Emmanuelle Cugy

Safety and self-reported efficacy of botulinum toxin for adult spasticity in current clinical practice: a prospective observational study

Objective: To determine the safety and the self-reported efficacy of botulinum toxin injections for adult spasticity in current clinical practice. Design: A prospective observational study. Subjects: A total of 406 adult patients with focal spasticity received of 1136 series botulinum toxin injections at Bordeaux University Hospital from January 2007 to December 2009. Methods: Adverse events following botulinum toxin injections were reported. Their severity and the therapeutic efficacy of botulinum toxin injections were estimated with a four-point self-reporting scale (0 to 3). Latency and duration of adverse events and subjective improvement were also noted. Results: The data of 640 series of injections were analyzed. Forty-six (7.2%) adverse events were reported, of which 36 (78%) were local. There were 18 (39%) cases of local muscular weakness with an average duration of 30.0 (SD 38.2) days, and an average severity score of 1.0 (SD 0.97). Among systemic adverse events, there were 8 (17%) cases of excessive fatigue without global muscular weakness and 2 (4%) cases of transitory generalized muscular weakness. The average subjective improvement score was 1.89 (SD 0.97) and was higher for upper, than for lower, limbs (P=0.007). Conclusion: Self-reported adverse events following botulinum toxin injections in spasticity are rare, often benign and of short duration in current clinical practice. Botulinum toxin is considered effective by patients in treating spasticity of the upper and lower limbs.

Stroke-Associated Pneumonia Risk Score: Validity in a French Stroke Unit

BACKGROUND Stroke-associated pneumonia is a leading cause of in-hospital death and post-stroke outcome. Screening patients at high risk is one of the main challenges in acute stroke units. Several screening tests have been developed, but their feasibility and validity still remain unclear. OBJECTIVE The aim of our study was to evaluate the validity of four risk scores (Pneumonia score, A2DS2, ISAN score, and AIS-APS) in a population of ischemic stroke patients admitted in a French stroke unit. METHODS Consecutive ischemic stroke patients admitted to a stroke unit were retrospectively analyzed. Data that allowed to retrospectively calculate the different pneumonia risk scores were recorded. Sensitivity and specificity of each score were assessed for in-hospital stroke-associated pneumonia and mortality. The qualitative and quantitative accuracy and utility of each diagnostic screening test were assessed by measuring the Youden Index and the Clinical Utility Index. RESULTS Complete data were available for only 1960 patients. Pneumonia was observed in 8.6% of patients. Sensitivity and specificity were, respectively, .583 and .907 for Pneumonia score, .744 and .796 for A2DS2, and .696 and .812 for ISAN score. Data were insufficient to test AIS-APS. Stroke-associated pneumonia risk scores had an excellent negative Clinical Utility Index (.77-.87) to screen for in-hospital risk of pneumonia after acute ischemic stroke. CONCLUSION All scores might be useful and applied to screen stroke-associated pneumonia in stroke patients treated in French comprehensive stroke units.

PREVENTIVE EFFECT OF AN ATHLETICS INJURY PREVENTION PROGRAM ON INJURY COMPLAINTS WITH DECREASED PARTICIPATION IN ATHLETICS: A PILOT PROSPECTIVE COHORT STUDY

Background Athletics practice leads risk of injuries with negative consequences on participation. It is therefore important to develop and validate strategies to prevent it. Objective To determine whether an Athletics Injury Prevention Program (AIPP), targeting the most common athletic injury types (hamstring strain, achilles and patellar tendinopathy, low back pain, ankle sprain), can reduce the occurrence of injury complaints with decreased participation (IC) related to athletics practice. Design Prospective cohort study. Setting Regional- to international-level athletics athletes. Participants A total of 63 athletes, with ≥75% of response rate to a questionnaire with weekly follow-up on AIPP adherence and IC, during one athletics season (43 weeks). Interventions An 8-exercise AIPP, addressing core stability, hamstrings and leg eccentric muscle strengthening and stretching, pelvis balance and stabilizing work. Main Outcome Measurements Adherence to AIPP, incidence of IC and prevalence of weeks with IC. Relative risks (RR) with 95% CI between two groups: “AIPP+” corresponding to athletes executing AIPP≥1/week vs. “AIPP-” corresponding to athletes performing AIPP<1/week. Results At short term (12 weeks, n=63 athletes), there was a significant lower incidence of IC in AIPP+ (n=33; 1.5±0.6 AIPP/week) compared to AIPP- (n=30; 0.5±0.3 AIPP/week) (6.1±2.8 vs. 11.3±4.0 IC per 1000 hours of practice; RR=0.53, 95% CI: 0.30–0.95). At long term (40 weeks, n=40 athletes), there were i) a significant reduction in number of weeks with IC in AIPP+ (n=11; 1.4±0.6 AIPP/week) compared to AIPP− (n=27; 0.6±0.3 AIPP/week) (8.0% vs. 16.4%; RR=0.49, 95% CI: 0.34–0.70), and ii) a significant lower incidence of hamstring IC in AIPP+ compared to AIPP− (1.3±1.3 vs. 2.6±1.2 IC per 1000 hours of practice; RR=0.13, 95% CI: 0.02–0.97). Conclusions An 8-exercise prevention program, based on a scientific evidence and performed more than once a week, resulted in a protective effect on injury complaints with decreased sport participation at both short and long term.