Spastic Cerebral Palsy Pain Improvement With Propofol: A Case Report

International audiencePropofol is a sedative and a hypnotic agent used in the induction and maintenance of general anesthesia. Propofol also relaxes skeletal muscles. It has been used successfully to treat local or diffuse muscular rigidity from various etiologies. Propofol also provides modulation of pain processing and perception. Our case report describes a 25-year-old patient with painful spastic cerebral palsy, who experienced prolonged improvement of his symptoms after treatment with propofol. The patient has received 13 administrations of propofol with similar efficacy each ti

Spasticity or periodic limb movements? Lessons from a not-uncommon case report

International audienc

Nutritional status in patients with advanced-stage multiple sclerosis

International audienceIntroduction: Motor and swallowing dysfunctions in multiple sclerosis (MS) unbalance calorie intake and energy expenditure, modifying nutritional status. Only one study has described nutritional status in MS patients at early disease stages (median Expanded Disability Status Scale [EDSS] = 3), but this has never been assessed in the most severe cases. The goal of the present study was to describe nutritional status in advanced-stage MS. Methods: The study was a non-interventional retrospective analysis of a prospective registry. We reviewed medical files of consecutive MS patients admitted for annual follow-up in a physical and rehabilitation medicine unit between May 2016 and October 2018. Malnutrition for frail people, according to the French Health Authority (Haute Autorité de Santé [HAS]) definition, was our composite primary outcome criterion: body mass index (BMI) <21 kg/m2 and/or albumin<35 g/L. First, we performed a descriptive analysis of the nutritional status. Second, we studied the association between malnutrition and MS characteristics in univariate and multivariate analyses. Results: A total of 163 patients with median EDSS = 8 [7; 8.5] were included. Ninety-three patients (57%) met HAS malnutrition criteria (36% with albumin <35 g/L, 31% with BMI <21 kg/m2 and 10% with both). Malnutrition was associated in univariate analysis with MS severity (EDSS ≥8.5, p = 0.0003), primary progressive type of MS (p = 0.01) and swallowing disorders (p = 0.002). Multivariate analysis showed that low disability status (EDSS <7) was the only independent (protective) factor associated with malnutrition (OR = 0.2, p = 0.03). Conclusions: Malnutrition is frequent in advanced stages of MS and is probably a key point for therapeutics, which has never been demonstrated previously. A standardized evaluation should be developed to improve nutritional therapeutic strategies in this population

Part of pain labelled neuropathic in rheumatic disease might be rather nociplastic

International audiencePain in rheumatic diseases is primarily due to mechanical or inflammatory mechanism, but neuropathic pain (NP) component is also occurring in many conditions and is probably underdiagnosed. The purpose of this article is to provide an overview of prevalence, pathophysiological and currently available treatment of NP in rheumatic diseases. When associated with clinical evaluation assessing neurological clinical signs and neuroanatomical distribution, Douleur Neuropathique 4 Questions, painDETECT, Leeds assessment of neuropathic symptoms and signs and Neuropathic Pain Questionnaire can detect NP component. Inflammatory or connective diseases, osteoarthritis, back pain or persistent pain after surgery are aetiologies that all may have a neuropathic component. Unlike nociceptive pain, NP does not respond to usual analgesics such as paracetamol and non-steroidal anti-inflammatory drugs. Entrapment neuropathy, peripheral neuropathy or smallfibre neuropathy are different aetiologies that can lead to NP. A part of the pain labelled neuropathic is rather nociplastic, secondary to a central sensitisation mechanism. Identifying the right component of pain (nociceptive vs neuropathic or nociplastic) could help to better manage pain in rheumatic diseases with pharmacological and nonpharmacological treatments

Prise en charge médicamenteuse des douleurs neuropathiques périphériques liées au cancer : une revue systématique de la littérature

International audienceNotre objectif était de faire un état des lieux des connaissances sur la prise en charge médicamenteuse des douleurs neuropathiques chez les patients avec cancer. Alors que le nombre de patients avec cancer ne cesse d’augmenter et que les douleurs sont très fréquentes lors de cancer, peu d’articles s’intéressent à la prise en charge médicamenteuse des douleurs, notamment neuropathiques, chez les patients ayant ou ayant eu un cancer. Cette revue systématique de l’ensemble des études publiées entre décembre 2012 et août 2018 devait permettre d’estimer l’ampleur du manque. Au total, 27 articles ont été identifiés sur la base d’une recherche systématique de la littérature (PubMed) et des connaissances des auteurs. Ces résultats confirment que peu de données ont été publiées. L’hétérogénéité des patients cancéreux, du cancer, et de la douleur expliquent en partie ce manque. Les recommandations, qui s’appuient sur des résultats obtenus auprès de patients généralement non cancéreux, suggèrent l’utilisation des antidépresseurs tricycliques et des antiépileptiques ; les traitements locaux sont appréciés pour leur bonne tolérance systémique. Des études incluant un plus grand nombre d’individus et tenant compte de l’étiologie de la douleur neuropathique, de ses caractéristiques (neuropathiques ou mixtes), et de la place de l’individu dans le parcours de soins (patient devant être traité, patient sous traitement anticancéreux, survivant récent ou ancien, ou patient en phase terminale) sont nécessaires pour pouvoir améliorer la connaissance. Les résultats de cette analyse de la littérature peuvent guider les chercheurs pour leurs futures études

Goal-Setting in Multiple Sclerosis-Related Spasticity Treated with Botulinum Toxin: The GASEPTOX Study

Spasticity is one of the most disabling symptoms in multiple sclerosis (MS). Botulinum toxin injection (BTI) is a first-line treatment for focal spasticity. There is a lack of evidence of a functional improvement following BTI in MS-related spasticity. To describe goal-setting for BTI in MS, and evaluate the degree of attainment, using goal attainment scaling (GAS) 4-to-6 weeks after injection session, a one-year multi-center retrospective observational study assessing goal-setting and achievement during BTI session in spastic patients with MS was set up. Following the GAS method, patients and their physicians set up to three goals and scored their achievement 4 to 6 weeks thereafter. Commonly used goals from three centers were combined into a standardized list and 125 single BTI sessions were analyzed. The most frequent goals regarded lower limb (LL) impairments (equinovarus foot, toe claw) or locomotion (stability, walking distance, clinging) and accounted for 89.1%, versus 10.9% for upper limb (UL), mostly for mild-to-moderate MS. Overall, goals were frequently achieved (85.77%) mainly when related to gait and mobility rather than hygiene and ease of care. This study gives an overview on the most frequent, relevant, and achievable goals to be set in real-life practice of BTI for spasticity management in MS

Impact of medical care, including use of anti-infective agents, on prognosis of COVID-19 hospitalized patients over time

International audienceIntroduction: The effect of anti-infective agents in COVID-19 is unclear. The impact of changes in practice on prognosis over time has not been evaluated. Methods: Single center, retrospective study in adults hospitalized in a medicine ward for COVID-19 from March 5 th to April 25 th 2020. Patient characteristics were compared between two periods (before/after March 19 th ) considering French guidelines. The aim of the study was to evaluate how medical care im- pacted unfavorable outcome, namely admission to intensive care unit (ICU) and/or death. Results: A total of 132 patients were admitted: mean age 59.0 ±16.3 years; mean C-reactive protein (CRP) level 84.0 ±71.1 mg/L; 46% had a lymphocyte count < 10 0 0/mm 3 . Prescribed anti-infective agents were lopinavir-ritonavir (n = 12), azithromycin (AZI) (n = 28) and AZI combined with hydroxychloroquine (HCQ) (n = 52). There was a significant decrease in ICU admission, from 43% to 12%, between the two periods ( P < 0.0 0 01). Delays until transfer to ICU were similar between periods ( P = 0.86). Pulmonary computerized tomography (CT)-scans were performed significantly more often with time (from 50% to 90%, P < 0.0 0 01), and oxygen-dependency (53% vs 80%, P = 0.001) and prescription of AZI ±HCQ (from 25% to 76%, P < 0.0 0 01) were also greater over time. Multivariate analyses showed a reduction of unfavorable outcome in patients receiving AZI ±HCQ (hazard ratio [HR] = 0.45, 95% confidence interval [CI: 0.21-0.97], P = 0.04), particularly among an identified category of individuals (lymphocyte ≥10 0 0/mm 3 or CRP ≥100 mg/L). Conclusion: The present study showed a significant decrease in admission to ICU over time, which was probably related to multiple factors, including a better indication of pulmonary CT-scan, oxygen therapy, and a suitable prescription of anti-infective agents