Mouvements choréo-athétosiques et syndrome anti-Hu

Introduction. Paraneoplastic choreo-athetoses are rare. We report a case of anti-Hu syndrome with choreoathetosis. Case report. A 48-year-old woman developed a small-cell lung carcinoma revealed by an anti-Hu syndrome. The neurological features included choreo-athetosis predominating in the upper limbs, chronic sensorimotor axonal polyneuropathy, and opsoclonus. The cerebrospinal fluid was acellular and contained several oligoclonal IgG bands, not found in the corresponding serum. Magnetic resonance imaging revealed bilateral high-intensity lesions on T2/FLAIR sequence in the corona radiata. Moderate transitory improvement of the paraneoplastic neurological syndrome was observed after several carboplatin-etoposid cycles. Conclusion. A paraneoplastic origin must be considered in all cases of unexplained choreo-athetosis. Paraneoplastic choreo-athetosis is most often associated with other neurological symptoms. The most frequent associated tumor is a small-cell lung carcinoma with anti-CRMP5 and/or anti-Hu antibodies. Our patient developed paraneoplastic choreo-athetosis related to an anti-Hu syndrome in the absence of anti-CRMP5/CV2 antibodies. Paraneoplastic choreo-athetosis might result from a central lesion, and/or from proprioceptive deafferentation subsequent to peripheral neuropathy

DO THE LANDMARKS USED IN THE MODIFIED SCHOBER TEST COVER THE ENTIRE LUMBAR SPINE? PROPOSAL FOR A NEW MARKING PROCEDURE

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WHOLE-BODY CRYOTHERAPY AN ADJUNCT TREATMENT ON PAIN AND FUNCTIONAL MOBILITY FOR PATIENTS WITH FIBROMYALGIA: A PROOF OF CONCEPT

J.J. Laskin1, R. Taiar2, M. Vitenet2, F. Tubez4, G. Dorban3, B. Bouchet4, G. Polidori2, R.F. Legrand2, A. Rapin2, F.C. Boyer2 1University of Montana, Missoula, MT; 2University of Reims Champagne-Ardenne, France; 3Robert Schuman University College, Libramont Chevigny, Belgium; 4Cryotherapy Pole, Reims, France Fibromyalgia is a chronic musculoskeletal disorder which causes fatigue, decrease functional status and sleep disorders. PURPOSE: To determine whether Whole-Body Cryotherapy (WBC) would be tolerated by individuals with fibromyalgia and would improve their short-term pain and functional status. METHODS: The study was a randomized controlled trial with one between-subject factor (group) and one within-subject factor (baseline, post study, 2 and 4-weeks post intervention). A sample of convenience of 17 women were randomized into either a WBC (n=8, age=58.9±7.5 yrs) or control group (CON) (n=9, age=53.3±10.5 yrs). The WBC group participated in 10 cryotherapy sessions and was performed (additional to usual care) in a two-stage cryogenic chamber over a duration of 8 days (same time of day, one session per day for the first 4 and last 2 days, 2 sessions per day on days 5 and 6). Duration of each cold exposure session was 3 minutes at a temperature of -110°C. Participants in the CON followed their usual care. The primary outcome measurement was pain intensity (NRS) using a numerical scale. Secondary outcomes included: Owestry disability index (ODI), Disabilities of the Arm, Shoulder and Hand (DASH), and Lower Extremity Functional Scale (LEFS). RESULTS: There were no significant differences between the groups in age, baseline pain, number of painful sites, severity scale score or the fibromyalgia scale nor in any of the outcome variables. There was a significant reduction (p=0.002, 95%CI=1.93-6.57) in NRS for the WBC group between the mean baseline measurement (7.25±1.58) and 4-weeks post intervention, (3.00±2.62). This same positive outcome was also observed for the ODI (p=0.007, 95%CI=8.18-42.93) and the DASH (p=0.012, 95%CI=7.12-48.30). These results were not only significant but also were within the reported minimal detectable change and minimal clinically important differences. CONCLUSION: The purpose of this study was to determine the feasibility and potential efficacy of WBC in individuals with fibromyalgia. While this group of women tolerate the therapy and even demonstrated some positive short-term benefits this study provides limited support for the notion of using WBC in this population. That said, this study does support the importance of further exploration of this novel therapy

Neuroimmune connections in ovine pharyngeal tonsil: potential site for prion neuroinvasion

Recent studies have proved the possible implication of nasal associated lymphoid tissues, mainly the pharyngeal tonsil, in prion pathogenesis. However, the mechanisms of this neuroinvasion are still being debated. To determine the potential sites for prion neuroinvasion inside the ovine pharyngeal tonsil, the topography of neurofilaments heavy (200 kDa) (NFH), neurofilaments light (70 kDa) (NFL) and glial fibrillar acidic protein (GFAP) was semi-quantitatively analysed inside the different compartments of the tonsil. The results showed that the most innervated areas were the interfollicular area and the connective tissue located beneath the respiratory epithelium. Even if the germinal centre of the lymphoid follicles was poorly innervated, the existence of rare follicular dendritic cell-nerve synapses inside the germinal centre indicates that this mechanism of neuroinvasion is possible but unlikely to be unique. The host PRNP genotype did not influence the pattern of innervation in these different tonsil compartments, unlike age: an increase of nerve endings in a zone of high trafficking cells beneath the respiratory epithelium occurred with ageing. A minimal age-related increase of innervation inside the lymphoid follicles was also observed. An increase in nerve fibre density around the lymphoid follicles, in an area rich in mobile cells able to transport PrPd, could ensure a more efficient infectivity, not in the early phase but in the advanced phase of lymphoinvasion after amplification of PrPd, or could act as direct site of entry during neuroinvasion