[Diagnosis and therapeutic current approach of obsessive compulsive disorder in children].

International audienceIn the past years, obsessive-compulsive disorder has mainly been described in adults. However, recent epidemiological data has shown that 2 to 3% of the school-age population has OCD symptoms in the clinical range of severity. Despite these findings, this disorder remains still unknown and under recognized by child's clinicians--general practitioners, paediatricians or child and adolescent psychiatrists. This may contribute to the particularly damaging delay occurring in diagnosis and specific treatment of childhood onset OCD. Therefore, this article intends to review the main clinical signs likely to allow an early detection of OCD in child as well as the principal therapeutic methods currently in progress

[From tics to obsessive-compulsive disorders in children: a subsequent risk now recognized].

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How much progress has there been in the second-line treatment of multiple sclerosis: A 2017 update

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Comparison of two individualized administration schemes of rituximab based on memory B cells monitoring in AQP4 positive disorder

International audienceBackground: Individualized dosing schedule of rituximab based of memory B-cells count has been demonstrated to be safe and effective for the treatment of patients with AQP4-antibody disorder.Objective: To compare the efficacy of two different individualized administration schemes of rituximab for the treatment of patients with AQP4-antibody disorder. Design/Methods: Adult patients with AQP4-antibody disorder treated with rituximabat the Multiple Sclerosis Center of Marseillewere included in a prospective observational study. Patients were treated using an individualized dosing schedule adapted to the biological effect of rituximab monitored by monthly memory B-cells counts. Between January 2012 and August 2016, rituximab re-infusion was performed only when memory B-cells reached 0.05% of the peripheral blood mononuclear cells ('original scheme'). Becauserelapses occurred after 6 months in several patients, we decided in August 2016 to optimize the protocol. Before 6 months, patients were re-treated if memory B-cells reached the threshold of 0.05%. At 6 months, patients were re-treated regardless of the level of memory B-cells if memory B-cells had not reemerged before ('optimized scheme'). Annual relapse rates were compared between the two administration schemes. Only data of patients treated during at least one year using one of the two schemes were included in the analysis.Results: Fifteen patients were treated using the 'original scheme' during at least one year (mean duration: 28 months (13 - 55)). In these patients mean annual relapse rate was 0.35 (0-1.6). Twenty-nine patients were treated using the 'optimized scheme' during at least one year (mean duration 22 months (13 - 25)). In these patients mean annual relapse rate was 0.04 (0-0.7). In patients first treated with the 'original scheme' and secondly with the 'optimized scheme' (n=15) relapse rate decreased from 0.35 (0-1.6) to 0 (p< 0.001).Conclusions: Compared to the non-individualized classical 6 months rituximab administration scheme, the present individualized 'optimized scheme' enables to detect rapid reemergence of memory B-cells before 6 months without the risk of relapse after 6 months inherent to the individualized 'original scheme'

Urinary tract infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society

International audienceObjectives: Establish recommendations for the management of UTIs in MS patients.Background: Urinary tract infections (UTIs) are common during multiple sclerosis (MS) and are one of the most common comorbidities potentially responsible for deaths from urinary sepsis.Methods: The recommendations attempt to answer three main questions about UTIs and MS. The French Group for Recommendations in MS (France4MS) did a systematic review of articles from PubMed and universities databases (01/1980-12/2019). The RAND/UCLA appropriateness method, which has been developed to synthesize the scientific literature and expert opinions on health care topics, was used for reaching a formal agreement. 26 MS experts worked on the full-text review and a group of 70 multidisciplinary health care specialists validated the final evaluation of summarized evidences.Results: UTIs are not associated with an increased risk of relapse and permanent worsening of disability. Only febrile UTIs worsen transient disability through the Uhthoff phenomenon. Some immunosuppressive treatments increase the risk of UTIs in MS patients and require special attention especially in case of hypogammaglobulinemia. Experts recommend to treat UTIs in patients with MS, according to recommendations of the general population. Prevention of recurrent UTIs requires stabilization of the neurogenic bladder. In some cases, weekly oral cycling antibiotics can be proposed after specialist advice. Asymptomatic bacteriuria should not be screened for or treated systematically except in special cases (pregnancy and invasive urological procedures).Conclusion: Physicians and patients should be aware of the updated recommendations for UTis and MS