A. Durufle

Influence of urinary management on urologic complications in a cohort of spinal cord injury patients

OBJECTIVE To study urologic complications in patients with spinal cord injury (SCI) in relation to their bladder management. DESIGN AND SETTING A cohort study of patients with SCI in a rehabilitation center. PARTICIPANTS One hundred eighty-two patients were studied; demographic data, disease characteristics, and urologic history were obtained for each. INTERVENTION Patients responding to a questionnaire were given a clinical exam. Their medical records were reviewed, with particular attention given to the following urologic complications: lithiasis, urinary infections, orchiepididymitis, urethral trauma, vesicorenal reflux, and renal failure. RESULTS Results are reported for 123 patients. Time since SCI was 8 years. Intermittent catheterization was the main method of bladder management. Only 32 patients had changed their method of vesical voiding. Urinary complications had developed in 75% of patients. The most common complication was urinary infection. Vesicoureteral reflux occurred in 26% of patients using percussion. Trauma related to catheterization was the main problem with intermittent catheterization, responsible for a high rate of orchiepididymitis. CONCLUSION Intermittent catheterization is the most-used method of bladder management, but with a nonnegligible rate of urethral trauma in men. Percussion and Credé maneuver appear to be acceptable techniques of bladder management if the patient is closely monitored.

Magnetoencephalography in stroke: a 1‐year follow‐up study

Recovery after stroke is closely linked to cerebral plasticity. Magnetoencephalography (MEG) is a non‐invasive technique, which allows location of cerebral cells activities. In the present work, a cohort of patients has been studied with MEG. Twelve patients with a recent ischemic or hemorragic stroke were included as soon as possible after onset of stroke. Neurologic assessment, including standard neurologic examination, functional independence measure (FIM) and Orgogozos scale was performed for 1 year in addition to a study of the somatosensory evoked field (SEF) using a 37‐channel Biomagnetometer system. No response could be recorded in five patients at the first SEF exploration. In three cases, no response was ever recorded during the study. All these patients had a bad recovery. The location of the SEF sources was always in the normal non‐infarcted cortex of the postcentral gyrus. Sensory recovery seemed to be linked to the reorganization of the persistent functional cortex, which was a limiting factor for recovery. These observations confirm the experimental results obtained in animal models. After stroke it can be assumed that in the case of incomplete lesion, an intensive sensory peripheral stimulation could maximize the use of residual sensory function and then contribute to improve the sensory deficit. In case of total sensory loss other techniques have to be used, such as visual monitoring of hand activity in order to improve hand function.

Role for botulinum toxin in back pain treatment in adults with cerebral palsy: report of a case

OBJECTIVE To report a case illustrating the usefulness of botulinum toxin A in the treatment of spinal dystonia responsible for low back pain and postural disorders. METHODS Critical appraisal of a case report. CASE REPORT A young woman with cerebral palsy had lumbar paraspinal muscle dystonia responsible for pain and hyperlordosis unresponsive to oral medications for muscle spasm. Botulinum toxin A (Botox(R), 200 U) was injected into the paraspinal muscles at six sites, to good effect. DISCUSSION The few reported cases consistently show a favorable effect of local botulinum toxin A injections in patients with painful paraspinal muscle dystonia related to neurological disease or chronic low back pain. CONCLUSION Botulinum toxin A may be a useful treatment for incapacitating painful dystonia of the paraspinal muscles. This treatment improves posture in the sitting position and facilitates the fitting of orthotic devices. Furthermore, botulinum toxin A treatment may help to determine whether an intrathecal baclofen test is in order.

Effects of pregnancy and child birth on urinary symptoms and urodynamics in women with multiple sclerosis

ObjectiveOur objective was to study the impact of pregnancy and delivery on vesicourethral disorders in patients with multiple sclerosis (MS).Design and settingWe performed a retrospective chart review of records of women diagnosed with MS who were referred to the clinic.ParticipantsA total of 102 women with MS (mean age of 44.7±11.4 years at the time of the study and mean age of 30.0±9.6 years at the onset of MS) participated in the study. The mean duration of disease was 15±10 years. The mean Expanded Disability Status Scale score was 5.4±1.8.Main outcome measuresFor each patient, demographic data, disease characteristics, urological and obstetrical history and urodynamic data were collected. Urinary disorders were classified as irritative (urinary urgency and frequency) or as obstructive (hesitancy of micturition, reduced or interrupted urinary stream and sensation of incomplete bladder emptying). Urodynamic study consisted of cystometry with continuous recording of urethral sphincter electromyography in 77 (76%) cases. Intravesical and intraurethral pressures were recorded. Bladder dysfunctions were classified into neurogenic detrusor overactivity or detrusor underactivity.ResultsPregnancies and deliveries did not influence symptoms. Moreover, the only statistical difference from a urodynamic point of view was a decrease in maximal urethral closure pressure.ConclusionNo interaction between pregnancy, delivery and urinary symptoms was found in this study. The effects of pregnancy and delivery seemed to be the same in women with MS and in healthy women, with a tendency towards a decrease in urethral pressure in women with MS.

Maintien à domicile et qualité de vie à distance d'un accident vasculaire cérébral

Introduction. – Stroke is the most disabling chronic disease among adults. The assessment of quality of life is of great importance to improve the management of patients with stroke sequelae returning to the community. Method. – A total of 93 patients and their referring clinicians were contacted. Quality of life of patients three years after stroke was assessed by use of the Short-Form Health Survey (SF-36). Results. – Thirteen patients died during this period. Fifty participated in the study. The average age was 66.8 years. The patients who died were older and had an initial greater impairment after stroke than survivors. In most of the cases, a life plan, built during the inpatient rehabilitation period, could be achieved. Just six patients had to change their way of life during the three years after stroke. A total of 44% of the patients needed human assistance for basic daily living activities. Patients with stroke had lower scores on the SF-36 than their healthy peers. All subscale scores differed for patients with stroke, as compared with health peers. Initial disability, the occurrence of falls, age and urinary incontinence at the time of the study indicated poor prognosis. Discussion. – Our results are close to those previously published: a great number of people who survive stroke live with sequelae that requires assistance in the home and have decreased quality of life. These results stress the importance of follow-up by a rehabilitation team to prevent altered quality of life, with a special care to urinary incontinence and falls, especially in old people with abundant sequelae of stroke.

Atypical low back pain: stiff-person syndrome

Stiff-person syndrome was diagnosed in a patient with chronic low back pain. The diagnosis of this rare neurological condition rests mainly on the clinical findings of axial and proximal limb rigidity, increased lumbar lordosis often accompanied with pain, and normal neurological findings apart from brisk deep tendon reflexes. Electromyography of the lumbar paraspinal muscles shows motor unit firing at rest with normal appearance of the motor unit potentials. Titers of antibody to glutamic acid decarboxylase are elevated. Diazepam is the treatment of reference. Physical therapy can substantially improve quality of life.

Une lombalgie atypique : le syndrome de l’homme raide

Resume Nous rapportons une observation de stiff man syndrome, decouvert a l’occasion d’une lombalgie chronique. Le stiff man syndrome est une pathologie neurologique rare de diagnostic principalement clinique avec une hypertonie axiale et des racines des membres, une hyperlordose souvent douloureuse, et un examen neurologique normal en dehors d’une augmentation des reflexes osteotendineux. Le diagnostic est confirme par l’examen electromyographique des muscles para-spinaux lombaires avec persistance d’une activite au repos de potentiel d’unite motrice d’allure normale, et une augmentation des anticorps anti acide glutamique decarboxylase (GAD). A cote du traitement de reference le diazepam, une prise en charge reeducative peut ameliorer considerablement la qualite de vie de ces patients.

Medication, rehabilitation and health care consumption in adults with cerebral palsy: A population based study.

Objective: To evaluate medication, rehabilitation and healthcare consumption in adults with CP as a function of Gross Motor Function Classification System (GMFCS) level. Design: Questionnaire-based cross-sectional study. Setting: Brittany, a French county. Subjects: Adults with cerebral palsy. Interventions: Questionnaires relating to drugs, orthotic devices, mobility aids, rehabilitation and medical input were sent to 435 members of a unique regional French network dedicated to adults with cerebral palsy. The questionnaire was completed by the participant or a helper if necessary. Results: Of the 282 responders, 7.8% had a GMFCS level of I, 14.2% II, 17.7% III, 29.1% IV and 31.2% V. Participants consumed a large amount of healthcare. Almost three-quarters took orally administered drugs, of which antispastic and antiepileptic drugs were among the most frequent. Nearly all patients had at least one type of rehabilitation, 87.2% had physiotherapy, 78% used at least one mobility aid and 69.5% used at least one orthotic device. The frequency of numerous inputs increased with GMFCS level. Specificities were found for each GMFCS level, e.g. participants with GMFCS level IV and V had a high level of medical input and a greater use of trunk-supporting devices, antireflux and laxative. Profiles could be established based on GMFCS levels. Conclusions: Adults with cerebral palsy use a large amount of drugs, mobility aids, orthotic devices, rehabilitation and medical input. Healthcare is targeted at cerebral palsy-related issues. GMFCS is a determinant of healthcare consumption and thus a useful tool for clinical practice to target care appropriately.

Kienböck's disease and cerebral palsy case report.

INTRODUCTION Pain is the main problem in patients suffering from cerebral palsy, particularly in adults. The upper limbs are affected in 25% of cases. Here, we report the case of a patient with Kienböcks disease. METHOD Clinical case and literature review. A 28-year-old man suffering from dystonic quadriplegia consulted for progressively worsening pain in the right wrist. Kienböcks disease was diagnosed and conservative treatment with botulinum toxin in the flexor carpi radialis recommended. A good result was obtained with a decrease in pain. This result was still present two years later. DISCUSSION Although few references are made to it in literature, Kienböcks disease in cerebral palsy is probably underestimated. Maintenance of the wrist in a permanent flexed position and muscular hypertonia may be risk factors. Knowledge of this particular clinical picture will enable it to be detected promptly and thus enable conservative treatment to be organised with a maximum chance of therapeutic success, preventing the need for surgery.

Assessment of cognitive rehabilitation in adults with cerebral palsy

Objectives To date, there is very little data available regarding cognitive functioning in adults with cerebral palsy. A research has been coordinated since 2012 by the network “Reseau Breizh paralysie cerebrale”. During its first phase, the research has established that the study population profile was characterized by a decreased processing speed, visuo-constructive problems and working memory impairment. The ongoing second phase aims at assessing the impact of a cognitive management on those disorders. Methods The research includes 18 ICP patients with reading and writing skills (lower secondary school; 2-year post-baccalaureat level), who expressed a cognitive complaint. The first phase of the assessment highlighted the neuropsychological profile of each patient. Among the 18 patients, with an average age of 28 years old [18; 50], 10 participated in a 6-month cognitive intervention, aimed at the disorders which were previously identified. A comparative assessment was conducted 9 to 12 months after the first one, in all patients. Results and discussion The patients mentioned a better functioning in their daily life (awareness of the disorders, etc.). The analysis shows that the performance improved in some areas. A comparative analysis was conducted between the patient group which participated at the cognitive intervention and the group which didn’t.