• Energy Research
• French close
• Neuroscience close

A concerted study of the clinical and electrophysiologic effects of tianeptine was conducted in alcoholic patients hospitalized for 5 weeks for alcohol withdrawal cures and subsequent depression. Because of the well known manifestations of infraclinical cognition impairment, sleep disorders and greater susceptibility to undesirable effects of psychotropic drugs, which hinder health care in this type of patient, the authors investigated changes in cognitive functions and the effect of tianeptine on sleep organization and daytime vigilance. Results after 4 weeks treatment (3 times 12.5 mg/day) included: besides its antidepressant effect, tianeptine reduces the manifestations of anxiety, without sedation effects, either clinical or electrophysiologic; tianeptine has no deleterious effect on cognitive functions, on the contrary, it appears to favour recovery when they are impaired; tianeptine does not modify sleep structure, notably in paradoxal sleep; tianeptine is an antidepressant which has a good acceptability, even for a population at "risk".

The significant impact of seasonality and climate change on stroke-related morbidity and mortality is well established, however, some findings on this issue are conflicting. The objective was to determine the impact of gender, age, season, year of admission, temperature, rainfall and El Nino phenomenon on ischemic and hemorrhagic strokes and fatal cases of stroke.The study was carried out at the teaching hospital of Kinshasa, DRC, between January 1998 and December 2004. Rainy and dry seasons, elevated temperatures, indices of rainfalls El Nino years 1998, 2002 and 2004, but La Nina years 1999-2000 and neutral/normal years 2001 and 2003 were defined.Among 470 incident strokes, 34.5% of victims (n=162) died. Traditional seasons (small dry season, small rainy season, great dry season, great rainy season) and temperatures did not significantly (P>0.005) impact on stroke incidence. However, there was a positive association between the decrease in rainfall, El Nino, and incident ischemic strokes, but a significant positive association between the increase in rainfall, La Nina, and incident hemorrhagic strokes. Using logistic regression analysis, age ≥ 60 years (OR: 1.7, 95% CI: 1.2-2.5; P=0.018) and El Nino years (OR: 2, 95% CI: 1.2-3.3; P=0.009) were identified as the independent predictors of fatal strokes.Early warning systems should be developed to predict the impact of seasons and climate variability on stroke morbidity and mortality.

The incidence of hepatocellular carcinoma (HCC) in cirrhotic patients is increasing. Despite advances in imaging and laboratory screening which allow earlier diagnosis, the surgeon is all too often confronted with an HCC of advanced stage or arising in the setting of severe cirrhosis; this severely limits the treatment possibilities. Treatment options are constrained not only by the characteristics of the tumor but also by hepatocellular reserve, severity of portal hypertension, and the general condition of the host. "Curative treatments" envisage the complete eradication of the malignancy; they include liver transplantation, resection, or tumor destruction by radiofrequency or alcohol ablation. They are most effective in the early stages of HCC. Total hepatectomy and transplantation, by far the most complex surgical therapy, also has the best results avoiding the all-too-frequent local recurrence of HCC in the residual liver. Other medical and interventional treatments (chemo-embolization, radiotherapy with lipiodol) can only slow the progress of the HCC. Goals for the future include more precise and directed screening of the population at risk, and better chemopreventive and chemotherapeutic treatments.

The present study, conducted for the consensus conference "Orthotic management of stroke patients", organized by the International Society of Prosthetics and Orthotics, on September 2003, reviews the pharmacological, general, or local treatments available for post-stroke upper-limb spasticity.A search of the international literature in the Medline and the Reedoc data banks for papers related to post-stroke upper-limb spasticity. Each paper was given a rating of A, B, or C (in term of quality) according to the instructions of the organization committee.General pharmacological treatments such as use of baclofen, tizanidine and dantrolene, regional treatments such as intrathecal baclofen, and local treatments with use of chemical neurolysis and alcohol or phenol are recommended for conditions described in papers with a grade of B. Neuromuscular blockade with botulinum toxin is recommended for conditions described in papers with a grade of A.Despite a satisfactory grade of recommendation, general pharmacological treatments are limited by adverse events and lack of evidence of functional benefit. Intrathecal baclofen should be discussed for upper-limb spasticity, but further studies are needed before its use can be recommended. The place of chemical neurolysis with use of alcohol or phenol should be evaluated with surgical neurotomy and botulinum toxin therapy. The use of botulinum toxin is the only treatment supported by scientific results, but many questions remain about the site of injection, how to improve efficacy and influence on neurological recovery.

Authors report a case of focal action myoclonus due to a localized hemispheric lesion. The woman had cardiac arrest complicated by ischemic stroke involving the left parietal region. Action myoclonus of the inferior right limb was the sole residual complaint, provoked by movement and maintenance of posture. Patient noted that myoclonus was worsened by carbamazepine and vigabatrin. EEG-EMG polygraphic study demonstrated action myoclonus and showed a particular EEG activity consisting in a volley of spikes on the vertex region during the right inferior limb movements. Contralateral movements did not elicit this activity. Pharmacological response to clonazepam, piracetam and alcohol was studied. A marked improvement of myoclonus was obtained with alcohol. Pathophysiology of this exceptional form of cortical action myoclonus is discussed.