Long-Term Relief of Painful Bladder Syndrome by High-Intensity, Low-Frequency Repetitive Transcranial Magnetic Stimulation of the Right and Left Dorsolateral Prefrontal Cortices

Aim: To show the value of low-frequency repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) to treat bladder pain syndrome (BPS), characterized by suprapubic pain, urgency and increased micturition frequency.Methods: A 68-year-old woman with BPS underwent 16 sessions of high-intensity, low-frequency (1 Hz) rTMS of the DLPFC, first on the right hemisphere (one daily session for 5 days, followed by one weekly session for 5 weeks), and then on the left hemisphere (one monthly session for 6 months).Results: At the end of the rTMS protocol, suprapubic pain completely vanished, micturition frequency dramatically decreased (by 60–80%), while fatigue and sleep quality improved (by 57–60%). The patient reported an overall satisfaction rate of 80% and her activities of daily living tending to normalize.Conclusion: This is the first report showing that high-intensity, low-frequency rTMS delivered on the DLPFC region of both hemispheres can relieve most symptoms of BPS (pain, urinary symptoms, and interference with physical functioning) in clinical practice

Les habitats carolingiens de Montours et La Chapelle-Saint-Aubert (Ille-et-Vilaine)

Quatre sites ruraux du haut Moyen Âge ont été fouillés dans la région de Fougères lors des opérations d’archéologie préventive conduites de 1995 à 1997 sur le tracé de l’autoroute des Estuaires (A84). La contemporanéité de ces gisements a conduit, d’emblée, à harmoniser les problématiques et à accorder une part importante à l’approche paléoenvironnementale ainsi qu’à l’analyse du mobilier céramique. L’étude des trois ensembles d’habitats et d’un gué carolingiens laisse entrevoir une gestion organisée et dynamique des terroirs environnants (parcellaire, réseaux fossoyés, chemins, aménagement d’un fond de vallon tourbeux...) qui ont été structurés et exploités entre le XIIe et le Xe s. Parallèlement à la contribution que cette synthèse apporte à la connaissance de l’habitat et du mode de vie dans les campagnes bretonnes au haut Moyen Âge, domaine encore peu abordé par l’archéologie, les données bioarchéologiques précisent l’impact des activités agro-pastorales sur l’évolution du milieu végétal et du paysage.From 1995 to 1997, four early medieval sites were excavated in the Fougères region as part of archaeological research work carried out prior to the construction of the A84 motarway. As the sites all date from the same period, a comprehensive research plan was implemented from the outset, with special emphasis on paleo-environmental analysis and examination of pottery finds. Examination of the three Carolingian settlement sites, as well as a ford from the same period, reveals an organised, interactive approach to environmental management of the surrounding lands (land division, ditch Systems. tracks, development of a peatcovered valley floor), which were developed and systematically exploited from the 7th to 10th century. The present volume provides a significant contribution to our understanding of early medieval rural settlements in Brittany, an area of study which has hitherto received little attention from archaeologists The research is enhanced by an analysis of bio-archaeological data from the sites, showing the impact of agro-pastoral activities on the landscape and vegetation in nearby areas

Anesthésie pour endoscopie trachéobronchique thérapeutique (Alfentanil versus Remifentanil : étude randomisée prospective sur 39 patients)

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Peripheral Nerve Stimulation of Brachial Plexus Nerve Roots and Supra-Scapular Nerve for Chronic Refractory Neuropathic Pain of the Upper Limb

International audienc

Machine Learning Algorithms Provide Greater Prediction of Response to Scs Than Lead Screening Trial: A Predictive AI-Based Multicenter Study

International audiencePersistent Pain after Spinal Surgery can be successfully addressed by Spinal Cord Stimulation (SCS). International guidelines strongly recommend that a lead trial be performed before any permanent implantation. Recent clinical data highlight some major limitations of this approach. First, it appears that patient outcomes, WITH OR WITHOUT lead trial, are similar. In contrast, during trialing, infection rate drops drastically within time and can compromise the therapy. Using composite pain assessment experience and previous research, we hypothesized that ma-chine learning models could be robust screening tools and reliable predictors of long-term SCS efficacy. We developed several algorithms including logistic regression, Regularized Logistic Regression (RLR), naive Bayes classifier, artificial neural networks, random forest and gradient boosted trees to test this hypothesis and to perform internal and external validations, the objec-tive being to confront model predictions with lead trial results using a 1-year composite out-come from 103 patients. While almost all models have demonstrated superiority on lead trial-ing, the RLR model appears to represent the best compromise between complexity and inter-pretability in prediction of SCS efficacy. These results underscore the need to use AI based-predictive medicine, as a synergistic mathematical approach, aimed at helping implanters to optimize their clinical choices on daily practice

Comparison of Spinal Cord Stimulation vs. Dorsal Root Ganglion Stimulation vs. Association of Both in Patients with Refractory Chronic Back and/or Lower Limb Neuropathic Pain: An International, Prospective, Randomized, Double-Blinded, Crossover Trial (BOOST-DRG Study)

While spinal cord stimulation (SCS) is a well-established therapy to address refractory persistent spinal pain syndrome after spinal surgery (PSPS-T2), its lack of spatial selectivity and reported discomfort due to positional effects can be considered as significant limitations. As alternatives, new waveforms, such as burst stimulation and different spatial neural targets, such as dorsal root ganglion stimulation (DRGS), have shown promising results. Comparisons between DRGS and standard SCS, or their combination, have never been studied on the same patients. “BOOST DRG” is the first prospective, randomized, double-blinded, crossover study to compare SCS vs. DRGS vs. SCS+DRGS. Sixty-six PSPS-T2 patients will be recruited internationally in three centers. Before crossing over, patients will receive each stimulation modality for 1 month, using tonic conventional stimulation. After 3 months, stimulation will consist in switching to burst for 1 month, and patients will choose which modality/waveform they receive and will then be reassessed at 6 and 12 months. In addition to our primary outcome based on pain rating, this study is designed to assess quality of life, functional disability, psychological distress, pain surface coverage, global impression of change, medication quantification, adverse events, brain functional imaging and electroencephalography, with the objective being to provide a multidimensional insight based on composite pain assessment

The Challenge of Converting “Failed Spinal Cord Stimulation Syndrome” Back to Clinical Success, Using SCS Reprogramming as Salvage Therapy, through Neurostimulation Adapters Combined with 3D-Computerized Pain Mapping Assessment: A Real Life Retrospective Study

While paresthesia-based Spinal Cord Stimulation (SCS) has been proven effective as treatment for chronic neuropathic pain, its initial benefits may lead to the development of “Failed SCS Syndrome’ (FSCSS) defined as decrease over time related to Loss of Efficacy (LoE) with or without Loss of Coverage (LoC). Development of technologies associating new paresthesia-free stimulation waveforms and implanted pulse generator adapters provide opportunities to manage patients with LoE. The main goal of our study was to investigate salvage procedures, through neurostimulation adapters, in patients already implanted with SCS and experiencing LoE. We retrospectively analyzed a cohort of patients who were offered new SCS programs/waveforms through an implanted adapter between 2018 and 2021. Patients were evaluated before and at 1-, 3-, 6- and 12-month follow-ups. Outcomes included pain intensity rating with a Visual Analog Scale (VAS), pain/coverage mappings and stimulation preferences. Last follow-up evaluations (N = 27) showed significant improvement in VAS (p = 0.0001), ODI (p = 0.021) and quality of life (p = 0.023). In the 11/27 patients with LoC, SCS efficacy on pain intensity (36.89%) was accompanied via paresthesia coverage recovery (55.57%) and pain surface decrease (47.01%). At 12-month follow-up, 81.3% preferred to keep tonic stimulation in their waveform portfolio. SCS conversion using adapters appears promising as a salvage solution, with an emphasis on paresthesia recapturing enabled via spatial retargeting. In light of these results, adapters could be integrated in SCS rescue algorithms or should be considered in SCS rescue

Un indice de réponse clinique multidimensionnel pour améliorer l’évaluation de la douleur chez les patients souffrant d’un syndrome de douleur rachidienne persistante après une chirurgie rachidienne, une étude multicentrique prospective en vie réelle

International audienceIntroductionLes lomboradiculalgies postopératoires (LRPO), comme d’autres types de douleur, sont considérées comme une expérience sensorielle et émotionnelle désagréable influencée par des facteurs biologiques, psychologiques et sociaux [1, 2, 3]. Malgré l’innovation constante de la technologie numérique et de l’intelligence artificielle, la douleur est toujours évaluée par des « outils de référence » tels que l’échelle visuelle analogique de la douleur (EVA) [4]. La principale limite de cet outil est qu’il ne tient pas compte des nombreuses dimensions de la douleur, comme les incapacités fonctionnelles, la détresse psychologique ou de la qualité de vie [3]. En pratique, les évaluations de ces dimensions sont considérées indépendamment, même si l’expérience clinique souligne l’imbrication de ces dimensions les unes avec les autres. Notre objectif était de développer un nouvel indice multidimensionnel de réponse clinique (MCRI), incluant l’intensité de la douleur, la capacité fonctionnelle, l’anxiété/dépression, la qualité de vie et la cartographie de la douleur, l’objectif étant une évaluation multidimensionnelle des douleurs.Matériel et méthodesC’est une étude observationnelle, prospective, multicentrique (PREDIBACK) incluant 200 patients avec des LRPO avec un suivi de 12 mois. L’intensité de la douleur, la surface de la douleur corporelle (en cm2 via une interface tactile), l’incapacité fonctionnelle (Oswestry Disability Index), l’anxiété/dépression (Hospital Anxiety and Depression scale), la qualité de vie (EuroQol-5 dimensions). Ces résultats ont été combinés à l’aide d’une analyse factorielle pour créer l’indice composite MCRI. Le MCRI a été comparé aux autres mesures par des tests de corrélations. La capacité du MCRI à détecter la satisfaction du patient après une thérapie a également été analysée.RésultatsLe MCRI représentait de façon plus pertinente toutes les dimensions de la douleur comparée aux autres scores classiques (corrélation avec les autres critères>0,603). De plus, comparé aux autres critères, le MCRI a montré la plus grande sensibilité (77,4 %) et spécificité (79,8 %) pour détecter de la satisfaction du patient par rapport aux autres scores.Discussion/conclusionCe nouvel indice composite MCRI pourrait contribuer à affiner l’évaluation de l’état de santé général du patient douloureux chronique sur la base de paramètres objectifs. Ce nouvel indice MCRI doit être éprouvé en milieu clinique afin de déterminer l’efficacité des thérapies

A Novel Multi-dimensional Clinical Response Index Dedicated to Improving Global Assessment of Pain in Patients with Persistent Spinal Pain Syndrome After Spinal Surgery, Based on a Real-life Prospective Multicentric Study (PREDIBACK) and Machine Learning

International audienceThe multidimensionality of chronic pain forces us to look beyond isolated pain assessment such as pain intensity, which does not consider multiple key parameters, particularly in patients suffering from post-operative Persistent Spinal Pain Syndrome (PSPS-T2). Our ambition was to provide a novel Multi-dimensional Clinical Response Index (MCRI), including not only pain intensity but also functional capacity, anxiety-depression, quality of life and objective quantitative pain mapping assessments, the objective being to capture patient condition instantaneously, using machine learning techniques. Two hundred PSPS-T2 patients were enrolled in a real-life observational prospective PREDIBACK study with 12-month follow-up and received various treatments. From a multitude of questionnaires/scores, specific items were combined using exploratory factor analyses to create an optimally accurate MCRI; as a single composite index, using pairwise correlations between measurements, it appeared to better represent all pain dimensions than any other classical score. It appeared to be the best compromise among all existing indexes, showing the highest sensitivity/specificity related to Patient Global Impression of Change (PGIC). Novel composite indexes could help to refine pain assessment by changing the physician’s perception of patient condition on the basis of objective and holistic metrics, and by providing new insights to therapy efficacy/patient outcome assessments, before ultimately being adapted to other pathologies

Finite Mixture Models Based on Pain Intensity, Functional Disability and Psychological Distress Composite Assessment Allow Identification of Two Distinct Classes of Persistent Spinal Pain Syndrome after Surgery Patients Related to Their Quality of Life

Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), (Failed Back Surgery Syndrome), dramatically impacts on patient quality of life, as evidenced by Health-Related Quality of Life (HRQoL) assessment tools. However, the importance of functioning, pain perception and psychological status in HRQoL can substantially vary between subjects. Our goal was to extract patient profiles based on HRQoL dimensions in a sample of PSPS-T2 patients and to identify factors associated with these profiles. Two classes were clearly identified using a mixture of mixed effect models from a clinical data set of 200 patients enrolled in “PREDIBACK”, a multicenter observational prospective study including PSPS-T2 patients with one-year follow-up. We observed that HRQoL was more impacted by functional disability for first class patients (n = 136), and by pain perception for second class patients (n = 62). Males that perceive their work as physical were more impacted by disability than pain intensity. Lower education level, lack of adaptive coping strategies and higher pain intensity were significantly associated with HRQoL being more impacted by pain perception. The identification of such classes allows for a better understanding of HRQoL dimensions and opens the gate towards optimized health-related quality of life evaluation and personalized pain management