the subthalamic nucleus (STN), as evidenced by local field potentials recordings (LFPs) studies. The STN consistently shows an increase in theta oscillations power during conflict resolution. Some studies have shown that cognitive action control in Parkinson's dise...

Background: Within the heterogeneity of schizophrenia, apathy constitutes an independent cluster of negative symptoms associated with poor outcomes. Attempts to identify an emotional deficit in patients who have schizophrenia with negative symptoms have yielded mixed results, and studies that focus on the relationship between apathy and emotional...

Introduction: Treatment optimization using continuous subcutaneous apomorphine infusion (CSAI) improves the control of motor fluctuations of patients with Parkinson's disease (PD). Although CSAI seems to be cognitively and behaviorally safe and to improve the quality of life, very few studies have investigated its influence in these domains, especi...

The possible hemispheric specialization of the basal ganglia during emotional prosody (i.e., vocal emotion) processing has still to be elucidated. Coupled with affective measures and neuroimaging, Parkinson's disease offers a unique opportunity to study this question, on account of its characteristically asymmetric striatal dysfunction, which trans...

Deep brain stimulation effectively relieves most motor symptoms of Parkinson's disease • Effects on freezing of gait remain controversial with reports of improvement, worsening, and even induction post-surgery. Our objective was to evaluate the effects of bilateral subthalamic nucleus deep brain stimulation on subjective and objective freezing of g...

Subthalamic deep brain stimulation (STN DBS) is an effective treatment for reducing the motor symptoms of patients with Parkinson's disease (PD), but several side effects have been reported, concerning the processing of emotions. Music has been shown to evoke powerful emotional experiences - not only basic emotions, but also complex, so-called aest...

Objectifs Mettre en évidence une éventuelle différence du métabolisme glucidique cérébral obtenu par TEP FDG et des scores cliniques entre les patients parkinsoniens débutant leurs symptômes à droite (MPD) et ceux débutant à gauche (MPG). Matériels et méthodes Les patients inclus étaient les patients parkinsoniens droitiers sans antécédents psychi...

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Abstract topic: History of Neurology Title: The many faces of apomorphine: lessons from the past and challenges for the future Authors: Auffret Manon (PharmD, PhD), Sophie Drapier (MD), Marc Vérin (MD, PhD) OBJECTIVE: The aim of this research was to trace the rich and eventful history of apomorphine, bringing to light some of the forgotten names a...

Introduction Les rôles du cervelet et du noyau rouge dans la physiopathologie de la maladie de Parkinson doivent être précisés. Ces structures pourraient avoir un rôle compensateur dans cette maladie. Objectifs Étudier l’implication du noyau rouge et du cervelet dans les symptômes moteurs de la maladie de Parkinson. Méthodes Nous avons étudié rét...

Apomorphine is now recognized as the oldest antiparkinsonian drug on the market. Though still underused, it is increasingly prescribed in Europe for patients with advanced Parkinson’s disease (PD) with motor fluctuations. However, its history is far from being limited to movement disorders. This paper traces the history of apomorphine, from its ear...

Introduction: Continuous subcutaneous apomorphine infusion (CSAI) is increasingly used in Parkinson's disease (PD), notably in patients contraindicated for subthalamic deep brain stimulation. Although it has been suggested that CSAI is safe regarding cognition, few studies have actually investigated its effect, especially on cognitive control whic...

The present paper consists of a comprehensive review of the literature on apomorphine pharmacological properties and its usefulness in Parkinson’s disease (PD). The chemistry, structure–activity relationship, pharmacokinetics and pharmacodynamics of apomorphine are described with regard to its effects on PD symptoms, drug interactions, interindivid...

Background Ever since it was first defined, apathy has been described as a transnosographic entity, involved in many neuropsychiatric disorders not least depression. Owing to its impact on therapeutic outcomes and morbidity, this clinical dimension is of considerable interest in the pathophysiology of depression. However, the literature does not ad...

Parkinson's disease is a neurodegenerative disorder classically characterized by motor symptoms. Among them, hypomimia affects facial expressiveness and social communication and has a highly negative impact on patients' and relatives' quality of life. Patients also frequently experience nonmotor symptoms, including emotional-processing impairments,...

Background: Subcutaneous infusion of apomorphine is being increasingly used in Parkinson’s disease (PD) patients, notably in those with contraindications for subthalamic deep brain stimulation. Though very few studies have investigated the effect of continuous subcutaneous apomorphine infusion on cognitive functions, this treatment is considered to...

Introduction Au-delà des symptômes moteurs, des troubles des fonctions exécutives et limbiques sont aussi maintenant bien décrits dans la maladie de Parkinson, en lien avec une tri-compartimentation fonctionnelle des noyaux gris centraux. Objectif Le but de cette étude est de confirmer l’hypothèse d’une organisation fonctionnelle similaire du cerv...

Using intracranial local field potential (LFP) recordings in patients with Parkinson's disease (PD) undergoing deep brain stimulation (DBS), we explored the electrophysiological activity of the subthalamic nucleus (STN) in response to emotional stimuli in the auditory modality. Previous studies focused on the influence of visual stimuli. To this en...

Introduction: Patients with advanced Parkinson's disease (PD) and contraindications for subthalamic nucleus deep brain stimulation (DBS) could particularly benefit from subcutaneous infusion therapy with apomorphine. This original study was designed to evaluate the general efficacy of add-on apomorphine in motor and nonmotor symptoms in advanced P...

The effects of Parkinson's disease (PD) on the dynamics of impulsive action selection and suppression have recently been studied using distributional analyses, but with mixed results, especially for selection. Furthermore, some authors have suggested that impulsivity, regarded as a personality trait, shares common features with behavioral tasks' me...

Background A decrease in fatty acid amide hydrolase (FAAH) activity increases the levels of endogenous analogues of cannabinoids, or endocannabinoids. FAAH inhibitors have shown analgesic and antiinflammatory activity in animal models, and some have been tested in phase 1 and 2 studies. In a phase 1 study, BIA 10-2474, an orally administered revers...