La alteración de la mielina en la enfermedad de Alexander

Introduction

Alexander disease (AxD) is a type of leukodystrophy. Its pathological basis, along with myelin loss, is the appearance of Rosenthal bodies, which are cytoplasmic inclusions in astrocytes. Mutations in the gene coding for GFAP have been identified as a genetic basis for AxD. However, the mechanism by which these variants produce the disease is not understood.

Psychotraumatologie de la guerre en Ukraine : la question de la prise en charge psychologique des victimes réfugiées ou restées en Ukraine

The war in Ukraine is a major poly-traumatic event, which leads to massive population displacements. The question of the evaluation and psychological care of psychotraumatised people is an urgent matter. As many countries hosting refugees are well endowed with a number of psychologists, some of these interested professionals should mobilise themselves and make themselves known to carry out these clinical acts. Priority should be given to trained and experienced psychologists to support victims. The language barrier will have to be overcome. Initially, it would be desirable to make contact or get closer to local and national refugee centres to facilitate these operations. Face-to-face or remote consultations, as developed during the Covid-19 pandemic, are possible. Reinforcements of available and dedicated psychologists, including remotely, from the countries hosting the most refugees are also desirable. The issue of detection, assessment and care of psychologically traumatised people who remained in the Ukrainian territory is probably even more massive. Whether non-combatants or combatants, part of the international psychological community should mobilise, in addition to local colleagues, to provide them with this psychological help. These humanitarian actions would be feasible depending on the evolution of the conflict. Whether it is psychological support for refugees or people still on the Ukrainian soil, models for organizing and coordinating these actions must be carefully thought out and implemented in an evolving way to optimise their effectiveness.     

Comparaison des bénéfices médico-économiques des antipsychotiques dans la prise en charge de la schizophrénie en France

Introduction

The course of schizophrenia can vary widely, and patients experience remission phases alternating with relapse episodes, which generally lead to hospitalisation and have a significant impact on the burden of disease. The prevalence of schizophrenia in France is estimated to be approximately 600,000 people, with an incidence of 10,000 new patients per year. Patients with schizophrenia represent the largest group of hospitalised patients in French public institutions and specialised centres, and the French authorities recognise that the management of schizophrenia is a major public health concern. The Haute Autorité de Santé (HAS) and most of the evidence-based guidelines for the maintenance treatment of schizophrenia recommend long-acting injectable (LAI) antipsychotics to be used predominantly in the prevention of relapse for non-compliant patients; however, in clinical practice, the use of LAIs remains low.

La part positionnelle de la personne polyhandicapée en grande dépendance

The fragility of overall highly dependent polyhandicapped people against respiratory conditions is well known. An illness that is benign for an ordinary subject can lead to complications for them. By interacting with other pathological elements, it can easily evolve towards chronic respiratory failure. Complications supine wherein are maintained in these individuals, because of their engine failure, in part explain the constitution of these tables. To treat these complications, of which the constant positional seems to be the main case, it seems logical to bring changes of position to the patient. The approach that made it possible to install polyhandicapped sitting went in the right direction: the taking into account of their postural requirements. And there, some complications supine, as hypoventilation, were mitigated. But sitting position is not favorable to the chest deformities and muscle deficits. It can even cause and exacerbate distortions, if the installation which allows, is not sufficiently tailored to the individual neuro-orthopedic needs. The first action of the other positions, lateral and ventral especially on respiratory function, for example, seems to bring other perspectives, those of a positional treatment of respiratory ailments multiple disabilities. Then, and if in addition the approach is global, the idea of a specific treatment, basic treatment of respiratory problems severely multiple disabilities, appears.     

La recherche de la vérité en psychologie et psychiatrie judiciaires. La psychologie dans la décision judiciaire

The judge has the duty to render a decision in all impartiality. The “psychology of judicial decision-making” concerns the behaviour of the judge in the act of judging. In criminal and correctional maters, the psychological mechanisms of a magistrate have a notable incidence in the research of truth. The practitioner wanted to illustrate here how during the entire procedure, from the choice of cases till the verdict rendering, the personality of the magistrate (the president of the court in particular) weighs on the judicial decision-making. The practitioner will thus analyse the lessons we can draw from these facts.     

La tendresse des soignants,passager clandestin en néonatalogie ?

ObjectivesThe study took place in a neonatology unit, the aim of which was to analyse the different meanings of the signs of tenderness that caregivers might show towards their baby patients. Three hypotheses were put forward to explain tender behavioural attitudes that at first seemed surprising in such a technical and medical environment. The first hypothesis was that tenderness is used as a defense mechanism, an anticathexis, whereby the caregivers underwent violent feelings when taking care of the baby. The second hypothesis is that tenderness resulted from their position of “caring parentalisation”. The concept of caring parentalisation is inspired by Winnicott's primary maternal preoccupation and based on the possibility of sharing feelings between patient and caregiver. This parentalisation would work through a bigenerational, bisensual and biparental psychic position. The third hypothesis is that tenderness is the result of the caregiver's Ego Ideal coming under regular attack when the patient is not getting better or the care given does not meet his/her own expectations, or when the patient does not provide satisfaction. After such an attack, we would notice a tendency to try and repair what had been damaged, through words or gestures of reparation or acting out.Materials and methodsSix professionals working in a neonatology unit accepted to be part of the study, two doctors and four nurses. The protocol consisted of a 30-minute observation of the caregivers. The method of observation was based on E. Bick's fine observation method. Notes were taken immediately afterwards and analysed. There was a 30-minute semi-guided interview with the caregiver, about tenderness in general, parental tenderness and tenderness as a caregiver.ResultsTenderness appeared in every observation, notwithstanding the very different contexts. In each interview, parental tenderness was spontaneously mentioned. Tenderness mostly consists of gestures of patting or wrapping the baby, in the use of certain words, in the tone of the voice and the use of motherese. Regarding the hypothesis of anticathexis: tenderness increases when there is a painful or aggressive moment during caregiving. Denegation was used in interviews, half of the participants referring to what tenderness does not mean to them. Regarding the hypothesis of parentalisation: References to family would rise up in the chosen vocabulary, in the identification to multiple generations (bigenerational) and through the combination of soft and hard elements during care (bisensuality). Gestures and words of reparation, particular prosodies and even acting out in a tender way illustrated now the attacks on the professional Ego Ideal were compensated.ConclusionsTenderness can be used as a professional tool, under certain conditions. The minimal condition to transform these emerging feelings into professional behaviour is to be aware of this emerging tenderness and to share it, avoiding the repression of these feelings that might lead to acting out.     

La Méduse et la résignation

Géricault made his masterpiece, The Raft of the Medusa, in order to illustrate a tragedy of his time and to call to the mind of his contemporaries the perils of the return of the monarchy. This picture goes nonetheless beyond a simple illustration and Géricault achieved to embody on his painting a range of human distresses, including the phenomena of learned helplessness described in the 60ies by the American psychologist Martin Seligman.     

La consultation psychiatrique d’Yves Pélicier ou l’art de la biographie

The teaching and clinical practice of professor Yves Pélicier contributed to the international development of a psychiatry centered on the whole of the person in a humanist approach. The theoretical developments were marked by the authenticity of the practice of the therapist and its deep sense of the human being thus truly founding a School.     

Où en sont les études génétiques de la SEP ?

INTRODUCTION: Multiple Sclerosis (MS) is a multifactorial disorder caused by the interaction of environmental factors with a genetic predisposition. BACKGROUND: The chromosomal region comprising MHC contains one or several genes which contributes from 20 to 50 p. 100 to MS genetic predisposition. Other genes are unknown but are likely to have an individual contribution less than MHC. PERSPECTIVES AND CONCLUSION: Large DNA collections, high output genotyping facilities, a precise knowledge of the human genome and adequate statistical methods should allow the identification of MS predisposition genes.     

Valor predictivo de la resonancia magnética para la identificación de compresiones neurovasculares en la neuralgia del trigémino

IntroductionMicrovascular decompression (MVD) is accepted as the only aetiological surgical treatment for refractory classic trigeminal neuralgia (TN). There is therefore increasing interest in establishing the diagnostic and prognostic value of identifying neurovascular compressions (NVC) using preoperative high-resolution three-dimensional magnetic resonance (MRI) in patients with classic TN who are candidates for surgery.MethodsThis observational study includes a series of 74 consecutive patients with classic TN treated with MVD. All patients underwent a preoperative three-dimensional high-resolution MRI with DRIVE sequences to diagnose presence of NVC, as well as the degree, cause, and location of compressions. MRI results were analysed by doctors blinded to surgical findings and subsequently compared to those findings. After a minimum follow-up time of six months, we assessed the surgical outcome and graded it on the Barrow Neurological Institute pain intensity score (BNI score). The prognostic value of the preoperative MRI was estimated using binary logistic regression.ResultsPreoperative DRIVE MRI sequences showed a sensitivity of 95% and a specificity of 87%, with a 98% positive predictive value and a 70% negative predictive value. Moreover, Cohen's kappa (CK) indicated a good level of agreement between radiological and surgical findings regarding presence of NVC (CK 0.75), type of compression (CK 0.74) and the site of compression (CK 0.72), with only moderate agreement as to the degree of compression (CK 0.48).After a mean follow-up of 29 months (range 6-100 months), 81% of the patients reported pain control with or without medication (BNI score i-iiiI). Patients with an excellent surgical outcome, i.e. without pain and off medication (BNI score i), made up 66% of the total at the end of follow-up. Univariate analysis using binary logistic regression showed that a diagnosis of NVC on the preoperative MRI was a favorable prognostic factor that significantly increased the odds of obtaining an excellent outcome (OR 0.17, 95% CI 0.04-0.72; P=.02) or an acceptable outcome (OR 0.16, 95% CI 0.04-0.68; P=.01) after MVD.ConclusionsDRIVE MRI shows high sensitivity and specificity for diagnosing NVC in patients with refractory classic TN and who are candidates for MVD. The finding of NVC on preoperative MRI is a good prognostic factor for long-term pain relief with MVD.     

La gestión de la asistencia neurológica en tiempos de la pandemia de Covid-19

IntroductionThe COVID-19 epidemic has led to the need for unprecedented decisions to be made to maintain the provision of neurological care. This article addresses operational decision-making during the epidemic.DevelopmentWe report the measures taken, including the preparation of a functional reorganisation plan, strategies for hospitalisation and emergency management, the use of telephone consultations to maintain neurological care, provision of care at a unit outside the hospital for priority patients, decisions about complementary testing and periodic in-hospital treatments, and the use of a specific telephone service to prioritise patients with epileptic seizures.ConclusionDespite the situation of confinement, neurology departments must continue to provide patient care through different means of operation. Like all elements of management, these must be evaluated.     

Efecto de la alteración de los niveles de expresión de microARN neurogénicos y su implicación en la agresividad de glioblastomas localizados en la región paraventricular

IntroductionGlioblastoma multiforme is the most common primary brain tumour, with the least favourable prognosis. Despite numerous studies and medical advances, it continues to be lethal, with an average life expectancy of 15 months after chemo-radiotherapy.DevelopmentRecent research has addressed several factors associated with the diagnosis and prognosis of glioblastoma; one significant factor is tumour localisation, particularly the subventricular zone, which represents one of the most active neurogenic niches of the adult human brain. Glioblastomas in this area are generally more aggressive, resulting in unfavourable prognosis and a shorter life expectancy. Currently, the research into microRNAs (miRNA) has intensified, revealing different expression patterns under physiological and pathophysiological conditions. It has been reported that the expression levels of certain miRNAs, mainly those related to neurogenic processes, are dysregulated in oncogenic events, thus favouring gliomagenesis and greater tumour aggressiveness. This review discusses some of the most important miRNAs involved in subventricular neurogenic processes and their association with glioblastoma aggressiveness.ConclusionsMiRNA regulation and function play an important role in the development and progression of glioblastoma; understanding the alterations of certain miRNAs involved in both differentiation and neural and glial maturation could help us to better understand the malignant characteristics of glioblastoma.     

Una década después de la implantación en España de la hipotermia terapéutica en el recién nacido con encefalopatía hipóxico-isquémica perinatal

IntroductionMore than a decade has passed since therapeutic hypothermia (TH) was introduced in Spain; this is the only neuroprotective intervention that has become standard practice in the treatment of perinatal hypoxic-ischaemic encephalopathy (HIE). This article aims to provide a current picture of the technique and to address the controversies surrounding its use.DevelopmentIn the last 10 years, TH has been successfully implemented in the vast majority of tertiary hospitals in Spain, and more than 85% of newborns with moderate or severe HIE currently receive the treatment. The factors that can improve the efficacy of TH include early treatment onset (first 6 hours of life) and the control of comorbid factors associated with perinatal asphyxia. In patients with moderate HIE, treatment onset after 6 hours seems to have some neuroprotective efficacy. TH duration longer than 72 hours or deeper hypothermia do not offer greater neuroprotective efficacy, but instead increase the risk of adverse effects. Unclarified aspects are the sedation of patients during TH, the application of the treatment in infants with mild HIE, and its application in other scenarios. Prognostic information and time frame are one of the most challenging aspects.ConclusionsTH is universal in countries with sufficient economic resources, although certain unresolved controversies remain. While the treatment is widespread in Spain, there is a need for cooling devices for the transfer of these patients and their centralisation.     

Participación de los astrocitos en la patogénesis de la esclerosis múltiple

IntroductionMultiple sclerosis (MS) is a demyelinating autoimmune disease of the central nervous system (CNS), in which astrocytes play an important role as CNS immune cells. However, the activity of astrocytes as antigen-presenting cells (APC) continues to be subject to debate.DevelopmentThis review analyses the existing evidence on the participation of astrocytes in CNS inflammation in MS and on several mechanisms that modify astrocyte activity in the disease.ConclusionsAstrocytes play a crucial role in the pathogenesis of MS because they express toll-like receptors (TLR) and major histocompatibility complex (MHC) class I and II. In addition, astrocytes participate in regulating the blood-brain barrier (BBB) and in modulating T cell activity through the production of cytokines. Future studies should focus on the role of astrocytes in order to find new therapeutic targets for the treatment of MS.