Christos, une enquête sur limpossible (Littérature Française) (French Edition)


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Convulsive seizures without any clear evidence of a partial or generalized onset were labeled unclassified seizures. When someone had both myoclonic seizures and GTCS in a single day, the seizure type was classified as myoclonic. For patients who had simple or complex partial seizures and secondarily generalized partial seizures in the same day, the seizure type was classified as partial with secondary generalization. Etiologic factors were classified into two broad categories according to the Classification proposed by the ILAE Commission on Epidemiology and Prognosis 2.

The category of symptomatic unprovoked seizures was subdivided into remote symptomatic seizures owing to conditions resulting in a static brain damage and symptomatic seizures owing to progressive central nervous system disorders. Unprovoked seizures of unknown etiology were classified into two subheadings. Idiopathic etiology refers to syndromes that are characterized by both particular clinical features and specific EEG abnormalities. Cryptogenic etiology is used in reference to unprovoked seizures that do not conform to the criteria for the symptomatic or idiopathic categories.

Syndromes were classified according to the International Classification 1. A single seizure without any EEG or neuroimaging abnormalities was considered an isolated seizure syndrome 4. This seizure could be partial, generalized, or unclassified. Conversely, a single seizure with epileptiform EEG abnormalities or an epileptogenic lesion on neuroimaging was considered the first seizure of epilepsy and so was classified in an epilepsy syndrome.

For continuous variables age at first seizure and age at index seizure , the distributions were not normal. Comparison of means between the two groups first seizure and newly diagnosed epilepsy was therefore performed by using the Mann—Whitney rank sum test. The statistical software Statview version 5.

A total of 1, patients was entered in the study. Of these, 11 were ineligible one had a neonatal convulsion, nine had been previously diagnosed, and one had been included twice by two different investigators. In all, 1, patients aged from 1 month to 95 years with the diagnosis of unprovoked seizure s were included in the cohort: One or more imaging studies was performed in 1, Drug therapy was prescribed for 1, The median age 25—75th percentiles at the time of the first seizure also the index seizure for this group was 19 years 9—39 years.

Partial seizures occurred in GTCS All three reflected unusual situations, one individual with absence status epilepticus and two patients with myoclonic seizures followed by a GTCS in a single day. Based on the initial diagnosis and evaluation, The remaining A specific epilepsy syndrome was assigned for slightly more than half of the patients with a single seizure: 80 8. Of these, three patients had neither EEG nor neuroimaging.

A neuroimaging study was performed in This rate varied according to the epileptic syndrome: Drug therapy was prescribed in This rate also varied according to the epileptic syndrome: The median age at first seizure was 15 years 7—29 years , and at diagnosis, 17 years 8—35 years. The time between the first seizure and the diagnosis of epilepsy ranged from 1 day to 52 years, with a median of 7 months 1.

Diagnosis was made mainly within the first year Reasons for previously undiagnosed seizures included no access to medical care, unawareness of the nature of the events on the part of the patient and hence no effort to have them diagnosed, and events that were brought previously to medical attention but not diagnosed as seizures. First seizure type was partial in The index seizure type was partial in Seizure types that usually recur before diagnosis e.

The first seizure and the index event were different in For instance, a GTCS occurred in patients with absence seizures or myoclonic jerks 68 cases , and simple or complex partial seizures evolved to secondarily generalized partial seizures 66 cases. In 61 6. In all, Among the remaining, 12 1. An epileptic syndrome was assigned for 1, The remaining 14 1. Most differences between the two groups were statistically significant Table 1. The proportion of patients with a symptomatic etiology was virtually identical in the two groups.

We separately analyzed the 1, patients with a generalized convulsive seizure either primarily or secondarily generalized or unclassified whether focal or generalized at the onset as the first event Table 5 : As this study included both first seizures and newly diagnosed epilepsy, it serves as an important bridge between the first seizure and epilepsy literature and permits direct comparisons, within a single study, between these two types of clinical scenarios.

Le romantisme [Bac de français]

The fact that In a Swedish prospective incidence study, the initial seizure was the same as the seizure at time of initial diagnosis in The issue of delayed diagnosis is considered in another article We note that the fact that many patients do not present immediately for diagnosis has implications for a potential bias that might occur in prospective incidence studies, such as the Gironde study performed in southwest France 15 , in which the inclusion criterion is based on the date of the first seizure and not the date of the diagnosis.

In this circumstance, some syndromes could be disproportionately excluded because many diagnosed during the inclusion interval will have had their onset before the interval, yet many whose onset is during the interval will not be diagnosed until after the recruitment period is complete.

From a pragmatic standpoint, incidence surveys frequently suffer from small numbers of cases and very small numbers of cases with specific syndromes 15 , 16 , depending on the size of the source population.

Newly Diagnosed Unprovoked Epileptic Seizures: Presentation at Diagnosis in CAROLE Study

A survey larger than those already made 3 would be extremely difficult and costly both in time and in money. That explains the attraction of multicenter studies collecting a large number of cases: 3, reported in the Lombardy study 17 , and 1, in the NGPSE 10 , However, in France as in the United States 19 , specialists' visits are not limited to tertiary centers in which an underestimation of mild cases is likely 17 , Even if a panel of highly qualified specialists makes these determinations, such assessments and conclusions are based on the data collected by the practitioners who refer the patients to the study.

Nonspecialist practitioners who are unfamiliar with the more recent advances in understanding and classifying seizure disorders may miss important details. The information directly collected by specialists in this study is more likely to provide the clinical details necessary for accurate classification according to ILAE criteria.

Because of the French healthcare system almost all inhabitants benefit from the National Health Insurance , individuals not asking for medical care are few. Once having come to medical attention, it is rare for a patient with a seizure not to request a consultation with a specialist. One way in which the CAROLE study most likely is not entirely representative of the population at large is in a probable underrepresentation of the elderly.

The age distribution at the time of the first unprovoked seizure is clearly different from that observed in incidence studies In France, elderly patients tend to go to general practitioners and geriatricians, as found in the Gironde study The relative underrepresentation of elderly might also contribute to the lower proportion with remote symptomatic etiology, 15 vs. A key focus of this study is the epileptic syndrome. Seizure types are simply symptoms and give few indications regarding the possible paradoxic effect of certain antiepileptic drugs AEDs They also do not tell one much about the underlying cause and prognosis Classifications were fundamentally based on ILAE proposals 1 , 2.

However, we do not consider that the terms epilepsy and epileptic syndrome are synonymous Epilepsies are characterized by occurrence of at least two unprovoked seizures 2 , whereas a syndromic diagnosis may be possible after a single epileptic event 1. Examples are many: a single sylvian seizure in a child with centrotemporal spikes on the EEG; a nonconvulsive status epilepticus with bilateral spike—waves; and a temporal lobe seizure with a temporal cavernoma.

Thus, The use of the ILAE classification system, however, strongly depends on adequate evaluation of the patient. Required tests include, but are not limited to, an EEG, which should be routinely performed, and neuroimaging, for which the criteria are more controversial and tend to vary across countries. The small but definite possibility of finding a serious and treatable abnormality is, at least in the United States and in France, considered adequate motivation for using neuroimaging fairly routinely. How patients are evaluated, in turn, depends on the health care system and whether the necessary ancillary tests are routinely available.

Our knowledge of seizures and epilepsy and treatment has advanced tremendously in the past several years. To take advantage of this new knowledge, it is necessary that a patient's epilepsy be adequately characterized. For example, among consecutive adults and children having presented with unexplained seizures, King et al. It would be almost impossible to classify specific syndromes without at least an EEG. We suspect that there is reasonably good agreement across research groups in the criteria used to classify idiopathic syndromes the 1.

These syndromes are very specific, for the most part easily recognizable, and well defined with respect to several clinical factors. These factors include age at onset, seizure type, and specific EEG abnormalities e. Perhaps the main limitation encountered in the classification of idiopathic syndromes is the sensitivity of the initial EEG in detecting a diagnostic abnormality. This is in part because many other factors must be taken into account. These factors are frequently not so well defined, and the ways in which they are used to classify an epilepsy syndrome may vary substantially from one investigator to another.

The identification of a cause etiology depends on the types of evaluations performed and their sensitivity 2. Thus there are individuals whose epilepsy syndrome could be classified as symptomatic strictly by virtue of localization 1 but whose etiology would be classified as cryptogenic 2. This is why there were no remote symptomatic cases in the 3. Clearly, investigators who have addressed this issue previously recognized this dilemma and resolved it differently 16 , 19 , 23 , 33 , Further discussion among investigators in this field is necessary to reach a consensus on this definitional issue for which the two Commission statements are at odds.

Beyond these remarks, This last figure is similar to the The cryptogenic category corresponds to relatively nonspecific, poorly defined, or heterogeneous syndromes. The major difference between the 4. The minor difference was that a patient in the 3. Furthermore, more sophisticated MRI can now detect small epileptogenic lesions that passed unnoticed in Lennox—Gastaut syndrome LGS is a challenging area for nosology As we were not sure which diagnostic criteria had been retained, all possible cases were categorized only as symptomatic generalized epilepsy. It seems that LGS is often not apparent at diagnosis but evolves over time 15 , Only four 0.

The differences reflect the fact that certain seizure types are characteristic of specific syndromes and that some seizure types are less likely to present or virtually never present to medical attention at the time of an initial event. By the same token, simple and complex partial seizures often go unnoticed or unreported the first time they occur, whereas GTCS if witnessed are most likely to come to medical attention. If the analysis is restricted to convulsive seizures, only four differences between the two groups were significant.

Convulsive seizures and multiple seizures in a day or status epilepticus obviously lead to an earlier diagnosis. The issue remains of why a third of convulsive seizures do not come to attention the first time? Some occur in sleep or when the individual is alone. The event is later recalled and diagnosed as a probable seizure in retrospect. Antiepileptic medication was prescribed to By contrast, The decision to treat or not to treat varied depending on age, etiology, and syndrome and is the subject of a separate report The decision to treat after only one seizure is in accordance with the literature The presence of a lesion on neuroimaging is associated with a particularly high risk of recurrence EEG abnormalities are also a valuable reason for treating children 42 as well as adults Because specific abnormalities are associated with an increased risk of recurrence 44 , they tend to help decide whether to treat.

They also will help determine which drug to start if one is started. Specific abnormalities and hence some syndromes are associated. Whether a patient presents with a single seizure or newly diagnosed epilepsy does not appear to alter the initial diagnostic evaluation he or she receives. In fact, some of the assessment may be done before the full history of possible prior seizures has been obtained.

Conversely, the decision to initiate treatment was significantly and substantially influenced by whether a patient had had prior seizures. Baulac, F. Fagnani, P. Jallon, J. Leveau, P. Loiseau, J. Motte, P. Thomas, L. Allaire, A. Autret, M. Baulac, M. Clanet, G. Gastaut, M. Giroud, P. Jallon, E. Josien, P. Loiseau, C. Marescaux, P. Masnou, F. Motte, D. Parain, J. Perret, M. Revol, L.

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Boudon, J. Bouillat, J. Boulloche, A. Bredin, O. Brocard, P. Brosset, F. Cenraud, D. Chaigne, Y. Chaunu, D. Chavot, P. Clavelou, S. Cohadon, N. Collombier, P. Contis, P. Convers, J. Cournelle, S. Cuvellier, J. Damon, A. Danielli, P. Daubney, J. Deffond, T. Delangre, B. Delisse, P. Derambure, S. Derambure, P. Desbordes, F. Dien, B. Dubois, B. Ducrocq, J. Duhurt, J. Duprey, G. Durand, A. Escaillas, G. Fanjaud, D. Felten, C. Fischer, D. Fontan, F. Elle ne se soigne plus. Celle de Hanovre, par exemple, est fameuse.

Les Allemands lisent. Car Benjamin Rabier est un fabuliste, et il agit comme tous les fabulistes. Je ne vous dirai pas que Rabier a beaucoup de talent. Un titre court en explique le sens. Chaque vol. Des erreurs? Le Novellino de Masuccio ou Rasuccio? Il en est question. Strentz en un acte, et un drame en trois actes de M.

Selon un humoriste, M. Depuis un certain temps, M. Ambroise Vollard a sur le chantier un singulier ouvrage sur notre administration coloniale. Au reste, M. Depuis la guerre, elle est surtout goguenarde et malicieusement vengeresse. Georges Courteline, ceux que M. Henri Rosny. Les premiers volumes de J. Le roman de M. En , M. Or, par ordre de M. Dans le livre de M. En effet, M. Pour ce qui est du second, une erreur de M. Lucien Descaves avait trente-neuf ans, M. Georges Ohnet est mort. Henry Bordeaux. Ils sont intelligents. Jacques Copeau?

Au contraire, il y a des amateurs en extase. Sous le patronage de MM. Barthou, V. Burrows, A. Croiset, P. Deschanel, G. Gauvain, Th. Homolle, P. Puaux, J. Reinach, A. Ribot, A. Thomas, M. Paul Gsell qui versifie. Un critique italien, M. Marinetti sait-il nager? Le docteur J. Ce sont des sanglots, mais des sanglots harmonieux. Ce fut une merveille pour toutes les jeunes dames qui nous firent cercle. Mais que ne fait-on pas pour une duchesse! Je la reconduisis au bal en nous levant de table. Sa taille petite et grosse soutenait, je ne sais comment, un jupon sale, sur lequel flottait un petit mantelet de taffetas noir tout en loques.

Elle trouva sur sa route un bon accueil de la part des anciens sujets du duc de Courlande. Je remarquais toujours sur les figures de ces pauvres gens une de ces deux expressions. Anatole France. Chesterton que M.


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Le plus grand peintre suisse contemporain, Ferdinand Hodler, vient de mourir. Il avait un sentiment assez vif de la nature. Et cependant ils ne manquent point. Il y en a cependant. On sait que Rodin ne voulut jamais faire le portrait de M. Le mot est excessif. Picasso doit graver une eau-forte. La lettre de M. Mais pourquoi M. Elles ne manquent point. Les Dix le regretteront, sans doute. Vous demandiez qui est Nelligan, ou qui fut? Du Nelligan? Robinson, Frost, Masters, Sandburg, H.

On lui reprochait des attitudes un peu ridicules. Marinetti, de M. Henri Duvernois raconte une anecdote bien amusante. Pierre-Paul Plan, par exemple. Elle est extraordinaire. Pour subsister, ils se contentent souvent de balayer les rues. Jean-Pierre Jacques Dixi , caporal mitrailleur aviateur. Medardo Rosso qui est maintenant sans aucun doute le plus grand sculpteur vivant. En attendant, M. Depuis longtemps M. Le livre de guerre de M. Il est entre toutes les mains de la jeunesse. Soffici est maintenant son chef.

Junoy, Joaquim Folguera, J. Le prochain roman de M. Maurice Simart, Canudo, P. Grovlez, R. Marghiloman redoute le plus. Pour les soldats, il y a le poteau, il y a aussi le cercle. Le Dr S. Poinsot, M. Il y a en ce moment, en Italie, une affaire Goethe. Ils gagnent au change. Le conservateur de la Maison de Balzac, M. Le professeur M. Des illustrations en noir et en couleurs accompagnaient le texte qui est parfaitement clair. Guillaume Apollinaire y publia ses premiers vers. Cette expression intrigua jadis Wagner.

Cherchant alors sur le plan de Paris, il trouva en effet une rue des Lombards. On se demande en effet comment le chanteur aurait pu se faire entendre? Le chef des futuristes italiens, F. Il fut sans aucun doute le plus fashionable des peintres. Notre collaborateur M. Il comprend les noms de MM. Celle de Stendhal en est une. Les oiseaux chantaient dans les hautes branches. Berr, Le Lion devenu vieux de M. Villeroy, Monsieur Puic-Puic de M. Alfred Machard.

Willy, dans une lettre importante pour les biographes futurs. On nous affirme que M. Bien que M. Il est incontestable que M. Cette affirmation paraissait douteuse. Ses partisans restent turcophiles. On ne regarde pas dans les haremlik. Il faut souvent le canon pour forcer des bicoques. De temps en temps, dans cette cour passaient des pappas. Mais les miracles sont interrompus. Le catholicisme allemand est surtout pratique.


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  • Herbert Booth serait le directeur. Les socialistes allemands sont dans la joie. Les catholiques aussi. Le premier contact entre Russes et Japonais eut lieu en Mais les Japonais agirent avec promptitude et vigueur. Mais il agit comme elle et tandis que le nord se peuplait de Russes, au sud le nombre des Japonais augmentait. Cette action indigna les Japonais. Chemulpo fut ouvert en Le contrat fut accompli par les deux parties. Fernschreiben remplacera sous peu telegraphieren. De tout temps, je crois, on a vu Cabliaud ou Cabliot au lieu de cabillaud sur les menus des restaurants allemands.

    Mahmoud Nedim bey est un homme peu estimable, envieux, avare et jaloux. Il ne resta que la femme du ministre roumain. Mahmoud Nedim bey ne broncha pas. Henri Braun. Harden appelle tout simplement des mensonges. Il le crie violemment. Mais non, M. Harden, M. Bernhard fit amende honorable devant M. Harden cite une lettre dans laquelle M. Harden ne voulut plus recevoir M. Harden refusa les articles. Braun en , et Au sujet du compagnon Heine, M.

    Il promet de tout dire prochainement. Maximilien Harden nous parle longuement de Heine dans la Zukunft. Il semble sans cesse sur le point de prononcer le Tu quoque! Le bras droit lui restait. Je suis vieux. En , il survint quelque chose de semblable dans la vie de Kant. Ce fut un malheur, et avec cet arbre disparut une partie de la raison du vieillard. Il tomba malade. En , Kant introduisit quelques changements dans ses habitudes. Le philosophe changea plus tard le c en k pour germaniser son nom. Il y mettait de la recherche. Kant les remercia avec sa galanterie ordinaire et leur donna sa rose.

    Il avait soixante-dix-huit ans. Progressivement, la faiblesse du Beau Professeur augmenta. Pendant un voyage en Italie, je pense, Aladro prenait un bain. On pourrait intituler cette histoire Aladro ou la crampe merveilleuse. Grand bien lui fasse! Le Saint-Esprit va descendre sur moi.

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    Le prince avait des besoins. La presse le faisait chanter. Une aide intelligente a permis cette modification. Le voyage dura six jours. Johann Gottfried Herder fut pourtant un esprit universel. To answer your questions properly would mean writing a small volume. All I can say, in a few lines, is that. The great modem transition from abstract music to poetic music would have been impossible, on so large a scale, without the opulent modern orchestra.

    The question of expense, too, has to be considered. Larger orchestras mean extra cost, and there must be a limit to what the public will pay to hear good music. It looks, then, as if the impossibility of increasing the power of the strings. Cinquante violons sont, je pense, deux fois plus sonores que vingt-cinq. Mais je doute que cent violons donnent deux fois plus de son que cinquante.

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    At the beginning of the 18th century there was a rough sort of organisation of the orchestra, but it was less organized than is generaly realized. The orchestra as we know it begins with Haydn, and owes its development mainly to the new style of composition in which form was all important and counterpoint left to musty professors, a style which originated with the Italian composers of the early eighteenth century.

    The development of the orchestra in the 19th century cannot be dissociated from the other developments of music which went on at the same time. Thus it has come about that in our day the orchestra has come to be the vehicle for the expression of the most complicated musical thought.

    No composer at the present day, it may safely be said, has attained the perfect balance of sensuous and emotional beautv which we find in Mozart. With regard to modifications in the composition of the orchestra, it seems more desirable to reduce its size than to augment it. Both players and composers ought to realize that an instrument only justifies its existence by having a tone and a style of execution which no other instrument possesses.

    The last question is one for the student of literature rather than the musical historian. Mais je nommerai Swinburne et G. Il serait utile de poursuivre ces recherches. Je suis surpris que les imperfections de nos quatuors ne frappent pas davantage. Rimsky-Korsakow fait usage du pianino. Elle va devenir une cause. Berlioz romantique est un gluckiste. Son Requiem proportionne la clameur au drame de la mort. Et le grand Wagner lui doit beaucoup, sur ce point…. Depuis deux cents ans? Que cela prouve-t-il? Cela est un signe.

    Je ferai, M. Croyez, M. Schubert et Schumann sont pour le dessin, Gluck et Berlioz pour la couleur. Mais on craint un peu que toute cette reprise ne soit artificielle. La ville des trois mages et de Stollwerck est trop fameuse, M. Ainsi va le monde. Mais que la gloire ne le grise point. Pour M. Jean Rameau. Novicow qui chante la grandeur de la France comme il convient. Cette phrase de M. Mademoiselle Colette va partir. En France la masse du peuple ignore encore toutes les victoires japonaises.


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      Christos, une enquête sur limpossible (Littérature Française) (French Edition) Christos, une enquête sur limpossible (Littérature Française) (French Edition)
      Christos, une enquête sur limpossible (Littérature Française) (French Edition) Christos, une enquête sur limpossible (Littérature Française) (French Edition)
      Christos, une enquête sur limpossible (Littérature Française) (French Edition) Christos, une enquête sur limpossible (Littérature Française) (French Edition)
      Christos, une enquête sur limpossible (Littérature Française) (French Edition) Christos, une enquête sur limpossible (Littérature Française) (French Edition)
      Christos, une enquête sur limpossible (Littérature Française) (French Edition) Christos, une enquête sur limpossible (Littérature Française) (French Edition)
      Christos, une enquête sur limpossible (Littérature Française) (French Edition) Christos, une enquête sur limpossible (Littérature Française) (French Edition)
      Christos, une enquête sur limpossible (Littérature Française) (French Edition) Christos, une enquête sur limpossible (Littérature Française) (French Edition)
      Christos, une enquête sur limpossible (Littérature Française) (French Edition) Christos, une enquête sur limpossible (Littérature Française) (French Edition)
      Christos, une enquête sur limpossible (Littérature Française) (French Edition)

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