Opposite motor effects of pallidal stimulation in Parkinson's disease
Identifieur interne : 001429 ( PascalFrancis/Checkpoint ); précédent : 001428; suivant : 001430Opposite motor effects of pallidal stimulation in Parkinson's disease
Auteurs : P. Krack [France] ; P. Pollak [France] ; P. Limousin [France] ; D. Hoffmann [France] ; A. Benazzouz [France] ; J. F. Le Bas [France] ; A. Koudsie [France] ; A. L. Benabid [France]Source :
- Annals of neurology [ 0364-5134 ] ; 1998.
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Abstract
We studied the effects-on parkinsonian signs, on levodopa-induced dyskinesias, and on levodopa response-of acute experimental high-frequency stimulation of the internal pallidum (GPi) during off-drug and on-drug phases. Thirteen quadripolar electrodes were evaluated in 8 patients with Parkinson's disease (PD). Stimulation of the most ventral contacts, lying at the ventral margin of or just below the GPi, led to pronounced improvement in rigidity and a complete arrest of levodopa-induced dyskinesias. The antiakinetic effect of levodopa was also blocked and the patients became severely akinetic. Stimulation of the most dorsal contacts, lying at the dorsal border of the GPi or inside the external pallidum, usually led to moderate improvement of off-drug akinesia and could also induce dyskinesias in some patients. When using an intermediate contact for chronic stimulation, a good compromise between these opposite effects was usually obtained, mimicking the effect of pallidotomy. We conclude that there are at least two different functional zones within the globus pallidus, at the basis of a different pathophysiology of the cardinal symptoms of PD. The opposite effects may explain the variable results of pallidal surgery reported in the literature and may also largely explain the paradox of PD surgery. A possible anatomical basis for these differential functional effects could be a functional somatotopy within the GPi, with the segregation of the pallidofugal fibers from the outer portion of the GPi, on one hand, forming the ventral ansa lenticularis and from the inner portion of the GPi, on the other hand, forming the dorsal lenticular fasciculus.
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Benabid</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Clinical and Biological Neurosciences, and INSERM U.318, Joseph Fourier University of Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">98-0138458</idno><date when="1998">1998</date><idno type="stanalyst">PASCAL 98-0138458 INIST</idno><idno type="RBID">Pascal:98-0138458</idno><idno type="wicri:Area/PascalFrancis/Corpus">001640</idno><idno type="wicri:Area/PascalFrancis/Curation">001A06</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">001429</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">001429</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Opposite motor effects of pallidal stimulation in Parkinson's disease</title><author><name sortKey="Krack, P" sort="Krack, P" uniqKey="Krack P" first="P." last="Krack">P. Krack</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Clinical and Biological Neurosciences, and INSERM U.318, Joseph Fourier University of Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P." last="Pollak">P. Pollak</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Clinical and Biological Neurosciences, and INSERM U.318, Joseph Fourier University of Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Limousin, P" sort="Limousin, P" uniqKey="Limousin P" first="P." last="Limousin">P. Limousin</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Clinical and Biological Neurosciences, and INSERM U.318, Joseph Fourier University of Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Hoffmann, D" sort="Hoffmann, D" uniqKey="Hoffmann D" first="D." last="Hoffmann">D. Hoffmann</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Clinical and Biological Neurosciences, and INSERM U.318, Joseph Fourier University of Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Benazzouz, A" sort="Benazzouz, A" uniqKey="Benazzouz A" first="A." last="Benazzouz">A. Benazzouz</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Clinical and Biological Neurosciences, and INSERM U.318, Joseph Fourier University of Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Le Bas, J F" sort="Le Bas, J F" uniqKey="Le Bas J" first="J. F." last="Le Bas">J. F. Le Bas</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Clinical and Biological Neurosciences, and INSERM U.318, Joseph Fourier University of Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Koudsie, A" sort="Koudsie, A" uniqKey="Koudsie A" first="A." last="Koudsie">A. Koudsie</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Clinical and Biological Neurosciences, and INSERM U.318, Joseph Fourier University of Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A. L." last="Benabid">A. L. Benabid</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Clinical and Biological Neurosciences, and INSERM U.318, Joseph Fourier University of Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author></analytic><series><title level="j" type="main">Annals of neurology</title><title level="j" type="abbreviated">Ann. neurol.</title><idno type="ISSN">0364-5134</idno><imprint><date when="1998">1998</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Annals of neurology</title><title level="j" type="abbreviated">Ann. neurol.</title><idno type="ISSN">0364-5134</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antiparkinson agent</term><term>Dyskinesia</term><term>Experimental study</term><term>Human</term><term>Instrumental stimulation</term><term>Levodopa</term><term>On off effect</term><term>Pallidum</term><term>Parkinson disease</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Parkinson maladie</term><term>Dyskinésie</term><term>Lévodopa</term><term>Antiparkinsonien</term><term>Stimulation instrumentale</term><term>Pallidum</term><term>Effet on off</term><term>Etude expérimentale</term><term>Traitement</term><term>Homme</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">We studied the effects-on parkinsonian signs, on levodopa-induced dyskinesias, and on levodopa response-of acute experimental high-frequency stimulation of the internal pallidum (GPi) during off-drug and on-drug phases. Thirteen quadripolar electrodes were evaluated in 8 patients with Parkinson's disease (PD). Stimulation of the most ventral contacts, lying at the ventral margin of or just below the GPi, led to pronounced improvement in rigidity and a complete arrest of levodopa-induced dyskinesias. The antiakinetic effect of levodopa was also blocked and the patients became severely akinetic. Stimulation of the most dorsal contacts, lying at the dorsal border of the GPi or inside the external pallidum, usually led to moderate improvement of off-drug akinesia and could also induce dyskinesias in some patients. When using an intermediate contact for chronic stimulation, a good compromise between these opposite effects was usually obtained, mimicking the effect of pallidotomy. We conclude that there are at least two different functional zones within the globus pallidus, at the basis of a different pathophysiology of the cardinal symptoms of PD. The opposite effects may explain the variable results of pallidal surgery reported in the literature and may also largely explain the paradox of PD surgery. A possible anatomical basis for these differential functional effects could be a functional somatotopy within the GPi, with the segregation of the pallidofugal fibers from the outer portion of the GPi, on one hand, forming the ventral ansa lenticularis and from the inner portion of the GPi, on the other hand, forming the dorsal lenticular fasciculus.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0364-5134</s0></fA01><fA02 i1="01"><s0>ANNED3</s0></fA02><fA03 i2="1"><s0>Ann. neurol.</s0></fA03><fA05><s2>43</s2></fA05><fA06><s2>2</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Opposite motor effects of pallidal stimulation in Parkinson's disease</s1></fA08><fA11 i1="01" i2="1"><s1>KRACK (P.)</s1></fA11><fA11 i1="02" i2="1"><s1>POLLAK (P.)</s1></fA11><fA11 i1="03" i2="1"><s1>LIMOUSIN (P.)</s1></fA11><fA11 i1="04" i2="1"><s1>HOFFMANN (D.)</s1></fA11><fA11 i1="05" i2="1"><s1>BENAZZOUZ (A.)</s1></fA11><fA11 i1="06" i2="1"><s1>LE BAS (J. F.)</s1></fA11><fA11 i1="07" i2="1"><s1>KOUDSIE (A.)</s1></fA11><fA11 i1="08" i2="1"><s1>BENABID (A. L.)</s1></fA11><fA14 i1="01"><s1>Department of Clinical and Biological Neurosciences, and INSERM U.318, Joseph Fourier University of Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></fA14><fA20><s1>180-192</s1></fA20><fA21><s1>1998</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>16555</s2><s5>354000078336850070</s5></fA43><fA44><s0>0000</s0><s1>© 1998 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>61 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>98-0138458</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i2="1"><s0>Annals of neurology</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>We studied the effects-on parkinsonian signs, on levodopa-induced dyskinesias, and on levodopa response-of acute experimental high-frequency stimulation of the internal pallidum (GPi) during off-drug and on-drug phases. Thirteen quadripolar electrodes were evaluated in 8 patients with Parkinson's disease (PD). Stimulation of the most ventral contacts, lying at the ventral margin of or just below the GPi, led to pronounced improvement in rigidity and a complete arrest of levodopa-induced dyskinesias. The antiakinetic effect of levodopa was also blocked and the patients became severely akinetic. Stimulation of the most dorsal contacts, lying at the dorsal border of the GPi or inside the external pallidum, usually led to moderate improvement of off-drug akinesia and could also induce dyskinesias in some patients. When using an intermediate contact for chronic stimulation, a good compromise between these opposite effects was usually obtained, mimicking the effect of pallidotomy. We conclude that there are at least two different functional zones within the globus pallidus, at the basis of a different pathophysiology of the cardinal symptoms of PD. The opposite effects may explain the variable results of pallidal surgery reported in the literature and may also largely explain the paradox of PD surgery. A possible anatomical basis for these differential functional effects could be a functional somatotopy within the GPi, with the segregation of the pallidofugal fibers from the outer portion of the GPi, on one hand, forming the ventral ansa lenticularis and from the inner portion of the GPi, on the other hand, forming the dorsal lenticular fasciculus.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17G</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Parkinson maladie</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Parkinson disease</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Parkinson enfermedad</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Dyskinésie</s0><s5>04</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Dyskinesia</s0><s5>04</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Disquinesia</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Lévodopa</s0><s5>07</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Levodopa</s0><s5>07</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Levodopa</s0><s5>07</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Antiparkinsonien</s0><s5>08</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Antiparkinson agent</s0><s5>08</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Antiparkinsoniano</s0><s5>08</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Stimulation instrumentale</s0><s5>10</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Instrumental stimulation</s0><s5>10</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Estimulación instrumental</s0><s5>10</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Pallidum</s0><s5>11</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Pallidum</s0><s5>11</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Pallidum</s0><s5>11</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Effet on off</s0><s5>13</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>On off effect</s0><s5>13</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Efecto on off</s0><s5>13</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Etude expérimentale</s0><s5>16</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Experimental study</s0><s5>16</s5></fC03><fC03 i1="08" i2="X" l="GER"><s0>Experimentelle Untersuchung</s0><s5>16</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Estudio experimental</s0><s5>16</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Traitement</s0><s5>17</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Treatment</s0><s5>17</s5></fC03><fC03 i1="09" i2="X" l="GER"><s0>Aufbereiten</s0><s5>17</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Tratamiento</s0><s5>17</s5></fC03><fC03 i1="10" i2="X" l="FRE"><s0>Homme</s0><s5>20</s5></fC03><fC03 i1="10" i2="X" l="ENG"><s0>Human</s0><s5>20</s5></fC03><fC03 i1="10" i2="X" l="SPA"><s0>Hombre</s0><s5>20</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Système nerveux pathologie</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Système nerveux central pathologie</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Encéphale pathologie</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Extrapyramidal syndrome</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Trouble neurologique</s0><s5>46</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Neurological disorder</s0><s5>46</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Trastorno neurológico</s0><s5>46</s5></fC07><fC07 i1="07" i2="X" l="FRE"><s0>Mouvement involontaire</s0><s5>47</s5></fC07><fC07 i1="07" i2="X" l="ENG"><s0>Involuntary movement</s0><s5>47</s5></fC07><fC07 i1="07" i2="X" l="SPA"><s0>Movimiento involuntario</s0><s5>47</s5></fC07><fC07 i1="08" i2="X" l="FRE"><s0>Traitement instrumental</s0><s5>61</s5></fC07><fC07 i1="08" i2="X" l="ENG"><s0>Instrumentation therapy</s0><s5>61</s5></fC07><fC07 i1="08" i2="X" l="SPA"><s0>Tratamiento instrumental</s0><s5>61</s5></fC07><fN21><s1>089</s1></fN21></pA></standard></inist><affiliations><list><country><li>France</li></country><region><li>Auvergne-Rhône-Alpes</li><li>Rhône-Alpes</li></region><settlement><li>Grenoble</li></settlement></list><tree><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Krack, P" sort="Krack, P" uniqKey="Krack P" first="P." last="Krack">P. Krack</name></region><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A. L." last="Benabid">A. L. Benabid</name><name sortKey="Benazzouz, A" sort="Benazzouz, A" uniqKey="Benazzouz A" first="A." last="Benazzouz">A. Benazzouz</name><name sortKey="Hoffmann, D" sort="Hoffmann, D" uniqKey="Hoffmann D" first="D." last="Hoffmann">D. Hoffmann</name><name sortKey="Koudsie, A" sort="Koudsie, A" uniqKey="Koudsie A" first="A." last="Koudsie">A. Koudsie</name><name sortKey="Le Bas, J F" sort="Le Bas, J F" uniqKey="Le Bas J" first="J. F." last="Le Bas">J. F. Le Bas</name><name sortKey="Limousin, P" sort="Limousin, P" uniqKey="Limousin P" first="P." last="Limousin">P. Limousin</name><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P." last="Pollak">P. Pollak</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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