S. Petrilli

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.

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.

Evaluation at five years of post-acute unit (UPR) at the Saint-Hélier Pole, Rennes

international data. Patients and methods.– Descriptive study with prospective collection. Survey on the state of play of Physical Medicine and Rehabilitation (PMR) established two institutions in Lebanon MPR: The RRTC Beit-Chabab and hospital Mgr Cortbaoui. A grid reference to the quality charter MPR rehabilitation facility and the criteria for accreditation RRTC is developed. It includes all team members present and their job profile and policy of the institution. Results.– Doctors: presence once a week, nowell-defined contract, the job profile is not clear. The meetings of the Board are often without doctors. There is no complementarity between doctors. Everyone has their own patients. No work within well-defined or inter-services. No weekly meeting study records. The evaluation of the patient is done with physical therapists during the visit but traceability is incomplete. The medical record is incomplete, does not contain all the elements. Physiotherapists working in the absence of rehabilitation physician who evaluates and modifies the program every week. There is more solidarity and complementarity intra-team work. Sometimes insufficient, given the limited time to an hour a day patient. Little cooperation with the occupational therapist and speech therapist, which are only three half-days per week on request. The orthotics are from outside experts on demand. No role of the social worker. Conclusions.– This study shows that the qualified personnel of the multidisciplinary team work well in their respective fields. But the lack of physical medicine doctors presence is an obstacle for multidisciplinary work. In addition each specialty team tends to work in isolation for reasons which will be set if the hospital policy is made according to quality charter.

Bilan à cinq ans d’une unité post-réanimation (UPR) au Pôle Saint-Hélier, Rennes

handicap implique une visite sur les lieux de vie. Materiel et methode.– Un questionnaire a ete diffuse par mail a l’ensemble des professeurs de reeducation dans les CHU metropolitains, portant sur l’existence, les personnels, l’organisation et le financement d’equipes de reeducation intervenant extra muros au domicile des patients. Resultats.– Trente-trois services contactes ; 27 reponses ; dix equipes interviennent en dehors de l’hopital, dont neuf au domicile des patients. Les missions, les moyens humains, l’organisation de ces equipes sont tres heterogenes, allant de la visite de l’ergotherapeute a une hospitalisation a domicile. Conclusion.– Les equipes evaluant les situations de handicap hors CHU sont peu nombreuses avec des modalites de fonctionnement tres differentes. Une harmonisation parait necessaire.

Rééducation des membres supérieurs dans la sclérose en plaques

Mots clés : Sclérose en plaques ; Rééducation ; Membres supérieurs L’atteinte des membres supérieurs est fréquente dans la SEP, touchant les deux tiers des sujets, avec un retentissement important au quotidien. Pourtant peu de travaux ont été consacrés à la prise en charge rééducative des membres supérieurs dans ce contexte. Spooren, dans une revue récente de 2012, ne retenait que 11 études au final. À l’examen de la plupart de ces études, il s’agissait en fait le plus souvent de prise en charge globale, sans description précise des protocoles employés au niveau des membres supérieurs. Avec le développement de la robotique, de la réalité virtuelle, la thématique de la prise en charge du handicap des membres supérieurs connaît un développement important ces dernières années. Dans quelle mesure peut-on partir des données concernant d’autres pathologies neurologiques comme les AVC, pour développer des programmes spécifiques de la SEP ? Ces programmes doivent tenir compte de la spécificité de la SEP, notamment de la fatigabilité, de l’atteinte visuelle, et parfois cognitive, qui va venir perturber les phases d’apprentissage. Nous essayerons dans cet exposé de faire le point sur les données récentes et d’envisager les possibles développements de cette prise en charge.