Contribution a l'étude des accidents vasculaires cérébraux par la stimulation magnétique transcranienne du cortex moteur

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Complications of Spine Surgery and Litigations – Managing Malpractice Risk

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Magnetic transcranial stimulation: Clinical interest of the silent period in acute and chronic stages of stroke

There is little information on the silent period during facilitation of the target muscle at the acute stage of stroke and the ultimate clinical status. We studied 69 subjects with transcranial magnetic stimulation: 20 matched controls and 49 hemiparetic patients investigated 7 and 90 days after the stroke (D7, D90). We measured the silent period duration (SPD) in the first dorsal interosseous muscle at 10 and 100% of maximal voluntary isometric contraction (VIC). The SPD index (the ratio of SPD at VIC 100% by SPD at VIC 10%) at D7 was matched with the clinical outcome at D90. Two patterns of responses could be determined at D7. In the normal subjects and in 27 out of 32 patients who eventually recovered satisfactory function at D90, the SPDs were stable during facilitation (SPD index 100%). On the contrary, in 10 out of the 17 patients with a poor functional outcome, the mean SPD decreased when VIC was increased (SPD index 80%); besides, their muscle tone was significantly increased at D90. Similar patterns were still present in the patients at D90: the mean SPD indexes were not significantly different from D7. We conclude that in the early stage of stroke, a low SPD index appears to be correlated with the eventual occurrence of spasticity.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Magnetic transcranial stimulation: Dissociation of excitatory and inhibitory mechanisms in acute strokes

Magnetic transcranial stimulation was applied to 12 normal subjects and 30 patients (24 acute and 6 chronic) with hemiparesis contralateral to an ischaemic stroke. In the 24 acute patients, the recordings were made at the 7th day on the contralateral first dorsal interosseous (FDI) muscle. We studied the amplitudes of the motor evoked potential (MEP) responses and the post-MEP silent period durations (SPD) at different levels of stimulation intensity (SI) and voluntary isometric contraction (VIC). The evolution of these parameters was matched to the clinical status of the 24 acute patients evaluated 7, 30 and 90 days after the stroke (D7, D30 and D90). Our results may be summarised as follows: (1) in all cases, the MEP-amplitudes increased with facilitation and SI; (2) in the normal subjects and in patients who did recover, the SPD augmented with stronger SI but was found to be independent on the strength of voluntary contraction; (3) in the acute patients with poor recovery, as well as in the chronic patients with spasticity, the SPD decreased with stronger VIC. It may be concluded that MEP-amplitudes and SPD patterns point out excitatory and inhibitory mechanisms which may be differently affected in cerebral injuries. The association between shortening of the SPD with increasing VIC of the target muscle and poor recovery of the stroke after 3 months could be a useful clinical test to predict eventual recovery early after a stroke.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

La responsabilité professionnelle dans le secteur des soins de santé. Une vision de la procédure par le thérapeute, ou l'envers du décor

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Magnetic transcranial stimulation in acute stroke: Early excitation threshold and functional prognosis

Magnetic transcranial stimulation was used in 90 subjects (60 acute ischaemic sylvian strokes and 30 healthy controls) in order to evaluate the clinical value of the excitation threshold (ET) in the estimation of functional prognosis. ET mean values recorded 7, 30 and 90 days after stroke (at D7, D30 and D90) in two distal muscles of the upper limbs of the patients were compared with results obtained in 30 healthy control subjects. The data from the patients who ultimately achieved a satisfactory functional recovery at D90 were compared with those from patients who had not recovered in that time. Our results suggest that ET evolution differs according to functional outcome: (1) ET mean values were increased in the stroke patients at D7, but ET was constantly lower at D30 and D90 in patients who recovered than in those who did not. (2) ET temporal evolution showed a gradual decrease of the mean values from D7 to D90 in both stroke groups. This ET decrease was more marked in the patients who recovered from D30 to D90, but with only minor change after D30. (3) The localisation of the lesion had no significant effect on ET mean values at D7, D30 or D90. We conclude that the predictive value of ET estimation might be utilised at D30 in patients with ischaemic sylvian strokes.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Magnetic transcranial stimulation in non-haemorrhagic sylvian strokes: interest of facilitation for early functional prognosis

Magnetic transcranial stimulation was applied to 40 patients in the early stage of a non-haemorrhagic sylvian stroke. Results were evaluated with regards to the clinical outcomes at days 7, 30 and 90. The presence or absence of an early response had a critical prognostic significance. Response latency and amplitude parameters and the excitation threshold were of little value. Facilitation in patients unresponsive at rest was another determinant parameter since 9 out of 10 such cases ultimately recovered. © 1995.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Is the Nociception Coma Scale-Revised a Useful Clinical Tool for Managing Pain in Patients with Disorders of Consciousness?

OBJECTIVES: Our objective was to assess the clinical interest of the Nociception Coma Scale Revised (NCS-R) in pain management of patients with disorders of consciousness. METHODS: Thirty-nine patients with potential painful conditions (e.g., due to fractures, decubitus ulcers or spasticity) were assessed during nursing cares before and after the administration of an analgesic treatment tailored to each patient's clinical status. In addition to the NCS-R, the Glasgow Coma Scale (GCS) was used before and during treatment in order to observe fluctuations in consciousness. Twenty-three of them had no analgesic treatment prior to the assessment whereas the analgesic treatment has been adapted in the other 16 patients. We performed non-parametric Wilcoxon tests to investigate the difference in the NCS-R and GCS total scores but also in the NCS-R subscores before versus during treatment. The effect of the level of consciousness and the etiology were assessed using a U Mann Whitney. RESULTS: NCS-R total scores were statistically lower during treatment when compared to the scores obtained before treatment. We also found that the motor, verbal and facial expression subscores were lower during treatment than before treatment. On the other hand, we found no difference between the GCS total scores obtained before versus during treatment. DISCUSSION: Our results suggest that the NCS-R is an interesting clinical tool for pain management. Besides, this tool seems useful when a balance is needed between reduced pain and preserved level of consciousness in patients with disorders of consciousness