Aspects electroneuromyographiques des traumatismes du plexus brachial

Introduction: L’électroneuromyogramme (ENMG) garde une place cruciale dans l’exploration du plexus brachial. L’objectif de cette étude était d’étudier les caractéristiques électroneuromyographiques des atteintes plexiques brachiales post-traumatiques et de déterminer les facteurs associés à la topographie et à la sévérité des lésions. Patients et méthodes: Une étude rétrospective a été réalisée dans le service de Neurologie du CHU RAZI incluant les patients adressés à l’unité d’électroneurophysiologie pour une atteinte traumatique du plexus brachial durant la période allant de janvier 2003 à juin 2018. Les données démographiques, cliniques et les résultats de l’ENMG ont été recueillis et analysés. La sévérité de la lésion a été évaluée selon la version modifiée de l’échelle de Dumitru et Wilbourn. Résultats: Nous avons colligé 36 plexopathies brachiales post traumatiques chez 35 patients (H/F = 30/5, âge moyen = 39,3 ans). L’ENMG a été réalisé 3 semaines après le traumatisme chez 91,3% des patients. Il a montré une conduction nerveuse altérée (97,2 %), un tracé neurogène (91,7 %) et des signes de dénervation (55,6 %). Le niveau lésionnel concernait les troncs primaires (66,7 %) et les troncs secondaires (33,3 %). Il était sans lien significatif avec la cause (p>0,05). La lésion était sévère (61,1 %), modérée (36,1 %) et légère (2,8 %) sans association significative ni avec la cause ni avec le site lésionnel (p>0,05). Conclusion: Notre étude a permis d’appuyer le rôle de l’ENMG dans l’étude de la plexopathie brachiale post traumatique. Elle a démontré que la topographie et la sévérité des lésions étaient indépendantes des étiologies du traumatisme.   English title: Electroneuromyogram findings of traumatic brachial plexus injuries Background: Electroneuromyogram (ENMG) plays a crucial role in the exploration of the brachial plexus. The purpose of this study was to investigate the electroneuromyographic characteristics of posttraumatic plexus brachial damage and to determine the factors associated with the topography and severity of the lesions. Patients and methods:  A retrospective study was carried out in the Neurology Department of the RAZI University Hospital including patients referred to the electroneurophysiology unit for traumatic brachial plexus damage during the period from January 2003 to June 2018. Demographic, clinical and ENMG’s data results were collected and analyzed. The severity of the lesion was evaluated according to the modified version of the Dumitru and Wilbourn scale. Results:  We collected 36 post-traumatic brachial plexopathies in 35 patients (M / F = 30/5, mean age = 39.3 years). ENMG was performed 3 weeks after trauma in 91.3% of patients. He showed impaired nerve conduction (97.2%), a neurogenic trace (91.7%) and signs of denervation (55.6%). The lesion level concerned the primary trunks (66.7%) and the secondary trunks (33.3%). It was not significantly related to the cause (p> 0.05). The lesion was severe (61.1%), moderate (36.1%) and mild (2.8%) with no significant association with either the cause or the site of injury (p> 0.05). Conclusion:  Our study supported the role of ENMG in the study of post-traumatic brachial plexopathy. It demonstrated that the topography and the severity of the lesions were independent of the etiologies of the trauma. &nbsp

Investigating the potential link between lunar cycle and multiple sclerosis relapses: a call for further studies

ABSTRACTMultiple sclerosis (MS) is a debilitating disease that causes inflammation of the central nervous system, resulting in myelin damage and axon degeneration. Although the cause of MS remains unknown, various factors such as sex, latitude, sun exposure, serum vitamin D levels, Epstein Barr Virus infection, diet, microbiota and ethnicity are being studied for their potential roles in the development of the disease. While chronobiological factors such as circadian rhythm and seasonality have been explored for their potential influence on the onset, exacerbation, and/or relapses of MS, the potential influence of the lunar cycle on MS has yet to be studied. Therefore, the authors of this letter call for future studies to investigate the possible effects of the lunar cycle on MS activity and course, given evidence suggesting that the lunar cycle may affect sleep, fatigue, melatonin secretion, and mood state in humans. A deeper understanding of the chronobiology of MS could have practical implications for the development of chronotherapeutic strategies and the prevention or mitigation of MS relapses, potentially improving the quality of life of MS patients

Sensitivity of Awaji Criteria and Revised El Escorial Criteria in the Diagnosis of Amyotrophic Lateral Sclerosis (ALS) at First Visit in a Tunisian Cohort

Background. Amyotrophic lateral sclerosis (ALS) is a fatal disease whose diagnosis and early management can improve survival. The most used diagnostic criteria are the revised El Escorial criteria (rEEC) and Awaji criteria (AC). The comparison of their sensitivities showed contradictory results. Our study aimed to compare the sensitivities of these two criteria in the diagnosis of definite ALS, at first visit, in a Tunisian hospital cohort. Materials and Methods. This was a retrospective study including 173 patients diagnosed with ALS at the Department of Neurology of the Razi Hospital between January 2003 and April 2018.After studying the clinical features of the disease in our study population,each patient was categorized according to the rEEC and AC based on data collected in his medical record during his first visit to our department. Then, we compared the sensitivities of these two criteria in the diagnosis of definite ALS. Results. Our Tunisian cohort was characterized by a slower disease progression. The sensitivity of the AC (69.4%) was significantly higher than that of the rEEC (40.5%) (p < 0.001). When the clinical signs evolved for less than 6 months, the sensitivities were 61% for AC and 12% for rEEC (p < 0.001). After 24 months of disease progression, the sensitivities were 78.2% for AC and 69.1% for rEEC (p = 0.063). It was impossible to categorize seventeen patients by the two criteria. Conclusion. Our study demonstrated that patients in AC are more sensitive than rEEC in the early diagnosis of ALS in our Tunisian cohort. However, this superiority is gradually reduced during the evolution of the disease

Disease-Modifying Therapies, Outcomes, Risk Factors and Severity of COVID-19 in Multiple Sclerosis: A MENACTRIMS Registry Based Study

International audienceMultiple sclerosis (MS) patients have been considered a higher-risk population for COVID-19 due to the high prevalence of disability and disease-modifying therapy use; however, there is little data in our Middle East and North Africa region (MENA) identifying clinical characteristics of MS associated with worse COVID-19 outcomes