A - 9 Épilepsie partielle pharmacorésistante : traitement...

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AdvancedArticle previewAbstractRecommended articles (6)Revue NeurologiqueVolume 163, Issue 4, Supplement 1, April 2007, Pages 148-149ÉpilepsieA - 9 Épilepsie partielle pharmacorésistante : traitement par thermocoagulations (THC) guidées par la stéréoelectroencéphalographie (SEEG)Author links open overlay panelH.CatenoixM.GuenotP.RyvlinF.MauguièreM.SindouJ.IsnardShow more

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Citehttps://doi.org/10.1016/S0035-3787(07)90774-2Get rights and contentIntroduction

L’utilisation de la SEEG permet la réalisation de THC directement au sein de la zone épileptogène chez tout patient souffrant d’épilepsie partielle pharmacorésistante exploré par électrodes intracérébrales.

Objectifs

Nous rapportons les résultats obtenus chez 43 patients ayant bénéficié de ce traitement entre 2001 et 2006, avec un recul de 4 à 64 mois.

Méthodes

43 patients souffrant d’épilepsie temporale (n = 24), frontale (n = 7), pariétale (n = 3), occipitale (n = 4) ou insulaire (n = 5) ont été traités par THC. Les THC produites par un générateur de radiofréquence, étaient délivrées au sein de la zone épileptogène, identifiée sur la base des enregistrements intracérébraux des crises. Les patients présentant une diminution d’au moins 50 % de la fréquence de leurs crises ont été considérés comme répondeurs à ce traitement.

Résultats

Le suivi a été de 21 mois en moyenne. À la dernière consultation, 21 patients (48,8 %) présentaient une diminution d’au moins 50 % de la fréquence de leurs crises. 3 patients (7 %) sont devenus libres de crises. Les résultats étaient d’autant plus favorables si l’épilepsie était symptomatique d’une malformation corticale (p = 0,001). Une seule rechute (à 12 mois) a été observée chez les patients répondeurs suivis au-delà de 6 mois. Aucun effet indésirable significatif n’a été observé.

Discussion

Le traitement par THC est une procédure thérapeutique simple, dénuée de risque, susceptible d’apporter un bénéfice direct et immédiat à tout patient épileptique, sans surcoût financier ni opératoire, et sans grever le pronostic chirurgical d’une éventuelle opération réalisée au décours. Cette procédure a permis également de proposer un traitement actif aux patients considérés comme inopérables au terme de l’exploration invasive.

Conclusion

Ces résultats amènent à considérer l’exploration SEEG comme un véritable outil thérapeutique et nous ont incités à proposer ce traitement de manière systématique à tout patient exploré par SEEG.

References (0)Cited by (0)Recommended articles (6)Research articleEffects of osteopathic manipulative treatment on patients with multiple sclerosis: A pilot studyComplementary Therapies in Medicine, Volume 43, 2019, pp. 154-156Show abstract

To describe the effects of osteopathic manipulative treatment in patients affected by Multiple Sclerosis (MS).

This is a pilot study involving 20 MS patients attending the IRCCS Neurolesi “Bonino-Pulejo”, Messina, Italy.

The clinical evaluation was performed before starting rehabilitation treatment (T0) and after 8 weeks of treatment (T1). The CG sample undergo a conventional rehabilitation training (CRT), 5 times/week for 60 min (for a total of 40 sessions), the EG performed the same CRT (but with a different frequency, i.e. 3 times/week, for a total of 24 sessions) and a specific OMT 2 times/week for 60 min (for a total of 16 sessions).

We analyzed the scores recorded in the following main scales: Expanded Disability Status Scale (EDSS), 10 m walking test (10mWT), Hamilton anxiety rating scale (HRS-A), and the Fatigue severity scale (FSS).

Our data showed a reduction in the FSS score for the EG (40 ± 1,41 at T0 vs 37 ± 2,32 at T1; p = 0.04) but not in the CG (41 ± 2,41 at TO vs 39 ± 2,6 at T1) with an intergroup difference p   0.00. An improvement of HRS-A and 10mWT was also detected in the EG.

Our data raise idea that OMT might be useful in rehabilitative setting in MS patients, with particular regard to anxiety and fatigue.

Research articleL’implantation de la télésanté et la pérennité de son utilisation au Canada : quelques leçons à retenirEuropean Research in Telemedicine / La Recherche Européenne en Télémédecine, Volume 5, Issue 4, 2016, pp. 105-117Show abstract

Les écrits sur les défis posés par l’usage de la télésanté mettent souvent en évidence les difficultés rencontrées pour son implantation, déploiement et la pérennité de son utilisation. La lenteur de la progression de l’utilisation des TIC dans le domaine de la santé est souvent dénoncée. Pourtant des progrès sont réalisés. Sur quoi reposent-ils ?

Cet article a pour objectif de mettre en évidence des conditions et facteurs qui influencent la pérennité des projets de télésanté.

Nous avons analysé, sur un intervalle de huit ans, 29 projets de télésanté financés dans le cadre du Programme de partenariats de l’infostructure canadienne de la santé (PPICS) de Santé Canada. En 2006, une première analyse a été faite, notamment pour identifier des conditions de succès, de déploiement et de pérennité. En 2014, les résultats issus de cette première analyse ont été enrichis par une revue des écrits. Ensuite, pour la deuxième analyse, nous avons fait des entrevues et envoyé des questionnaires ouverts aux responsables de projets pour identifier les conditions de pérennité des projets et les facteurs qui les influencent. Des recherches sur Internet ont été aussi effectuées pour approfondir l’information sur l’évolution et les suites qu’ont eues ces projets.

La pérennité requiert la disponibilité de plusieurs éléments, à savoir : (1) le soutien organisationnel et la gouvernance ; (2) un financement récurrent et adapté ; (3) des technologies et environnements technologiques adéquats ; (4) des stratégies de communication actives et ciblées auprès des autorités décisionnelles et du public ; (5) des approches de gestion participatives, collaboratives et pluralistes ; (6) la formation et le développement continus ; et (7) un leadership politique affirmé.

La pérennité ne peut pas être dissociée du succès de l’implantation et du déploiement des projets. Celle-ci doit être abordée dans le cadre d’un processus continu, avec une vision dynamique, dès les phases de conception et de planification, ce qui permet de faciliter la transition entre l’étape de projet réussi et le statut de service au sein de l’organisation ou du système de santé. L’évaluation est importante à cet égard pour avoir des rétroactions, assurer des apprentissages et partager des expériences.

The literature on the challenges raised by the implementation of telehealth often highlights the difficulties encountered in the implementation, deployment and sustainability of its use. The slow increase in the use of ICTs in the health sector is often denounced. Yet progress has been made. What is it based on?

This article aims to highlight the conditions and factors that influence the sustainability of telehealth projects.

We analyzed, within an eight-year interval, 29 telehealth projects funded through the Canada Health Infostructure Partnerships Program (CHIPP) of Health Canada. In 2006, a first analysis was made, especially to identify conditions for success, deployment and sustainability. In 2014, the results of this first analysis were enriched by a literature review. Then, for the second analysis, we did interviews and sent out open questionnaires to project managers to identify the conditions for sustainability of the projects and the factors influencing it. Internet searches were also made for further information on the evolution and the outcomes that these projects have had.

Sustainability requires the availability of several elements, namely: (1) organizational support and governance; (2) a recurring and appropriate financing; (3) adequate technologies and technological environments; (4) active and targeted communication strategies with decision-making authorities and the public; (5) participatory, collaborative and pluralistic management approach; (6) training and continuous development; and (7) strong political leadership.

Sustainability cannot be dissociated from the successful implementation and deployment of projects. This must be addressed as part of an ongoing process, with a dynamic vision, from the design and planning phases, which allows the transition between the successful project stage and service status within the organization or health system. Evaluation is important in this regard for feedback, ensure learning and sharing experiences.

Research articleInteraction between hypoxia and perfluorobutane sulfonate on developmental toxicity and endocrine disruption in marine medaka embryosAquatic Toxicology, Volume 222, 2020, Article 105466Show abstract

The co-occurrence of hypoxia and xenobiotics is extremely common in natural environments, highlighting the necessity to elicit their interaction on aquatic toxicities. In the present study, marine medaka embryos were exposed to various concentrations (nominal 0, 1, 3.3 and 10 mg/L) of perfluorobutane sulfonate (PFBS), an environmental pollutant of emerging concern, under either normoxia (6.9 mg/L) or hypoxia (1.7 mg/L) condition. After acute exposure till 15 days post-fertilization, single or combined toxicities of PFBS and hypoxia on embryonic development (e.g., mortality, hatching and heartbeat) and endocrine systems were investigated. Sex and thyroid hormones were measured by enzyme-linked immunosorbent assay. Transcriptional changes of endocrine genes were determined by quantitative real-time PCR assays. Co-exposure to 10 mg/L PFBS and hypoxia caused a further reduction in survival rate and heart beat compared to single exposure. PFBS induced a precocious hatching, while no larvae hatched under hypoxia condition. By disturbing the balance of sex hormones, either PFBS or hypoxia single exposure produced an anti-estrogenic activity in medaka larvae. However, PFBS and hypoxia combinations reversed to estrogenic activity in co-exposed larvae. Variation in disrupting pattern may be attributed to the interactive effects on steroidogenic pathway involving diverse cytochrome P450 enzymes. Regarding thyroid system, PFBS exposure caused detriments of multiple processes along thyroidal axis (e.g., feedback regulation, synthesis and transport of thyroid hormones, receptor-mediated signaling and thyroid gland development), while hypoxia potently impaired the development and function of thyroid gland. Combinations of PFBS and hypoxia interacted to dysregulate the function of thyroid endocrine system. In summary, the present study revealed the dynamic interaction of PFBS pollutant and hypoxia on aquatic developmental toxicities and endocrine disruption. Considering the frequent co-occurrence of xenobiotics and hypoxia, current results would be beneficial to improve our understanding about their interactive mechanisms and provide baseline evidences for accurate ecological risk evaluation.

Research articleBarriers to access for Canadians who use cannabis for therapeutic purposesInternational Journal of Drug Policy, Volume 25, Issue 4, 2014, pp. 691-699Show abstract

There is increased interest in the therapeutic potential of cannabis in recent decades. Canada, the Netherlands, Israel and some states in the United States have developed programs to allow access to cannabis for therapeutic purposes (CTP). In Canada, enrollment in the federal CTP program represents fewer than 5% of the estimated users of CTP. The discrepancy between the number of Canadians who report using CTP and the rate of utilization of the federal CTP program suggests the existence of barriers to access to this program.

In the present study we employ a health services analytical framework to examine barriers to access to CTP among 628 current CTP users. We define barriers to access as areas of poor fit between clients and services. We use five dimensions of accommodation, accessibility, availability, affordability, and acceptability to examine access to CTP.

Our findings reveal that it is difficult for Canadians to find a physician to support their application to access CTP. Accessing CTP from unauthorized sources was common; only 7% of respondents accessed CTP exclusively from authorized sources. Access to CTP was positively associated with the presence of medical cannabis dispensaries, which were not included in the regulatory regime. Access to CTP varied by medical condition and general quality of health. Affordability of CTP was a substantial barrier to access.

Strategies need to be developed to encourage scientific inquiry into CTP and address the barriers to access to CTP and the stigma and controversy that surround CTP and strain patient–physician relationships.

Research articleLithium Treatment for Agitation in Alzheimer s disease (Lit-AD): Clinical rationale and study designContemporary Clinical Trials, Volume 71, 2018, pp. 33-39Show abstract

Symptoms of agitation, aggression, and psychosis frequently occur in patients with Alzheimer s disease (AD). These symptoms are distressing to patients and caregivers, often lead to institutionalization, are associated with increased mortality, and are very difficult to treat. Lithium is an established treatment for bipolar and other psychotic disorders in which agitation can occur. The Lit-AD study is the first randomized, double-blind, placebo-controlled trial to assess the efficacy of lithium treatment for symptoms of agitation or aggression, with or without psychosis, in older adults diagnosed with AD.

Patients are randomly assigned to low dose (150–600 mg) lithium or placebo, targeting a blood level of 0.2–0.6 mmol/L, stratified by the presence/absence of psychotic symptoms. The study duration for each patient is 12 weeks. The primary study outcome is change in the agitation/aggression domain score on the Neuropsychiatric Inventory (NPI) over the study period. The secondary outcome is improvement in neuropsychiatric symptoms defined as a 30% decrease in a NPI core score that combines agitation/aggression and psychosis domain scores. The Treatment Emergent Symptom Scale (TESS) is used to assess somatic side effects. Other exploratory analyses examine the associations between improvement on lithium and indices shown to be associated with response to lithium in bipolar disorder: serum brain-derived neurotrophic factor (BDNF) levels, a SNP in intron 1 of the ACCN1 gene, and variation at the 7q11.2 gene locus. If lithium demonstrates efficacy in this Phase II pilot trial, a Phase III study will be developed to establish its clinical utility in these patients.

ClinicalTrials.gov Identifier NCT02129348.

Research articleIncomplete resection increases the risk of local recurrence and negatively affects functional outcome in patients with tenosynovial giant cell tumor of the hindfootFoot and Ankle Surgery, Volume 26, Issue 7, 2020, pp. 822-827Show abstract

Diffuse tenosynovial giant cell tumors (TGCT) are more likely to occur in the hindfoot and tend to recur after surgical excision. We performed a pooled analysis of hindfoot TGCT cases to identify factors associated with local recurrence and functional outcomes.

We retrospectively reviewed medical records of 33 patients diagnosed with TGCT (15, localized cases; 18 diffused cases) of the hindfoot between 1998 and 2017. Median follow-up was 32 months. Multivariable Cox proportional hazards regression analysis was conducted to estimate the hazard ratios for risk factors for local failure. Generalized linear regression models were used to assess whether resection status, tumor size, tumor type or bone involvement correlated with the Musculoskeletal Tumor Society (MSTS) score.

Local failure was reported in 30% (10/33) patients. Multivariable analysis showed that macroscopically incomplete resection was the only independent prognostic factor for poor local failure-free survival (P = .001). Incomplete resection significantly decreased MSTS score and negatively affected functional outcome (P = .047).

Incomplete resection increases the risk of local recurrence and negatively affects functional outcome in patients with TGCT of the hindfoot.

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