Epidemiological situation of Lyme borreliosis in Belgium, 2003 to 2012.

BACKGROUND: Some studies show that the incidence of Lyme borreliosis is increasing in different European countries. In order to evaluate if this is also the case in Belgium, different data sources were consulted to describe the epidemiology of Lyme borreliosis in the country during the last decade. METHODS: Data from two databases were analyzed for the time period 2003-2010 and 2003-2012 for respectively: the registration of minimal clinical data from Belgian hospitals (principal and secondary diagnosis), and a sentinel laboratory network reporting positive laboratory results. RESULTS: The number of hospitalized cases per year remained stable between 2003 and 2010, ranging from 970 (in 2008) to 1453 (in 2006), with a median of 1132.5 cases per year. Between 2003 and 2012, yearly fluctuations in the number of positive tests were reported by the sentinel laboratory network (with a minimum of 996 positive tests in 2007 and a maximum of 1651 positive tests in 2005), but there is no increasing trend over the study period (median = 1200.5 positive tests per year). The highest incidence rates of hospitalization and the highest reported incidence of positive laboratory results are registered in the provinces of Luxemburg, Limburg, Flemish Brabant and Antwerp, with a typical seasonal pattern (peak in September). The age groups affected most are those from 5 to 14 years and 45 to 69. CONCLUSION: Based on hospital records and laboratory results, no increasing trend in Lyme disease was observed over the 2003-2012 period in Belgium. These results are in line with the stable incidence of erythema migrans reported by a sentinel network of general practitionners between 2003 and 2009. Multi-source surveillance of vector-borne diseases should be further implemented

Correction to: Eight years after an international workshop on myotonic dystrophy patient registries: Case study of a global collaboration for a rare disease (Orphanet Journal of Rare Diseases (2018) 13 (155) DOI: 10.1186/s13023-018-0889-0)

The original version of this article [1] unfortunately included an error to an author\u27s name. Author Jordi Díaz-Manera was erroneously presented as Jorge Alberto Diaz Manera. The correct author name has been included in the author list of this Correction article. For citation purposes the author\u27s given name is Jordi and family name Diaz-Manera. Therefore, the correct citation of the author\u27s details is: Diaz-Manera J

Eight years after an international workshop on myotonic dystrophy patient registries: case study of a global collaboration for a rare disease.

Background Myotonic Dystrophy is the most common form of muscular dystrophy in adults, affecting an estimated 10 per 100,000 people. It is a multisystemic disorder affecting multiple generations with increasing severity. There are currently no licenced therapies to reverse, slow down or cure its symptoms. In 2009 TREAT-NMD (a global alliance with the mission of improving trial readiness for neuromuscular diseases) and the Marigold Foundation held a workshop of key opinion leaders to agree a minimal dataset for patient registries in myotonic dystrophy. Eight years after this workshop, we surveyed 22 registries collecting information on myotonic dystrophy patients to assess the proliferation and utility the dataset agreed in 2009. These registries represent over 10,000 myotonic dystrophy patients worldwide (Europe, North America, Asia and Oceania). Results The registries use a variety of data collection methods (e.g. online patient surveys or clinician led) and have a variety of budgets (from being run by volunteers to annual budgets over €200,000). All registries collect at least some of the originally agreed data items, and a number of additional items have been suggested in particular items on cognitive impact. Conclusions The community should consider how to maximise this collective resource in future therapeutic programmes

Kinematic covariation in pediatric, adult and elderly subjects : Is gait control influenced by age?

BACKGROUND: In human walking, kinematics of lower limb segments covary. Our objective was to assess the impact of age at different speeds (slow, medium and fast) on kinematic segmental covariation in normal subjects. METHODS: Thirty subjects ranged into 6 age groups ("5years", "10years", "15years", "20years" and "70years") were included. We performed a gait analysis on a treadmill at 3 predetermined speeds: 1 (slow), 3 (medium) and 5 (fast) kmh(-1), except for the 5years group who was unable to walk at 5kmh(-1). Kinematic segmental covariation was computed and represented by a 3D-loop, described by a principal component analysis (Borghese's methodology). We studied the percentage of variance of each component of the principal component analysis, knowing that the percentage of variance of the first and the second components reflected the shape of the loop, and that the percentage of variance of the third component was an index of its planarity. The effect of age was tested using a one-way analysis of variance. FINDINGS: When comparing the age groups at the same speed, we found a significant difference in the percentage of variance of the first and the second components between the 5 and the 10years at 3kmh(-1). We also noticed a difference in the percentage of variance of the third component at 5kmh(-1) between the 10years and the 15 and 20years groups. INTERPRETATION: We observed that kinematic covariation remains stable throughout adulthood between 15 and 70years old at slow, medium and fast speed. In children, a mature percentage of variance of the first and the second components is acquired from 10years old and a mature percentage of variance of the third component from 15years old

Influence of ankle-foot orthoses on kinematic segmental covariation among stroke patients.

OBJECTIVES: To evaluate the effect of ankle-foot orthosis on lower limbs kinematic segmental covariation (KSC) among stroke patients. METHODS: Ten chronic hemiparetic spastic stroke patients presenting with a lack of ankle dorsiflexion were assessed with instrumented gait analysis under three conditions: wearing a shoe, with a prefabricated ankle-foot orthosis (AFO), and with a dynamic AFO. Kinematic parameters were recorded and computed KSC was calculated according to Borghese's methodology. RESULTS: Contrary to the prefabricated AFO, the dynamic AFO improved KSC of the paretic side. We observed a high correlation between the external mechanical work and the affected side's KSC. In the unaffected side, KSC was globally unchanged. CONCLUSION: In stroke patients, wearing a dynamic AFO improves KSC of the paretic lower limb only

Assessment of the Chignon ® dynamic ankle-foot orthosis using instrumented gait analysis in hemiparetic adults

OBJECTIVE: In the hemiplegic adult, gait is frequently perturbed by lack of ankle dorsiflexion at toe-off and may prompt prescription of an ankle-foot orthosis (AFO). Our objective was to evaluate the effect on gait of a dynamic AFO (the Chignon((R)) orthosis) in comparison with a prefabricated AFO (PAFO). METHOD: Ten chronic hemiplegic patients performed a 10m gait test and then underwent an instrumented treadmill gait test under three different sets of conditions (without an orthosis, with a PAFO and with a Chignon((R)) orthosis). The energy cost was calculated by measuring the oxygen consumption during gait. RESULTS: The patients' free-walking speed was higher with the Chignon((R)) orthosis (0.81+/-0.25ms(-1)) than without it (0.64+/-0.25ms(-1); p<0.001). The ankle's segmental kinematics were better with the Chignon((R)) orthosis than without an orthosis, notably in terms of ankle position at heel strike (-0.8 degrees +/-4.6 versus -7.9 degrees +/-8.3; p=0.009) and ankle dorsiflexion at toe-off (1.7 degrees +/-4.6 versus -5.5 degrees +/-7.2; p=0.006). External mechanical work was lower with both the PAFO (0.61+/-0.2Jkg(-1)m(-1)) and the Chignon((R)) orthosis (0.61+/-0.23Jkg(-1)m(-1)), relative to gait without an orthosis (0.73+/-0.25Jkg(-1)m(-1); p=0.003). Total mechanical work was also lower with the PAFO (0.9+/-0.25Jkg(-1)m(-1)) and the Chignon((R)) orthosis (0.87+/-0.25Jkg(-1)m(-1)), relative to gait without an orthosis (1.09+/-0.37Jkg(-1)m(-1); p=0.001), whereas the reduction in energy cost with orthosis use was borderline-significant (p=0.06). CONCLUSION: Mechanical work was similarly improved by the two orthoses. The Chignon((R)) orthosis improved the free-walking speed and the ankle's segmental kinematics

Évaluation de l’intérêt d’une orthèse suro-pédieuse dynamique (orthèse Chignon®) par analyse quantifiée de la marche chez l’adulte hémiparétique

Objectif La marche de l’adulte hémiparétique est fréquemment perturbée par un déficit de flexion dorsale de la cheville en phase oscillante pour lequel une orthèse suro-pédieuse peut être indiquée. Notre objectif est d’évaluer l’effet d’une orthèse suro-pédieuse dynamique, l’orthèse Chignon® sur la marche en la comparant à une orthèse suro-pédieuse préfabriquée (OSPP). Méthode Dix patients hémiparétiques chroniques ont réalisé un test de marche de 10 m et une analyse quantifiée de la marche sur tapis roulant sous trois conditions différentes : sans orthèse, avec une OSPP et avec une orthèse Chignon®. Le coût énergétique a été calculé à partir de la mesure de la consommation d’oxygène pendant la marche. Résultats Les patients marchent spontanément plus vite avec l’orthèse Chignon® (0,81 ± 0,25 ms−1) que sans orthèse (0,64 ± 0,25 ms−1 ; p < 0,001). La cinématique segmentaire de la cheville est meilleure avec l’orthèse Chignon® que sans orthèse pour la position de la cheville à la pose du pied au sol (−0,8° ± 4,6 contre −7,9° ± 8,3 ; p = 0,009) et la flexion dorsale de cheville en milieu de phase oscillante (1,7 ° ± 4,6 contre −5,5° ± 7,2 ; p = 0,006). Le travail mécanique externe est diminué avec l’OSPP (0,61 ± 0,2 J kg−1 m−1) et l’orthèse Chignon® (0,61 ± 0,23 J kg−1 m−1) par rapport à la marche sans orthèse (0,73 ± 0,25 J kg−1 m−1 ; p = 0,003). Le travail mécanique total est également diminué avec l’OSPP (0,9 ± 0,25 J kg−1 m−1) et l’orthèse Chignon® (0,87 ± 0,25 J kg−1 m−1) par rapport à la marche sans orthèse (1,09 ± 0,37 J kg−1 m−1 ; p = 0,001), alors que l’amélioration du coût énergétique est à la limite de la signification (p = 0,06). Conclusion Le travail mécanique est amélioré de façon similaire avec les deux orthèses. L’orthèse Chignon® améliore la vitesse spontanée de marche et la cinématique segmentaire de cheville

Experience with external pump trial prior to implantation for intrathecal baclofen in ambulatory patients with spastic cerebral palsy [Prédiction de l'efficacité du baclofène intrathécal chez les patients infirmes moteurs cérébraux à potentiel ambulatoire : intérêt du placement d'une pompe externe]

OBJECTIVES: To evaluate effectiveness and safety of intrathecal baclofen administration (ITB) testing with continuous infusion via an external pump before the implantation of an internal one in ambulatory spastic patients with cerebral palsy (CP). PATIENTS AND METHODS: Seven CP patients (3 diplegic, 4 quadriplegic - 18.4+/-7.0 years) with a progressive decrease in walking ability were included. Assessments included: Ashworth's scale, Observational Gait Scale (OGS), and GMFM-66. RESULTS: During the ITB test (45-150 microg/24h), spasticity decreased by more than two points on Ashworth's scale (p<0.001) and walking ability improved (median OGS increased from 7 to 9, p<or=0.05). After implantation of an internal Synchromed pump (dosage 66-160 microg/24h), mean GMFM-66 increased from 49.9+/-7.3 to 54.5+/-7.7 (p<0.05) and median OGS from 7 to 10 (p<0.05). Two nonambulatory patients recovered some walking ability following implantation of the pump. Adverse effects included one case of chemical meningitis during the test and two temporary CSF leaks. CONCLUSIONS: Tests of ITB using a continuous infusion by an external pump allowed precise evaluation of the effects of different ITB doses on walking ability, enabling prediction of how the patient would respond to an internal pump. All patients showed ambulatory improvement with ITB

Reliability of lower limb kinematics, mechanics and energetics during gait in patients after stroke.

OBJECTIVE: To assess the reliability of kinematic, mechanical and energetic gait variables at short (1 day) and medium (1 month) intervals in adult patients after stroke. DESIGN: Prospective study. SUBJECTS: Ten patients with chronic post-stroke (mean age 53.5 years; age range 25-80 years). METHODS: Three-dimensional gait analysis was performed 3 times in these subjects: at baseline (T0), after 1 day (T1) and after 1 month (T2). The reliability of the gait analysis was tested by comparing gait variables measured at T1 and T0 (1 day interval), at T2 and T0 (1 month interval). The inter-session reliability of kinematic, mechanical and energetic variables was calculated by intra-class correlation coefficient (ICC). RESULTS: The reliability of kinematic variables ranged from excellent to moderate (ICC >or= 0.51), except for the ankle position at heel strike (ICC = 0.44). The reliability of mechanical and energetic variables ranged from excellent to good (ICC >or= 0.71). The most reliable variable was external mechanical work (ICC = 0.96). The kinematic, mechanical and energetic variables did not change significantly between T0, T1 and T2 (repeated-measures analysis of variance). CONCLUSION: Kinematic, mechanical and energetic gait variables present good reliability when measured at 1 day and 1 month intervals in adult patients after stroke