Cognitive performance in relapsing remitting multiple sclerosis: A longitudinal study in daily practice using a brief computerized cognitive battery

<p>Abstract</p> <p>Background</p> <p>There is need for a cognitive test battery that can be easily used in clinical practice to detect or monitor cognitive performance in patients with multiple sclerosis (MS). In order to conduct, in this patient group, a preliminary investigation of the validity and utility of a brief computerized battery, the Cognitive Drug Research (CDR) battery, we longitudinally assessed cognition in patients with relapsing remitting (RR) MS.</p> <p>Methods</p> <p>Forty-three mildly disabled, clinically active RRMS patients were repeatedly assessed with the Digit Symbol Substitution Test (DSST), Paced Auditory Serial Addition Test (PASAT) and five composite scores derived from the CDR computerized cognitive test system (CDR System): Power of Attention, Continuity of Attention, Quality of Working Memory, Quality of Episodic Memory and Speed of Memory. The Multiple Sclerosis Functional Composite (MSFC) and Expanded Disability Status Scale (EDSS) measured disability.</p> <p>Results</p> <p>The composite scores from the CDR battery generally showed excellent test-retest reliability over the repeated assessments, though was low on occasions for the Quality of Working Memory and Quality of Episodic Memory measures. The CDR measures tended to be highly correlated with other measures of cognition (DSST and PASAT) and were also strongly related to disability (EDSS and MSFC). Baseline scores indicated large impairments to visual information processing speed and attention (DSST, Cohen's d 1.1; Power of Attention d 1.4 [reaction time on tasks of focussed and sustained attention]), and a moderate impairment both to sustained attention (Continuity of Attention d 0.6) and complex information processing speed (Speed of memory d 0.7 [reaction time on tasks of working and episodic Memory]), when compared to normative data derived from healthy volunteers enrolled in a series of separate, prior clinical trials. Working memory (Quality of Working Memory) and episodic memory (Quality of Episodic Memory) were unimpaired.</p> <p>Conclusions</p> <p>Preliminary validation of the CDR System indicated that for most, but not all measures psychometric properties were adequate and the measures were related to disability (EDSS and MSFC) and other measures of cognition.</p

Acute isolated ophthalmoplegia associated with high levels of anti-GQ1b antibodies.

Acute isolated ophthalmoplegia associated with high levels of anti-GQ1b antibodies

Développement des compétences relationnelles des étudiants en médecine par les jeux de rôle : s’affranchir des savoirs et savoir-faire pour travailler le savoir-être

International audienceLe développement de capacités de communication et de réflexivité dans le cadre de la relation médecin-patient fait partie des objectifs pédagogiques du deuxième cycle des études médicales en France. La réforme du Certificat de Compétence Clinique (arrêté du 8 avril 2013) en demande l’évaluation sous la forme d’une mise en situation clinique auprès d’un patient ou d’une épreuve de simulation. Dans ce contexte nous avons mis en place des jeux de rôle de simulation relationnelle et nous sommes intéressés aux conditions dans lesquelles ils permettent de développer les compétences relationnelles.Une étude observationnelle a été menée dans le cadre de l’enseignement de Sciences Humaines et Sociales auprès des 360 étudiants en troisième année de médecine de la Faculté Lyon Est en septembre 2015. Deux séances de jeux de rôle de 2h avec 4 synopsis de consultations de médecine générale chacune ont été conçues en tenant compte des recommandations de la Haute Autorité de Santé (HAS, 2012). Un questionnaire d’évaluation quantitatif et qualitatif a été utilisé pour recueillir la satisfaction et le ressenti des étudiants concernant ces séances et identifier les conditions qui ont pu favoriser le développement de compétences relationnelles.Parmi les 268 étudiants ayant répondu, 86% ont trouvé les jeux de rôle formateurs, mais 35% des étudiants ne les ont pas trouvé utiles pour se préparer aux stages hospitaliers et 16% ne se sont pas sentis à l’aise pour participer. Les commentaires mentionnaient des difficultés à rendre les jeux de rôle crédibles, ainsi qu’un manque de savoirs et de savoir-faire (conduites à tenir médicales, conduite d’un entretien). Le décalage entre le vécu des étudiants et les situations à simuler suggère qu’à ce stade de leur formation, il pourrait être intéressant de faire jouer le rôle d’étudiant hospitalier plutôt que celui de médecin, pour optimiser le travail du savoir-être relationnel

Clinical relevance of polymerase chain reaction (PCR) assays and antigen-driven immunoblots for the diagnosis of neurological infectious diseases.

Polymerase chain reaction assays are a powerful tool for detecting the presence of infectious genomes in the cerebrospinal fluid. Positive results always mean a current or pending infection of the central nervous system. Subacute (>7 days) or chronic infections induce an intrathecal humoral immune response and the appearance of oligoclonal IgG antibodies directed against the causal infectious agent. This local synthesis may be observed even in cases of severe systemic immunodeficiency. The use of polymerase chain reactions in combination with the detection of a specific intrathecal immune response should represent the most reliable strategy for the diagnosis of viral and chronic infections of the central nervous system. The authors describe their experience, using this approach, in herpetic encephalitis, acute and recurrent herpetic meningitis, varicella zoster-induced neurological diseases, cytomegalovirus encephalitis, progressive multifocal leukoencephalitis and tuberculous meningitis

The intrathecal humoral immune response: laboratory analysis and clinical relevance.

In normal conditions, albumin and immunoglobulin (Ig)G in the cerebrospinal fluid (CSF) originate from the blood, and there is no antibody production within the central nervous system. Up to 20% of CSF proteins are intrathecally synthesized, but the major fraction is blood-derived. The CSF/serum albumin quotient (QAlb) is the best marker of the blood-CSF barrier function. The corresponding immunoglobulin quotients (QIGG, QIGA, QIGM) are not linearly related to QAlb and their correlations are defined by an hyperbolic equation. This equation is used to discriminate between a blood-derived and a locally produced fraction of immunoglobulins in case of an intrathecal humoral immune response. The detection of CSF-specific oligoclonal IgG is more sensitive than the quantitative comparison between QIGG and QAlb. A further step is the determination of antibody indices and the detection of specific oligoclonal antibodies by antigen-driven immunoblots. CSF analysis remains a cornerstone for the diagnosis of various neurological disorders, including multiple sclerosis and infectious diseases of the central nervous system

Small-Cell Lung Cancer with Positive Anti-NMDAR and Anti-AMPAR Antibodies Paraneoplastic Limbic Encephalitis

We report the case of a 66-year-old woman, with paraneoplastic limbic encephalitis, treated 6 months earlier for bladder neoplasia. The patient presented to the emergency room with rapidly increasing symptoms, noninfectious cerebral spinal fluid associated with positive anti-NMDAR (as well as in serum) and positive AMPAR antibodies in the serum. Four months later, the patient was diagnosed with a small-cell lung cancer for which chemotherapy and radiotherapy was commenced. Simultaneously, endoscopic surgical treatment was undertaken for an in situ relapse of the bladder neoplasm. After the completion of 3 cycles of chemotherapy her neurological status temporarily worsened. The cerebral MRI did not show signs of encephalitis such as increased T2/FLAIR signal intensity in the mesial temporal lobes and limbic systems. No specific treatment was prescribed. Limbic encephalitis can be associated with malignant tumors such as lung carcinoma. Several cases reported in the literature have shown cognitive improvement after tumoral therapy. Regarding our experience, significant progress was achieved through immuno-modulatory treatment. A transitory deterioration of the cognitive process was perceived during the chemotherapy sessions

Eosinophilic pleocytosis and myelitis related to Toxocara canis infection

Toxocara canis causes the visceral larva migrans syndrome in which central nervous involvement is rare. We report the case of a 40-year-old woman presenting with a subacute weakness of the right leg and dysaesthesiae in the right Th8-Th10 dermatomas. Spinal magnetic resonance imaging examination showed abnormal hyperintensity within the spinal cord. Cerebrospinal fluid analysis revealed eosinophilic pleocytosis. Antibody titres to Toxocara canis were higher in the cerebrospinal fluid than in the serum. Treatment using mebendazole led to a complete clinical recovery, normalization of cerebrospinal fluid parameters and improvement in spinal magnetic resonance imaging abnormalities

Les manifestations vasculaires pulmonaires des télangiectasies hémorragiques héréditaires.

La maladie d'Osler-Rendu ou télangiectasie hémorragique héréditaire est une maladie génétique, de transmission autosomique dominante. Elle a une prévalence de 1/5000 à 1/10000. Elle associe la présence d'épistaxis, de télangiectasies cutanéo-muqueuses ainsi qu'une atteinte viscérale surtout pulmonaire, hépatique, cérébrale et digestive. L'atteinte pulmonaire est caractérisée par l'hypertension artérielle pulmonaire (rare) et par les malformations artério-veineuses pulmonaires. Ces malformations devront arfois être traitées par occlusion artérielle percutanée afin d'éviter les complications hémorragiques et emboliques. Durant la grossesse, ces malformations augmentent en taille et en nombre. Elles nécessitent donc un dépistage systématique et une prise en charge adéquate avant la grossesse. Nous rapportons ici le cas d’une patiente de 31 ans atteinte d’une maladie d’Osler-Rendu chez qui une embolisation de deux malformations artério-veineuses pulmonaires a été nécessaire

Herpes simplex encephalitis relapse associated with positive N-methyl-D-aspartate receptor antibodies.

Sir, Autoimmune encephalitis (AE) occurring following a neuroinfectious event is an uncommon event, representing a diagnostic challenge. Although NMDA-R antibodies can occur both in patients’ serum and/or cerebrospinal fluid (CSF) during the course of herpes simplex virus encephalitis (HSE), their presence is not equivalent to the diagnostic of AE [1]. We present the case of N-methyl-D-aspartate receptor (NMDA-R) antibody-associated AE following HSE, an emerging clinical entity.[...