La tomographie par émission de positons (TEP) est une méthode d’imagerie clinique en forte expansion dans le domaine de l’oncologie. De nombreuses études cliniques montrent que la TEP permet, d’une part de diagnostiquer et caractériser les lésions cancéreuses à des stades plus précoces que l’imagerie anatomique conventionnelle, et d’autre part d’évaluer plus rapidement la réponse au traitement. Le raccourcissement du cycle comprenant le diagnostic, la thérapie, le suivi et la réorientation thérapeutiques contribue à augmenter le pronostic vital du patient et maîtriser les coûts de santé. La durée d’un examen TEP ne permet pas de réaliser une acquisition sous apnée. La qualité des images TEP est par conséquent affectée par les mouvements respiratoires du patient qui induisent un flou dans les images. Les effets du mouvement respiratoire sont particulièrement marqués au niveau du thorax et de l’abdomen. Plusieurs types de méthode ont été proposés pour corriger les données de ce phénomène, mais elles demeurent lourdes à mettre en place en routine clinique. Des travaux récemment publiés proposent une évaluation de ces méthodes basée sur des critères de qualité tels que le rapport signal sur bruit ou le biais. Aucune étude à ce jour n’a évalué l’impact de ces corrections sur la qualité du diagnostic clinique. Nous nous sommes focalisés sur la problématique de la détection des lésions du thorax et de l'abdomen de petit diamètre et faible contraste, qui sont les plus susceptibles de bénéficier de la correction du mouvement respiratoire en routine clinique. Nos travaux ont consisté dans un premier temps à construire une base d’images TEP qui modélisent un mouvement respiratoire non-uniforme, une variabilité inter-individuelle et contiennent un échantillonnage de lésions de taille et de contraste variable. Ce cahier des charges nous a orientés vers les méthodes de simulation Monte Carlo qui permettent de contrôler l’ensemble des paramètres influençant la formation et la qualité de l’image. Une base de 15 modèles de patient a été créée en adaptant le modèle anthropomorphique XCAT sur des images tomodensitométriques (TDM) de patients. Nous avons en parallèle développé une stratégie originale d’évaluation des performances de détection. Cette méthode comprend un système de détection des lésions automatisé basé sur l'utilisation de machines à vecteurs de support. Les performances sont mesurées par l’analyse des courbes free-receiver operating characteristics (FROC) que nous avons adaptée aux spécificités de l’imagerie TEP. L’évaluation des performances est réalisée sur deux techniques de correction du mouvement respiratoire, en les comparant avec les performances obtenues sur des images non corrigées ainsi que sur des images sans mouvement respiratoire. Les résultats obtenus sont prometteurs et montrent une réelle amélioration de la détection des lésions après correction, qui approche les performances obtenues sur les images statiques. / Positron emission tomography (PET) is nuclear medicine imaging technique that produces a three-dimensional image of functional processes in the body. The system detects pairs of gamma rays emitted by a tracer, which is introduced into the body. Three-dimensional images of tracer concentration within the body are then constructed by computer analysis. Respiratory motion in emission tomography leads to image blurring especially in the lower thorax and the upper abdomen, influencing this way the quantitative accuracy of PET measurements as well a leading to a loss of sensitivity in lesion detection. Although PET exams are getting shorter thanks to the improvement of scanner sensitivity, the current 2-3 minutes acquisitions per bed position are not yet compatible with patient breath-holding. Performing accurate respiratory motion correction without impairing the standard clinical protocol, ie without increasing the acquisition time, thus remains challenging. Different types of respiratory motion correction approaches have been proposed, mostly based on the use of non-rigid deformation fields either applied to the gated PET images or integrated during an iterative reconstruction algorithm. Evaluation of theses methods has been mainly focusing on the quantification and localization accuracy of small lesions, but their impact on the clinician detection performance during the diagnostic task has not been fully investigated yet. The purpose of this study is to address this question based on a computer assisted detection study. We evaluate the influence of two motion correction methods on the detection of small lesions in human oncology FDG PET images. This study is based on a series of realistic simulated whole-body FDG images based on the XCAT model. Detection performance is evaluated with a computer-aided detection system that we are developing for whole-body PET/CT images. Detection performances achieved with these two correction methods are compared with those achieved without correction, ie. with respiration average PET images as well as with reference images that do not model respiration effects. The use of simulated data makes possible the creation of theses perfectly corrected images and the definition of known lesions locations that serve as a reference.

Epileptic syndromes with continuous spikes and waves during slow sleep (CSWS) are age-related epileptic encephalopathy characterized by the development of various psychomotor regressions in close temporal concordance with the appearance of the electroencephalogram (EEG) pattern of CSWS (Tassinari et al. 2000). This EEG pattern consists in sleep-related activation and diffusion of spike-wave discharges during usually more than 85% of non-rapid eye movement (non-REM) sleep (Tassinari et al. 2000). <p>A minority of the CSWS cases has been associated to cortical or thalamic lesions (symptomatic cases), while in the other cases, the aetiology is unknown. We reported two families combining benign childhood epilepsy with centro-temporal spikes (BCECS), which is the most common form of idiopathic epilepsy in childhood, and cryptogenic epilepsy with CSWS in first-degree relatives. As idiopathic epilepsies are by definition epilepsies related to a genetic predisposition, these data suggests the existence of a continuum ranging from asymptomatic carriers of centro-temporal spikes to cryptogenic epilepsies with CSWS. This hypothesis is further supported by common clinical characteristics between BCECS and epilepsies with CSWS (Fejerman et al. 2000).<p>Epileptic syndromes with CSWS are characterized by an acute phase defined by the emergence of psychomotor deficits, various types of seizures and CSWS activity at around three to eight years of age (Holmes and Lenck-Santini, 2006; Veggiotti et al. 2001). This acute phase is followed by a recovery phase in which patients’ clinical condition improves together with the remission of CSWS pattern, which spontaneously occur at around 15 years of age but may be prompted by using antiepileptic drugs (AED) including corticosteroids (Holmes and Lenck-Santini, 2006; Veggiotti et al. 2001). This biphasic evolution suggests that CSWS activity largely contributes to the psychomotor deficits observed in these patients (Holmes and Lenck-Santini, 2006; Van Bogaert et al. 2006). However, some authors still consider CSWS activity as an epiphenomenon reflecting the underlying brain pathology, rather than the direct cause of the psychomotor regression (Aldenkamp and Arends, 2004). The pathophysiological mechanisms of how CSWS activity could actually lead to psychomotor regression are still poorly understood.<p>Functional cerebral imaging techniques such as positron emission tomography (PET) or functional magnetic resonance imaging (fMRI), represent unique ways to non-invasively study the impact of epileptic activity on normal brain function. The PET technique using [18F]-fluorodeoxyglucose (FDG) gives information about the regional neuronal glucose consumption via the neurometabolic coupling while the fMRI technique studies the regional perfusional changes directly related to specific events of interest via the neurovascular coupling. We applied both FDG-PET and EEG combined with fMRI (EEG-fMRI) techniques to epileptic children with CSWS to better approach the functional repercussions of CSWS activity on neurophysiological functions and to determine the potential pathophysiological link between CSWS activity and psychomotor regression.<p>In a first FDG-PET study, we determined the regional cerebral glucose metabolic patterns at the acute phase of CSWS in 18 children. We found three types of metabolic patterns: the association of focal hypermetabolism with distinct hypometabolism in 10 patients, focal hypometabolism without any associated area of increased metabolism in five children, and the absence of any significant metabolic abnormality in three patients. The hypermetabolic brain areas were anatomically related to an EEG focus. This anatomical relationship was clearly less consistent for hypometabolic regions. The metabolic abnormalities involved mainly the associative cortices. The metabolic heterogeneity found in these children could be due to the use of corticosteroids before PET as it was significantly associated with the absence of focal hypermetabolism. At the group level, patients with at least one hypermetabolic brain areas showed significant increased metabolism in the right parietal region that was associated to significant hypometabolism in the prefrontal cortex. This finding was interpreted as a phenomenon of remote inhibition of the frontal lobes by highly epileptogenic and hypermetabolic posterior cortex. This hypothesis was supported by effective connectivity analyses which demonstrated the existence of significant changes in the metabolic relationship between these brain areas in this group of children compared to the control group or to the group of children without any significant hypermetabolic brain area. <p>This remote inhibition hypothesis would be reinforced by the demonstration, at the recovery phase of CSWS, of a common resolution of hypermetabolism at the site of epileptic foci and hypometabolism in distant connected brain areas. We thus performed a second FDG-PET study to determine the evolution of cerebral metabolism in nine children recovering from CSWS. At the acute phase of CSWS, all children had a metabolic pattern characterized by the association of focal hypermetabolism with distinct focal hypometabolic areas. The evolution to CSWS recovery was characterized by a complete or almost complete regression of both hypermetabolic and hypometabolic abnormalities. At the group level, the altered effective connectivity found at the acute phase between focal hypermetabolism (centro-parietal regions and right fusiform gyrus) and widespread hypometabolism (prefrontal and orbito-frontal cortices, temporal lobes, left parietal cortex, precuneus and cerebellum) markedly regressed at recovery. These results were of particular interest because they strongly suggested that the metabolic abnormalities observed during the acute phase of CSWS were mainly related to the neurophysiological effects of CSWS activity and not to the underlying cause of the epileptic disease. Moreover, this study confirmed that phenomena of remote inhibition do occur in epileptic syndromes with CSWS. <p>EEG-fMRI is a functional cerebral imaging technique that allows non-invasive mapping of haemodynamic changes directly associated to epileptic activity. In a first EEG-fMRI study, we determined the clinical relevance of the perfusional changes linked to interictal epileptic discharges in a group of seven children with pharmacoresistant focal epilepsy. This study showed that the EEG-fMRI technique is a promising tool to non-invasively localize the epileptic focus and its repercussion on normal brain function in children with epilepsy. Then, to further demonstrate the involvement of CSWS activity in the neurophysiological changes detected by FDG-PET, we used the EEG-fMRI technique to study the perfusional changes directly related to the epileptic activity in an epileptic girl with CSWS. This patient developed a cognitive and behavioural regression in association with a major increase in frequency and diffusion of the spike-wave discharges during the awake state (spike index: 50-75%) and non-REM sleep (spike index: 85-90%). The patient’s neuropsychological profile was dominated by executive dysfunction and memory impairment. During runs of secondarily generalized spike-wave discharges, EEG-fMRI demonstrated deactivations in the lateral and medial fronto-parietal cortices, posterior cingulate gyrus and cerebellum together with focal relative activations in the right frontal, parietal and temporal cortices. These results suggested that the neuropsychological impairment in this case could be related to specific cortical dysfunction secondary to the spread of the epileptic activity from focal hypermetabolic foci. <p>Taken together, both FDG-PET and EEG-fMRI investigations performed in epileptic children with CSWS have shown increases in metabolism/perfusion at the site of the epileptic focus that were associated to decreases in metabolism/perfusion in distinct connected brain areas. These data highly suggest that the neurophysiological effects of CSWS activity are not restricted to the epileptic focus but spread to connected brain areas via a possible mechanism of surrounding and/or remote inhibition. This mechanism is characterised by an epilepsy-induced inhibition of neurons that surround or are remote from the epileptic focus and connected with it via cortico-cortical or polysynaptic pathways (Witte and Bruehl, 1999). The existence of surrounding and remote inhibition phenomena have been well documented in different types of animal models of focal epilepsy using various functional cerebral imaging methods such as autoradiography or optical imaging (Bruehl et al. 1998; Bruehl and Witte, 1995; Witte et al. 1994). Their occurrence in human epilepsy have also been suspected in temporal or extra-temporal lobe epilepsies using FDG-PET, EEG-fMRI or single photon emission computed tomography (SPECT) (Blumenfeld et al. 2004; Schwartz and Bonhoeffer, 2001; Van Paesschen et al. 2003; Van Paesschen et al. 2007). Moreover, the demonstration of the regression of distant hypometabolic areas after surgical resection or disconnection of the epileptic focus further suggest that such inhibition mechanism do occur in epilepsy (Bruehl et al. 1998; Jokeit et al. 1997). On a clinical point of view, the demonstration of the existence of such inhibition mechanisms in epilepsies with CSWS brings new important insights for the understanding of the pathophysiological mechanisms involved in the psychomotor regression observed in these conditions. Indeed, these data highly suggest that the psychomotor regression is not only related to the neurophysiological impairment at the site of the epileptic foci but also to epilepsy-induced neurophysiological changes in distant connected brain areas. <p><p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

(ENGLISH) Hematopoiesis is dependent on the actions of hematopoietic stem cells (HSCs). This process is tightly controlled through a complex array of extrinsic and intrinsic factors. Even though the hematopoiesis seems to be well conserved across the disparate vertebrate animals, erythroid and thrombocytic differentiation have changed during the evolution of mammals. Specifically, adult mammalian red blood cells have the unique feature of being enucleated, and mammalian thrombocytes are not individual cells, but fragments of megakaryocytes, instead. It is likely that these enhancements provided a survival advantage to early mammalian species; however, they also bring up the question of evolutionary origin of these cells that studied using zebrafish (Danio rerio) model. First, it was necessary to generate a toolbox of a recombinant cytokines and optimized culture media that allowed us to manipulate zebrafish hematopoietic cells ex vivo in liquid and clonal cultures. Interestingly, teleost species underwent an extra duplication event during their evolution and as a result, two copies (paralogs) of some of the genes are present in zebrafish. This was also the case for majority of the cytokines from our toolbox and here, we provide functional characterization of these paralogs. Strikingly, our results...

The subject of this diploma thesis is the design of heating and hot water in the administrative building in Zlin on Jižní Svahy. The building has five floors above ground and one underground floor. There are designed two variants of heat source for heating and hot water (transfer sta-tions and gas boiler). Part A solves water quality in heating systems. Part B deals with design of the heating system, hot water heating, insurance and facility expansion, technical report and drawings heating in the building. The last part C is the experimental measurement of the quality of heating water in the CZT systems.

Les récepteurs de l'adrénomédulline sont fortement exprimés dans les capillaires alvéolaires humains et fournissent une cible moléculaire pour l'imagerie de la circulation et de l'embolie pulmonaire. Au cours des années précédentes, le dérivé DFH12 marqué au 99mTc (PulmoBind) a démontré son potentiel en tant qu'agent d'imagerie SPECT de l'hypertension pulmonaire dans des études cliniques de phase I et II. L’objectif principal de mon projet est de développer le nouvel analogue DFH17 pour l’imagerie TEP des récepteurs de l'adrénomédulline via la méthode de l’Al18F. Pour atteindre cet objectif, un système d’élution semi-automatique a été conçu pour produire l’Al18F concentré directement dans le vial de réaction. En utilisant des tests de complexation avec le chélateur NOTA, des conditions optimales ont été trouvées pour le radiomarquage du DFH17 avec l’Al18F. La combinaison du rapport Al/DFH17 1:3 dans l'éthanol 50% a permis de produire le [18F]AlF-DFH17 avec des puretés radiochimiques et chimiques élevées. Les études TEP avec le [18F]AlF-DFH17 ont démontré un rapport élevé poumon-bruit de fond ainsi qu’une grande stabilité in vivo chez le rat, le chien et le primate. Des captations différenciées dans les poumons des trois espèces ont aussi été détectées par imagerie TEP et leurs différences ont été associées à des variations de la composant RAMP2. Compte tenu de l’importante captation pulmonaire, de la stabilité in vivo et de la dosimétrie favorable, le nouveau dérivé [18F]AlF-DFH17 est un excellent candidat potentiel en tant que traceur TEP des récepteurs adrénomédulline humains. L’expression des récepteurs AT1 de l’angiotensine II est altérée dans plusieurs maladies cardiovasculaires et rénales, telles la défaillance cardiaque, rénale et l’hypertension ainsi que dans certains cancers. Auparavant, le dérivé [11C]méthyl-Candesartan a démontré un potentiel comme agent d'imagerie TEP de l'AT1R rénal mais une proportion élevée du signal TEP correspondait à une liaison non-spécifique d'un radiométabolite hydrophobe. Dans ce travail, l’objectif principal est de développer le nouveau dérivé [18F]fluorobenzyl-Candesartan en utilisant le 4[18F]fluoroiodobenzène ([18F]FIB) avec un profil métabolique et de biodistribution potentiellement meilleurs. Pour atteindre cet objectif, des paramètres réactionnels de fluorination tels que le solvant, la quantité de précurseur, le catalyseur et la température ont été optimisés permettant la radiosynthèse du [18F]FIB avec des rendements et pureté élevés. Ensuite, le couplage du [18F]FIB au dérivé alcyne-trityl-Candesartan a été évalué en utilisant la réaction de Sonogashira suivie d'une détritylation acide. Suite à l’étude de plusieurs conditions de couplage, le rendement de radioconversion a été légèrement augmenté en utilisant le catalyseur Pd(PPh3)4/CuI et K2CO3 comme base. Les meilleures conditions de fluorination et de couplage ont été automatisées pour le module de synthèse Synthra® RNPlus Research. La production du [18F]FB-Candesartan été atteinte avec de faibles rendements et activités molaires en raison de la formation d’impuretés ayant des structures et temps de rétention par HPLC similaires à ceux de notre traceur. Des études supplémentaires afin d'améliorer le rendement, la purification par HPLC et l'activité molaire se sont avérées infructueuses pour l’instant. D’autres expériences devront être effectuées à cette fin. En conclusion, l'utilisation de la réaction de Sonogashira pour produire le [18F]FB-Candersartan avec des rendements et des activités molaires élevées s'est avérée difficile. / Adrenomedullin receptors are highly expressed in human alveolar capillaries and provide a molecular target for imaging the integrity of pulmonary microcirculation. In previous years, the 99mTc-labeled DFH12 derivative (PulmoBind) demonstrated its potential as a SPECT imaging agent of pulmonary hypertension in phase I and II clinical trials. In this work, we aimed to develop a NOTA-derivatized adrenomedullin analog (DFH17), radiolabeled with aluminum fluoride ([18F]AlF), for PET imaging of pulmonary microcirculation. To achieve this goal, highly concentrated [18F](AlF)2+ was produced from purified 18F using a semi-automatic system. Using inexpensive complexation assays with NOTA, optimal conditions at each step of the process were determined facilitating the radiolabeling optimization of DFH17. Furthermore, combining the Al-to-DFH17 1:3 ratio in 50% ethanol as co-solvent, allowed [18F]AlF-DFH17 production in high radiochemical and chemical purities. PET/CT and biodistribution demonstrated high [18F]AlF-DFH17 lung-to-background ratio and in vivo stability in rats, dog and primate. Contrasted inter-species uptake in the lungs associated with variations of RAMP2 were also detected by PET imaging. Considering high lung uptake, in vivo stability and favorable dosimetry observed in the monkey, the novel AM derivative [18F]AlF-DFH17 exhibits an excellent potential as a PET tracer of human AM receptors. Alterations of the expression levels of AT1R has been linked to cardiac and renal diseases, such as cardiac and renal failures, hypertension and some type of cancers. Previously, [11C]methyl-Candesartan displayed potential for PET imaging of AT1Rs, but a high proportion of PET signal corresponded to non-specific binding from a 11C-labeled hydrophobic metabolite. In this work, the main objective was to develop the novel derivative [18F]fluorobenzyl-Candesartan, with potentially better metabolic profile and biodistribution, using 4-[18F]fluoroidobenzene ([18F]FIB) as prosthetic group. To pursue this goal, radiofluorination parameters such as solvent, amount of precursor, type of catalyst and temperature were optimized to reliably synthesize [18F]FIB in high yield and purity. Coupling of [18F]FIB to the alkyne-trityl-Candesartan was evaluated using the Sonogashira cross-coupling reaction followed by an acid deprotection. After studying several Pd-cross-coupling conditions, the radioconversion yield was slightly increased by means of a Pd(PPh3)4/CuI catalyst and K2CO3 as base in DMF. Therefore, the best reaction conditions for [18F]FIB fluorination and its coupling to alkyne-Candesartan followed by an acid hydrolysis, was fully automated for Synthra® RNPlus Research synthesis module. In general, the synthesis of [18F]FB-Candesartan was achieved in low yields and molar activities due to the formation of structurally-close by-product(s) with similar HPLC retention time. Additional studies to further improve the yield, HPLC purification and molar activity (MA) have been unsuccessful. Other experiments will need to be performed to this end. In conclusion, the use of Sonogashira cross-coupling reaction to produce [18F]FB-Candesartan in high yields and molar activities was found to be challenging.

La modélisation pharmacocinétique en tomographie par émission par positrons (TEP) permet d’estimer les paramètres physiologiques liés à l’accumulation dynamique d’un radiotraceur. Les paramètres estimés sont biaisés par le bruit dans les images TEP dynamiques durant l’ajustement des courbes d’activité des tissus, plus communément appelées TAC de l’anglais Time Activity Curve. La qualité des images TEP dynamiques est limitée par la statistique de comptage et influencée par les paramètres de reconstruction choisis en termes de résolution spatiale et temporelle. Il n’existe pas de recommandations claires pour les paramètres de reconstruction à utiliser pour les images dynamiques TEP. L’objectif de ce projet de maitrise est d’évaluer le biais dans l’estimation des paramètres pharmacocinétiques afin de trouver les paramètres de reconstruction TEP les plus optimaux en termes de résolution spatiale et de niveau de bruit. Plus précisément, ce projet cherche à déterminer quel modèle d’AIF offre les meilleurs ajustements, mais aussi quel modèle de poids permet la meilleure estimation des paramètres pharmacocinétiques pour le modèle à deux compartiments. Ce faisant, il serait possible de mieux planifier la reconstruction d’images TEP dynamique et potentiellement améliorer leur résolution spatiale. Afin de tester les biais dans les paramètres pharmacocinétiques sous différents niveaux de bruit, un objet de référence numérique (DRO) avec les informations trouvées dans la littérature sera construit. Ensuite, des simulations numériques seront effectuées avec ce DRO afin de trouver les paramètres de reconstruction et le niveau de bruit le plus optimal. Un biais réduit des paramètres pharmacocinétiques et une meilleure résolution spatiale des images TEP dynamique permettrait de détecter des cancers ou tumeurs à des stades moins avancés de la maladie, permettant potentiellement un traitement plus efficace et avec moins de séquelles et d’effets secondaires pour les patients. En outre, cela permettrait aussi de visualiser l’hétérogénéité des tumeurs. / Pharmacokinetic models in positron emission tomography (PET) allow for the estimation of physiological parameters linked to the dynamic accumulation of a radiotracer. Estimated parameters are biased by noise in dynamic PET images during the fitting of Time Activity Curves (TAC). Image quality in dynamic PET is limited by counting statistics and influenced by the chosen reconstruction parameters in terms of spatial and temporal resolution. Clear recommendations and guidelines for the reconstruction parameters that should be used do not exist at the moment for dynamic PET. The goal of this masters project is to evaluate the bias in the pharmacokinetic parameters estimation to find the optimal PET reconstruction parameters in terms of spatial resolution and noise levels. More precisely, this project aims to determine which AIF model produces the best fits, but also which weight noise model allows for the best parameters estimation with the two compartment model. It would then be possible to plan the PET image reconstruction more finely and potentially improve spatial resolution. To test the pharmacokinetic parameters’ biases under different noise levels, a Digital Reference Object (DRO) with information and specifications found from the litterature will be built. Then, numerical simulations will be done with that DRO to find the optimal noise level and value for the pharmacokinetic parameter. A reduced bias in these parameters and an improved spatial resolution would allow the detection of tumors or lesions at earlier stages, which could potentially allow for a more potent treatment with less short and long term side effects. It would also allow the visualization and quantification of lesion heterogeneity.

Les patients atteints de maladie de Parkinson présentent des troubles de la marche, parfois paroxystiques, pouvant être aggravés ou améliorés par les stimuli environnementaux. L'attention portée, soit aux stimuli extérieurs, soit à la marche, pourrait ainsi moduler la locomotion.L’objectif principal était donc de mieux caractériser la manière dont les stimuli environnementaux modulent par le biais de réseaux attentionnels la locomotion. Ceci a été étudié chez les sujets sains puis chez les patients parkinsoniens, avec ou sans enrayage cinétique.Nous avons d'abord défini précisément les déficits attentionnels des patients, avec ou sans troubles de la marche. Ils présentaient respectivement des difficultés en flexibilité mentale et plus particulièrement en attention divisée.Nous avons ensuite exploré l'interaction attention-locomotion grâce à l'étude de la préparation motrice. Ainsi, nous avons pu démontrer que les ajustements posturaux anticipés étaient un marqueur sensible de l’attention. Chez les patients, ils pouvaient témoigner d’une altération de l'interaction attention-programmation motrice.L'étude des régions cérébrales activées lors de la locomotion visuo-guidée chez ces patients a permis de confirmer l'implication de structures corticales attentionnelles. Un déséquilibre d’activation au sein du réseau pariéto-prémoteur (nécessaire à la modulation de l'action motrice en fonction des stimuli externes) était présent.Enfin, nous avons essayé de modifier l'excitabilité du cortex prémoteur via des techniques de stimulation magnétique transcrânienne répétitive afin de moduler la locomotion visuo-guidée. / Patients with Parkinson 's disease present gait impairments, sometimes sudden and unexpected, either improved or deteriorated with environmental stimuli. Attention focalization, either on external stimuli or on gait, could then modulate locomotion.The main objective was to better characterize how environmental stimuli would modulate locomotion, via attentional networks, in healthy subjects and in parkinsonian patients, with or without freezing of gait.At first, we precisely defined the attentional deficits in patients, with or without gait impairment. They showed altered performance respectively in mental flexibility and in divided attention.Then, we explored the attention-locomotion interaction by studying motor preparation. So, we highlighted that anticipatory postural adjustments were a sensitive marker of attention. In patients, they evidenced an alteration of the attention-motor program interaction.Studying the brain activation during the visuo-driven locomotion in these patients confirmed the involvement of cortical attentional regions. We observed an imbalance inside the parieto-premotor network (useful to modulate motor action according external stimuli)Finally, we tried to change the excitability of the premotor cortex with transcranial magnetic stimulation to modulate visuo-driven locomotion.