Résumé
Les glucocorticoïdes sont des dérivés de synthèse chimique du cortisol. Leur utilisation thérapeutique, découverte au début des années 50, s’est depuis largement développée. Rapidement les cliniciens ont constaté l’émergence de troubles neuropsychiatriques induits par ces traitements.
Les glucocorticoïdes se font médiateurs, via leurs récepteurs cérébraux, des effets sur la transduction des signaux, mais également sur la structure et la viabilité des neurones. Cela est particulièrement bien connu pour les neurones hippocampiques. L’action de ces molécules sur les structures cérébrales plus complexes à aborder reste mal connue chez l’homme. Les troubles cognitifs aigus induits par les corticoïdes sont très fréquents, rapidement réversibles et le plus souvent d’intensité modérée, difficilement détectables. Ces troubles semblent spécifiquement concerner les processus de mémoire dépendant de l’hippocampe (mémoire verbale). Les troubles cognitifs chroniques secondaires aux corticothérapies sont rares et complexes, incompatibles avec une atteinte hippocampique isolée.
Les sujets recevant une corticothérapie doivent être systématiquement prévenus des potentiels effets secondaires psychiatriques du traitement prescrit. Ils doivent être revus rapidement après l’instauration de la corticothérapie, en particulier lorsque la dose quotidienne est supérieure à 40 mg d’équivalent predni-sone - la dose étant le seul facteur de risque clairement établi des troubles neuropsychiatriques induits par les corticoïdes. Le geste préventif le plus consensuel est la prescription des doses minimales nécessaires au traitement de la pathologie sous-jacente. Après avoir vérifié l’absence d’étiologie organique aux symptômes psychiatriques et cognitifs observés, le premier geste thérapeutique recommandé est la diminution ou l’arrêt de la corticothérapie. Si cette option thérapeutique s’avère impossible en raison de la gravité de la maladie somatique sous-jacente, la prescription d’un traitement psychotrope est envisageable. Une seule étude suggère l’efficacité de la Lamotrigine.
Abstract
Glucocorticoids are derived from chemical synthesis of cortisol. They have been extensively used since their discovery in the fifties. Physicians immediately noticed emergent corticosteroids-induced adverse neuropsychiatric effects.
Glucocorticoids mediate, via cerebral receptors, effects on both signals transduction and neurones structure and viability. Their actions on hippocampal neurons are well documented, in contrast to those on more complex cerebral structures.
Acute cognitive induced disorders are common although moderate and hardly detectable without sensitive cognitive tests. These cognitive alterations specifically affect hippocampal dependant memory process. Chronic cognitive disorders are uncommon, complex, and inconsistent with an isolated alteration of the hippocampal structure.
Patients treated with corticoids should be systematically told about potential neuropsychiatric side-effects of the therapy. Especially when daily doses are higher than 40 mg equivalent prednisone, a medical checking should be made by the physician rapidly after starting corticotherapy. Actually daily dose is the only risk factor of glucocorticoids induced neuropsychiatric disorders clearly established. Thus, preventive therapy is the prescription of minimal daily doses necessary to cure underlying somatic pathology. After ruling out organic aetiology of psychiatric and cognitive symptoms, reduction or stopping the corticotherapy is the first advised therapeutic management step. Depending upon the seriousness of the underlying somatic illness, this therapeutic step may be impossible. If so psychotropic drugs prescription is conceivable. A single study suggest efficiency of Lamotrigine.
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Cornic, F., Caroli, F. Les troubles cognitifs induits parles traitements glucocorticoïdes. Psychiatr Sci Hum Neurosci 4, 11–19 (2006). https://doi.org/10.1007/BF03028394
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DOI: https://doi.org/10.1007/BF03028394