Syphilitic periostitis

International audienc

Mésusage et dépendance aux opioïdes de prescription : prévention, repérage et prise en charge

International audienc

Evolution of non-treated restless legs syndrome Síndrome das pernas inquietas: evolução após um ano sem tratamento

PURPOSE: The primary concern of this study is to evaluate the clinical course of restless legs syndrome (RLS) in a group of patients who refused treatment. METHOD: This study compares the outcome of a group of RLS patients after one year without any specific treatment. The International Restless Legs Syndrome Scale (IRLS) was applied at baseline (irls_1) and after one year (irls_2). The patients answered a simple questionnaire for the evaluation of possible environmental or life habit changes after one-year evolution. Serum ferritin was determined at baseline. An improvement index (%improvement) was established through the formula: irls_1- irls_2/irls_1 ' 100. Results were compared and a correlation analysis performed. RESULTS: A negative significant correlation was found between the patientsí age and irls_2 (r= -0.9 p=0.0018) and between %improvement and irls_2 (r= -0.88 p=0.0039). A positive and significant correlation was determined between %improvement and age. There was only a marginally significant correlation between serum ferritin and ilrs_2 (r= -0.7 p=0.052). No significant changes were found in the other elements analyzed. CONCLUSION: A favorable outcome was found in this group of RLS patients after one year evolution without treatment. The outcome was positively influenced by the patientsí age.<br>OBJETIVO: O objetivo deste estudo é avaliar a evolução de oito pacientes com diagnóstico de síndrome das pernas inquietas (SPI) após doze meses sem tratamento. MÉTODO: Estudo de coorte, retrospectivo, consistindo na aplicação da escala de gravidade da SPI (IRLS), de questionário para avaliação de mudanças ambientais ou de hábitos de vida e dosagem de ferritina sérica. Realizada comparação da pontuação IRLS obtida na consulta inicial (irls_1) e após doze meses de evolução (irls_2) e estabelecido um índice de melhora percentual (%melhora=irls_1 - irls_2 / irls_1 ' 100). Análise de correlação dos dados obtidos. RESULTADOS: Foi demonstrada correlação negativa e significativa entre a idade e a irls_2 (r= -0,9 e p=0,0018) e entre %melhora e irls_2 (r= -0,88 e p=0,0039). Encontrou-se correlação positiva e significativa entre %melhora e a idade. Houve apenas correlação negativa marginalmente não-significativa entre a dosagem de ferritina sérica e ilrs_2 (r= -0,7 e p=0,052). CONCLUSÃO: Neste grupo demonstrou-se evolução favorável da SPI após doze meses que se correlacionou positivamente com a idade dos pacientes, não tendo sido influenciada aparentemente por hábitos de vida ou mudanças ambientais

Efficacy and safety of a T-type calcium channel blocker in patients with neuropathic pain: A proof-of-concept, randomized, double-blind and controlled trial

International audienceBackgroundT‐type calcium channels have been shown to play an important role in the initiation and maintenance of neuropathic pain and represent a promising therapeutic target for new analgesic treatments. Ethosuximide (ETX), an anticonvulsant and a T‐type channel blocker has shown analgesic effect in several chronic pain models but has not yet been evaluated in patients with neuropathic pain.MethodsThis proof‐of‐concept, multicentre, double‐blind, controlled and randomized trial compared the efficacy and safety of ETX (given as add‐on therapy) to an inactive control (IC) in 114 patients with non‐diabetic peripheral neuropathic pain. After a 7‐day run‐in period, eligible patients aged over 18 years were randomly assigned (1:1) to ETX or IC for 6 weeks. The primary outcome was the difference between groups in the pain intensity (% of change from the baseline to end of treatment) assessed in the intention‐to‐treat population. This study is registered with EudraCT (2013‐004801‐26) and ClinicalTrials.gov (NCT02100046).ResultsThe study was stopped during the interim analysis due to the high number of adverse events in the active treatment group. ETX failed to reduce total pain and showed a poor tolerance in comparison to IC. In the per‐protocol analysis, ETX significantly reduced pain intensity by 15.6% (95% CI −25.8; −5.4) from baseline compared to IC (−7.8%, 95% CI −14.3; −1.3; p = 0.033), but this result must be interpreted with caution because of a small subgroup of patients.ConclusionEthosuximide did not reduce the severity of neuropathic pain and induces, at the doses used, many adverse events.SignificanceThis article shows that ETX is not effective to treat neuropathic pain. Nevertheless, per‐protocol analysis suggests a possible analgesic effect of ETX. Thus, our work adds significant knowledge to preclinical and clinical data on the benefits of T‐type calcium channel inhibition for the treatment of neuropathic pain