C Fischer

French National Centre for Scientific Research, Lutetia Parisorum, Île-de-France, France

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Publications (105)143.77 Total impact

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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.
    Full-text · Article · Aug 2014 · Annals of Physical and Rehabilitation Medicine
  • N. André-Obadia · C. Fischer

    No preview · Article · Apr 2013 · Revue Neurologique

  • No preview · Article · Oct 2012 · Archives of Disease in Childhood
  • Source

    Full-text · Article · Jun 2012 · Neurology: Clinical Practice (Print)
  • C. Fischer · J. Luaute · D. Morlet

    No preview · Article · Jun 2012 · Neurophysiologie Clinique/Clinical Neurophysiology

  • No preview · Article · Jun 2012 · Neurophysiologie Clinique/Clinical Neurophysiology
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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.
    Full-text · Article · Mar 2012 · Neurology: Clinical Practice (Print)
  • C. Fischer · J. Luaute · M. Kandel · F. Dailler · D. Mrlet

    No preview · Article · Jun 2011 · Clinical Neurophysiology
  • D. Morlet · A. Caclin · F. Brudon · C. Fischer · G. Demarquay

    No preview · Article · Jun 2011 · Clinical Neurophysiology
  • C. Fischer · J. Luaute · D. Morlet

    No preview · Article · Oct 2010 · Clinical Neurophysiology
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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.
    No preview · Article · Jul 2010 · Neurology
  • G. Polo · C. Fischer
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    ABSTRACT: Brainstem auditory evoked potentials (BAEP) monitoring is a useful tool to decrease the danger of hearing loss during pontocerebellar angle surgery, particularly in microvascular decompression (MVD). Critical complications arising during MVD surgery are the stretching of the VIII nerve – the main cause of hearing loss – labyrinthine artery manipulation, direct trauma with instruments, or a nearby coagulation, and at end of the surgery neocompression of the cochlear nerve by the prosthesis positioned between the conflicting vessel(s) and the VIIth–VIIIth nerve complex. All these dangers warrant the use of BEAP monitoring during the surgical team's training period. Based on delay in latency of peak V, we established warning thresholds that can provide useful feedback to the surgeon to modify the surgical strategy: the initial signal at 0.4ms is considered the safety limit. A second signal threshold at 0.6ms (warning signal for risk) corresponds to the group of patients without resultant hearing loss. The third threshold characterized by the delay of peak V is at 1ms (warning signal for a potentially critical situation). BAEP monitoring provides the surgeon with information on the functional state of the auditory pathways and should help avoid or correct manoeuvres that can harm hearing function. BAEP monitoring during VIIth–VIIIth complex surgery, particularly in MVD of facial nerves for HFS is very useful during the learning period.
    No preview · Article · Apr 2009 · Neurochirurgie
  • G Polo · C Fischer
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    ABSTRACT: Brainstem auditory evoked potentials (BAEP) monitoring is a useful tool to decrease the danger of hearing loss during pontocerebellar angle surgery, particularly in microvascular decompression (MVD). Critical complications arising during MVD surgery are the stretching of the VIII nerve - the main cause of hearing loss - labyrinthine artery manipulation, direct trauma with instruments, or a nearby coagulation, and at end of the surgery neocompression of the cochlear nerve by the prosthesis positioned between the conflicting vessel(s) and the VIIth-VIIIth nerve complex. All these dangers warrant the use of BEAP monitoring during the surgical team's training period. Based on delay in latency of peak V, we established warning thresholds that can provide useful feedback to the surgeon to modify the surgical strategy: the initial signal at 0.4 ms is considered the safety limit. A second signal threshold at 0.6 ms (warning signal for risk) corresponds to the group of patients without resultant hearing loss. The third threshold characterized by the delay of peak V is at 1 ms (warning signal for a potentially critical situation). BAEP monitoring provides the surgeon with information on the functional state of the auditory pathways and should help avoid or correct manoeuvres that can harm hearing function. BAEP monitoring during VIIth-VIIIth complex surgery, particularly in MVD of facial nerves for HFS is very useful during the learning period.
    No preview · Article · Apr 2009 · Neurochirurgie

  • No preview · Article · Jan 2009 · Frontiers in Cellular Neuroscience

  • No preview · Article · Jan 2008 · Frontiers in Human Neuroscience

  • No preview · Article · Jan 2008 · Frontiers in Human Neuroscience
  • F. Mauguière · C. Fischer
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    ABSTRACT: I potenziali evocati meritano ancora oggi che sia loro dedicato un capitolo in un’enciclopedia medica di neurologia. La questione in se stessa merita certamente di essere posta a proposito delle loro indicazioni diagnostiche, per il semplice fatto che la risonanza magnetica fornisce immagini lesionali sempre più precise. Di fronte a queste il neurologo si pone tuttavia quotidianamente la questione delle loro ripercussioni funzionali e il chirurgo quella delle conseguenze eventuali del suo intervento. Paradossalmente, le tecniche elettrofisiologiche, e i potenziali evocati in particolare, conoscono un ritorno di interesse presso i ricercatori in neuroscienze, poiché aggiungono una dimensione temporale, con una risoluzione dell’ordine del millisecondo (ms), alle immagini funzionali di attivazione prodotte dalla risonanza magnetica. L’esplosione delle scienze cognitive deve molto allo sviluppo dei potenziali evocati endogeni, anche se le applicazioni diagnostiche restano poco numerose. I potenziali evocati sono peraltro uno strumento di monitoraggio indispensabile per testare la funzionalità delle vie sensitive e motorie e la reattività corticale in tutte le situazioni in cui l’esame obiettivo clinico è inutile, che si tratti di una anestesia in corso di intervento chirurgico o di alterazioni della coscienza. Allo stesso modo, i potenziali evocati restano utili per confermare l’organicità di un sintomo sensitivo soggettivo o di un disturbo motorio la cui organicità è dubbia. La modellizzazione delle sorgenti a partire dalla distribuzione in superficie dei campi di potenziale e la possibilità di proiettare la sede di queste sorgenti sulle immagini RM rende obsoleta la contrapposizione tra la risoluzione spaziale delle immagini anatomiche e la precisione temporale dei segnali elettrofisiologici. Tecniche come la magnetoencefalografia, che in ragione del costo sono state confinate per molto tempo al campo della ricerca, hanno contribuito molto alla fusione delle rappresentazioni anatomiche e funzionali. Tra le risposte ottenute in soggetti sani nelle molteplici condizioni di stimolazione e di registrazione riportate negli articoli e nei testi di fisiologia, di neuroscienze e di scienze cognitive, abbiamo scelto di descrivere in questo capitolo quelle che sono utilizzate a titolo diagnostico in clinica neurologica.
    No preview · Article · Dec 2007
  • F. Mauguière · C. Fischer · N. André-Obadia
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    ABSTRACT: I potenziali evocati (PE) hanno come scopo sia individuare e localizzare le disfunzioni delle vie sensoriali e motorie, sia obiettivare risposte sottocorticali che riflettono dei processi attentivi o cognitivi. Tutte le situazioni cliniche in cui si deve conoscere lo stato funzionale delle vie sensoriali o motorie rappresentano quindi indicazioni utili. Si può trattare di documentare un segno funzionale puramente soggettivo, di esplorare le conseguenze di una lesione focale, di rilevare in tempo reale una disfunzione durante un intervento che presenta un rischio neurologico, di valutare le possibilità di successo di una neurostimolazione a scopo antalgico ecc. I disturbi della coscienza e i coma rappresentano un’indicazione privilegiata non soltanto per valutare le vie sensoriali, ma anche per predire l’evoluzione. È in quest’ultima indicazione che alcune risposte cognitive hanno dato prova della loro utilità, mentre globalmente il loro impatto diagnostico è più limitato di quello dei PE sensoriali o motori.
    No preview · Article · Dec 2007

  • No preview · Article · Dec 2007 · Revue Neurologique
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    ABSTRACT: Vagus Nerve Stimulation (VNS) is recognized as an efficient procedure for controlling seizures in patients with drug-refractory epilepsies. It is used as a palliative procedure as a complement to conventional treatment by antiepileptic (AE) drugs and, according to literature, 40 to 50p.cent of patients report a decrease in seizures frequency >or=50p.cent, which is usually accepted to classify patients as responders in add on AE drug trials. The objectives of this study based on retrospective analysis of 50 consecutive patients with partial (39) or generalized (11) refractory epilepsy non eligible for surgery were; firstly to evaluate the global long term VNS efficacy and secondly to identify potential predictors of the VNS effects on seizure frequency. No patient has been seizure free at any moment of the follow up (2.8+/-1.8 years, max: 6 years) and the AE has been maintained in all. During follow up 44, 66, 61 and 58p.cent of patients were classified as responders at 6 months, 1, 2 and 3 years, respectively. Logistic regression analysis showed that: the percentage of responders at 6 months of follow up and later was significantly higher than that before 6 months (p=0.002); generalized epilepsy was predictive of a better outcome as compared to partial epilepsy (p=0.03); there was a trend for a better outcome in partial epilepsies symptomatic of a focal lesion than in those with normal brain MRI (p=0.06). These results are in line with previously published data in terms of global efficiency and confirm that seizures control does not reach its maximal level before at least one year of VNS. In severe generalized epilepsies (either secondary or cryptogenic) manifesting by frequent falls due to atonic or tonic-clonic generalized seizures VNS is a useful palliative procedure, which entails much les of surgical risk than callosotomy. The better VNS effects in patients with partial epilepsy possibly reflect the high incidence in our series of Malformations of Cortical Development, which have been identified as one the few variables possibly predictive of a response over 50p.cent of seizures frequency reduction.
    No preview · Article · Dec 2007 · Revue Neurologique

Publication Stats

2k Citations
143.77 Total Impact Points

Institutions

  • 2014
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
  • 2012
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
  • 2001-2010
    • University of Lyon
      Lyons, Rhône-Alpes, France
  • 1988-2009
    • CHU de Lyon - Hôpital Neurologique et Neurochirurgical Pierre Wertheimer
      Lyons, Rhône-Alpes, France
  • 1996
    • Vojna akademija Beograd
      Beograd, Central Serbia, Serbia