UNIVERSITE SAINT-ESPRIT DEKASLIK. Faculte de Medecine '~

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UNIVERSITE SAINT-ESPRIT DEKASLIK Faculte de Medecine

'~ USEK I

BIBLIOTHEQUE

~ CENTRALE

LES VARIABLES INTER-SOCIO

DEMOGRAPHIQUES AFFECTENT-ELLES LES EFFETS SECONDAIRES PSYCHIATRIQUES

SURVENANT APRES LA STIMULATION CEREBRALE PROFONDE DU NOYAU SOUS THALAMI QUE CHEZ LES P ARKINSONIENS ?

These en vue d'obtention d 'un doctorat en medecine

Preparee par AZAR Michel Sous la direction de Dr BEJJANI Paul

Kaslik- Liban 2012

Soutenue le 4 juin 2012 devant le jury compose de Dr. Bejjani Paul : Tuteur

Dr. Nohra Georges : President

Dr. Matar Hanna : Rapporteur

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Resume

La maladie de Parkinson (PD) est une riialadie neurodegenerative caracterisee par la presence de symptomes moteurs, cognitifs, neuropsychiatriques et autonomes. L'efficacite de la stimulation cerebrale profonde (SCP ) pour les symptomes moteurs est bien etablie. Cependant , les effets de la SCP sur les symptomes cognitifs et neuropsychiatriques sont moins clairs.

Nous avons remarque que la difference entre les populations peut

aboutir a un resultat neuropsychiarique different.

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Abstract.

Parkinson's disease (PD) is a neurodegenerative disorder

characterized by motor, cognitive, neuropsychiatric, autonomic, and other nonmotor symptoms. The efficacy of deep brain stimulation (DBS) for the motor symptoms of advanced PD is well established.

However, the effects of DBS on the cognitive and neuropsychiatric symptoms are less clear. We hypothesized that differences in

populations may lead to a different neuropsychological outcome

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Table des matieres : -

I. Introduction

1. Noyau sous thalamique 1.1 Anatomie du NST

1.1.1 Organization intrinseque du NST 1.1.2 F aisceaux afferents

1.1.3 F aisceaux efferents 1.2 Physiologie du NST

1.2.1 Les proprietes physiologiques des cellules du NST 1.2.2 La stimulation du NST

1.2.3 L'inhibition du NST

2. Noyau sous thalamique et la maladie de parkinson 2.1 Schemas oscillatoires

2.2 Hyperactivite du NST

2.3 La dopamine et le NST chez les parkinsoniens

2.4 Les lesions du NST et la stimulation a haute frequence 3. La stimulation cerebrate profonde

3.1 Definition de la stimulation cerebrate profonde 3.2 Histoire de la stimulation cerebrate profonde 3.3 Indications de la SCP dans laMP

3.4 Contre-indications de la SCP dans laMP 3.5 Etapes prechirurgicales

3.6 Etapes chirurgicales 3.7 Etapes post-chirurgicales 3.8 Risques de la SCP

3.9 Resultats post SCP

4. La Stimulation Cerebrate Profonde et les complications psychiatriques II. Methodes

5.1 Patients

5.2 Intervention chirurgicale 5.3 Tests neuropsychologiques 5.4 Evaluation

5.5 Analyse statistique

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III. Resultats

6.1 Variables demographiques 6.2 Variables psychiatriques IV. Discussion

V . Conclusion

VI. Annexes

VII. References

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