Effets centraux de la toxine botulique : approche neurophysiologique chez le patient hémiplégique spastique après un AVC

Introduction : The therapeutic effects of intramuscular injections of Botulinum toxin type A (BTx) on spasticity can be largely explained by its blocking action at the neuromuscular junction. BTx is assumed to also have a central action by affecting the functional organization of the CNS. The aim of the present study is to assess the action of BTx on spinal motor networks by investigating the post-activation depression (Post-AD) of the soleus H-reflex in post-stroke patients presenting lower limb spasticity.Methods : Soleus H-reflex was investigated in chronic hemiplegic patients before and 3, 6, 12 weeks after BTxinjections in soleus. H-reflex amplitude was analyzed in response to electrical stimulation of the tibial nerve at 0.1 Hz and 0.5 Hz. Post-AD was quantified as the ratio H0.5 Hz/H0.1 Hz.Results : The Post-AD was significantly reduced in the affected side compared to the non-affected side before BTx injection. Three weeks after injection, the Post-AD was reinforced in the paretic leg and significantly higher than in pre-injection condition.Conclusion : BTx-treatment restores the Post-AD of soleus H-reflex in post-stoke paretic patients. As Post-AD amount is correlated to the severity of spasticity, it can be assumed that BTx’sIntroduction : les effets thérapeutiques des injections intramusculaires de toxine botulinique (BTx) sur la spasticité s'expliquent principalement par blocage de la jonction neuromusculaire. La toxine est supposée avoir également une action centrale en affectant l'organisation fonctionnelle du SNC. Le but de l’étude est d'évaluer l'action de la BTx sur les réseaux spinaux par l'analyse de la dépression post- activation (Post-AD) du réflexe-H du soléaire chez les patients post-AVC présentant une spasticité des membres inférieurs.Méthodes : le réflexe-H du soléaire est étudié chez les patients hémiplégiques chroniques avant et 3, 6, 12 semaines après l'injection BTx dans le soléaire. L’amplitude du réflexe est analysée en réponse à une stimulation électrique du nerf tibial à 0,1 Hz et 0,5 Hz. La post-activation est évaluée par le ratio H0,5 Hz/H0,1 Hz.Résultats : la Post-AD est significativement réduite du côté affecté par rapport au côté sain avant l'injection BTx. Trois semaines après l'injection, la Post-AD est renforcée dans la jambe parétique et significativement plus élevée qu‘en pré-injection.Conclusion : le traitement BTx restaure la Post-AD du réflexe H du soléaire chez les patients post-AVC. La Post-AD étant corrélée à la sévérité de la spasticité, on peut supposer que l'efficacité de la BTx dans la réadaptation post-AVC est également due à des changements induits dans les réseaux spinaux

Hitchcock Lost and Found: The Forgotten Films

Known as the celebrated director of critical and commercial successes such as Psycho(1960) and The Birds(1963), Alfred Hitchcock is famous for his distinctive visual style and signature motifs. While recent books and articles discussing his life and work focus on the production and philosophy of his iconic Hollywood-era films like Notorious(1946) and Vertigo(1958), Hitchcock Lost and Found moves beyond these seminal works to explore forgotten, incomplete, lost, and recovered productions from all stages of his career, including his early years in Britain. Authors Alain Kerzoncuf and Charles Barr highlight Hitchcock's neglected works, including various films and television productions that supplement the critical attention already conferred on his feature films. They also explore the director's career during World War II, when he continued making high-profile features while also committing himself to a number of short war-effort projects on both sides of the Atlantic. Focusing on a range of forgotten but fascinating projects spanning five decades, Hitchcock Lost and Found offers a new, fuller perspective on the filmmaker's career and achievements

La pêche maritime : son évolution en France et à l'étranger... / Joseph Kerzoncuf,...

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Satisfaction and long-term use of orthopedic shoes in people with chronic stroke

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