Posttraumatic stress symptoms and postpartum depression in couples after childbirth: the role of partner support and attachment

Aim

The roles of partner attachment and perceptions of partner support were explored in relation to symptoms of posttraumatic stress and postpartum depression in couples within the first three postnatal months.

Methods

Participants (n = 372) were recruited within the first seven days postpartum, and completed questionnaire measures of trait anxiety, symptoms of acute posttraumatic stress, and perceptions of partner support. Postal questionnaires were completed at six weeks and three months, assessing attachment, perception of partner support, symptoms of posttraumatic stress, and postpartum depression. Two hundred and twelve couples completed all time-points.

Results

Results indicated that symptoms were significantly related within couples. Men's acute trauma symptoms predicted their partner's subsequent symptoms of posttraumatic stress. Less secure attachment and dissatisfaction with partner support were associated with higher levels of postpartum depression and posttraumatic stress.

Conclusions

Men's and women's responses following childbirth appear to be strongly interlinked; services should target both members of the dyad.     

Relations paradoxales entre l’internalisation et l’externalisation en psychopathologie de l’enfant : exemples de l’hyperactivité et de la dépression avec idées suicidaires

Introduction

The difference between internalising disorders (anxious and depressive disorders) and externalising disorders (conduct disorder and oppositional defiant disorder) is largely accepted by clinicians and researchers. Although hyperactivity may seem linked with the externalising disorders, recent empirical research suggested it could be often comorbid with depression, and recent theoretical research suggested it could be, at least partially, founded on psychodynamic mechanisms intended to master separation anxiety. These works suggest that the internalising dimension of hyperactivity may have been underestimated in empirical research. The purpose of this paper is to assess the level of internalisation in hyperactivity.

Method

Twenty five hyperactive children were compared with children presenting anxious disorders (N = 22), depressive disorder without suicidal ideation (N = 28), with suicidal ideation (N = 20), and academic learning disorders (N = 23). All diagnoses were made according to the ICD-10 criteria, which are very similar to the DSM criteria for anxious, depressive, and academic learning disorders, but are more stringent regarding hyperkinetic disorder than the DSM criteria for attention-deficit/hyperactivity disorder. Internalisation and externalisation were assessed by the Child Behavior Checklist (completed by one of their parents), and the presence of suicidal ideation was assessed on the basis of the Children Depression Inventory item 9.

Results

Hyperactive children exhibit more internalisation problems than those with learning disorder, but less than those with anxious and depressive disorders. Unexpectedly, depressive children with suicidal ideation presented high levels of delinquent and aggressive behaviour, equal or superior to those of the hyperactive children.

Discussion

These findings bring partial support to the psychodynamic view of hyperactivity. But they also underscore the unexpectedly high rate of externalising symptoms among depressive-suicidal children, whose pathology is theoretically regarded as a typically internalising disorder. In conclusion, these results suggest the relationship between externalisation and internalisation could be more complex than is generally assumed, and support the possibility of simultaneous presence of high levels of externalisation and internalisation in some disorders.     

Confirmation de l’intérêt de la biopsie cutanée dans la neuropathie des petites fibres. Résultats préliminaires

Introduction

In small-fiber neuropathy, skin biopsy reveals a reduction of intraepidermal nerve fiber density (IENFD), a feature often necessary for diagnosis. In France, this technique has not been widely used for this purpose.

Patient and method

To validate this method, we studied 13 patients with suspected small-fiber neuropathy, analyzed their nervous intra- and subepidermal network with a punch skin biopsy and compared our data with those of literature.

Results

Ten patients had pure small-fiber neuropathy and three an axonal polyneuropathy involving large-caliber nerve fibers. In the group of patients with pure small-fiber neuropathy, we found medium IENFD (11.6 ± 4.46 fibers per millimeter in the proximal thigh and 7.15 ± 3.59 fibers per millimeter in distal leg), well correlated with the electron microscopy quantitative and qualitative analysis of the unmyelinated subepidermal fibers.

Conclusion

This work demonstrated the good reproducibility of skin biopsy for analyzing the small-fibers in our cohort. These results require further confirmation in a larger cohort and validation in comparison with controls analyzed on a local level. Nevertheless, these techniques seem to be useful to assess the difficult diagnosis of small-fiber neuropathy.     

Plasma levels of microparticle-associated tissue factor activity in patients with clinically suspected pulmonary embolism

Introduction

Microparticles (MPs) carrying active tissue factor (TF) have been detected in the plasma of cancer patients in particular in those presenting with acute deep vein thrombosis (DVT) or pulmonary embolism (PE). Experimental studies in mice have revealed that circulating MPs carrying TF contribute to thrombus formation.

Aim

To study whether unselected patients with an acute confirmed PE have elevated TF activity in the MP fraction (MP-TF activity).

Materials and Methods

Plasma MP-TF activity was measured in 159 non-selected patients with clinically suspected PE and in 48 healthy controls as previously described. Blood was collected at time of inclusion. The diagnosis of acute PE was confirmed in 54 patients and excluded in 105 patients.

Results

Median MP-TF activity in 159 patients with clinically suspected PE was 72 fM Xa/min [range 32-6657] fM Xa/min and higher than in healthy controls (66 [range 28-183] fM Xa/min; P < 0.05). There was no significant difference (P = 0.169) in MP-TF activity between patients with confirmed PE (median 84.5 fM Xa/min [range 36-2149]) and patients without PE (72 fM Xa/min [range 32-6657]) fM Xa/min). In the 159 patients with clinically suspected PE we observed in an exploratory analysis higher MP-TF activity levels in patients with active cancer (median 137 fM Xa/min [range 36-6657]) and cardiovascular disease (median 131.5 fM Xa/min [range 45-2149]) than in patients without these disorders (P = 0.0004 and P = 0.014, respectively).

Conclusion

In patients presenting with clinically suspected PE plasma MP-TF activity was not associated with confirmed PE.     

Bénéfice d’un programme cognitivo-comportemental et pluridisciplinaire de prise en charge de la maladie d’Alzheimer sur l’anxiété du conjoint : étude française ELMMA

Introduction

Over the last decade, several programs have been developed for caregivers of Alzheimer disease patients. In France however, studies exploring their effects are still scarce. We conducted a study to compare two different interventions: a structured multidisciplinary program versus a classical intervention designed for Alzheimer disease patients and their spouses.

Methods

Sixteen couples (Alzheimer's disease patient and spouse) residing in our administrative district participated in this monocentric study. For at least two years, these couples participated in a multidisciplinary program (n = 8 couples) or received usual care (n = 8 couples). The multidisciplinary program involved biannual consultations with a neurologist, a neuropsychologist and a psychologist, in addition to an annual meeting, stratified on the patient's MMSE score, for spouses). Usual care involved biannual consultations with the neurologist. The multidisciplinary program included a psychological intervention based on cognitive behavioral theories and centered on psycho-education, problem solving, adaptation strategies and on prevention of depression and anxiety. The spouses and the patients evaluated the 2-year follow-up during clinical interviews, completed by questionnaires. Sociodemographic data were noted for the patients and their spouses. Levels of depression and anxiety (Mini International Neuropsychiatric Inventory, Montgomery and Asberg Depression Scale, State-Trait Anxiety Inventory), perceived stress (Perceived Stress Scale) and care burden (Zarit Burden Inventory) were evaluated in spouses. Levels of cognitive impairment (Mini Mental State Examination), autonomy (Instrumental Activities of Daily Living), psychological state (Montgomery and Asberg Depression Scale, Covi Anxiety Scale), and behavioral symptoms frequency (Neuropsychiatric Inventory) were assessed in patients.

Results

The main significant result showed that the spouses’ state of anxiety was lower among participants in the multidisciplinary program, compared with the classical neurological intervention. It also was found that the spouses and the patients who participated in this multidisciplinary program were less depressed.

Conclusion

This study shows that a multidisciplinary structured intervention, with only two annual consultations and one annual meeting for spouses, can contribute to decrease significantly the spouses’ state of anxiety. Further studies including a larger number of subjects should be conducted to confirm these findings.     

De la non-expression à la surexpression des émotions ou comment l’expérience émotionnelle repose la question des liens entre sexe, alexithymie et répression

Objectives

Alexithymia, considered as a disorder of affect regulation, is well known for its consequences on the vulnerability to negative emotions, but nevertheless it raises the question of the repressive dimension according to Myers’ (1995) and Newton and Contrada’s (1994) researches. If, under certain conditions, alexithymia refers to this dimension we should observed traces of this repressive behaviour on emotional distress. We thus studied the influence of alexithymia scores on trait anxiety, state anxiety and depression, and this relatively to the gender of the participants.

Methodology

We first compared the mean scores of distress of our three groups of subjects (low alexithymia, N = 32; moderate alexithymia, N = 62, high alexithymia, N = 33) with the norms of the general population. Secondly, we studied the consequences of alexithymia intensity on depressive symptoms, trait and state anxiety, with regard to the gender differences. We used 1) the State-Trait Anxiety Inventory (Spielberger) to assess dispositional and acute anxiety, 2) the Center for Epidemiological Scale for Depression (Radloff) to evaluate depressive symptomatology and 3) the Toronto Alexithymia Scale (Bagby) for the alexithymia construct.

Results

In the lower alexithymia group, the total mean scores of depression for men or women (men: 8.06 ± 7.06; women: 8.88 ± 6.84) were significantly lower than those in the general population (men: 12.73 ± 3.02; women: 13.97 ± 3.62). We obtained the same pattern of consequences of a low alexithymia with regard to trait anxiety (men: 32.73 ± 10.20 versus 41.86 ± 9.48; women: 37.17 ± 8.48 versus 45.09 ± 11.11). Finally, there was no difference between the lower alexithymia group mean scores and the general population references, regardless of gender. In addition, in our group of women, the higher the alexithymia mean scores, the more important were the depression (F(2,68) = 21.13, P ≤ 0.000), trait anxiety (F(2,68) = 12.51, P ≤ 0.000) and state anxiety (F(2,68) = 6.72, P ≤ 0.002) mean scores. The male participants did not show a particular vulnerability to the alexithymia intensity, except for trait anxiety in the moderate condition (t(43) = -2.30, P ≤ 0.026).

Conclusion

Our results support the reality of the emotional repression in the condition of lower alexithymia and raise the question of the links between alexithymia and gender. Indeed, emotional experience follows different and surprising ways, inviting us to think about the relevance of a differentiation of the type of alexithymia according to whether one is a man or a woman.     

Qualité de vie de la fratrie d’enfants atteints de mucoviscidose : le point de vue des parents et des enfants

Objectives

The impact of the presence of a child with cystic fibrosis in the family on the siblings is rarely studied. Moreover, the available empirical data are not clear. This study aims at evaluating the siblings’ quality of life according to the assessments performed by, on the one hand, the parents and, on the other hand, the brothers and/or the sisters of the sick child.

Methods

Thirty families took part in this study for which we used two instruments. The parents filled out the Child Behavior Checklist, which is a questionnaire intended to assess the behavioral and emotional problems of their nonsick children. The parents and their nonsick children filled out the Duke Health Profile which is a questionnaire intended to assess the quality of life in three fields: physical health, social health, and mental health.

Results

The parents and their nonsick children differently assess this quality of life. The parents tend to over-estimate the physical health of their nonsick children and to incorrectly evaluate the risks of suffering that are—differently—expressed by their sons and/or their daughters. In particular, while they correctly estimate the social health of their sons, they overestimate their mental health (p < 0.02). At the contrary, while their evaluations of their daughters’ mental health are quite well adjusted, they overestimate their social health (p < 0.03).

Conclusion

As most of the parents directly provide affective support and follow-up care for their child with cystic fibrosis, it remains necessary to more precisely specify how their perceptions of the health of the different members of the family fall under the family dynamics of adjustment to the disease. This conclusion goes for the research level as well as for the services for educational and psychological aid one.     

Facteurs associés aux réadmissions psychiatriques des patients hospitalisés pour la première fois à Bingerville en 2001 (Cote d’Ivoire)

Objective

To ascertain the factors related to patients’ psychiatric readmissions at Bingerville.

Patients and method

It was a case-control study built on 436 files of patients who had been hospitalized for the first time in 2001 at Bingerville's psychiatric hospital. We called readmission all rehospitalization arisen 15 days after the end of the previous hospital stay. Sociodemographic and clinical characteristics of the patients who had been readmitted for at least a fold within 1st January 2001 and 31st December 2006 were compared to those who had not been readmitted during this period, by using the Chi-square test.

Results

Patients admitted for the first time at Bingerville psychiatric hospital were in majority less than 44 years old (87.8%) with mean age at 31.1 ± 10.9 years. More than half of them, had male gender (61.9%), was single or widowed or separated (70.6%), without a kid (55.5%). Numerous of them were not educated above secondary school (95.4%). In these first admitted patients, 50.9% did not earn a wage, 68.8% lived in Abidjan. Those who had both their mother and father alive represented 53.9% of the study sample. About two-third of the patients were younger in their siblings, as well in father's children as in mother's. Regarding the clinical features, schizophrenia and other psychotic disorders (59.2%) were the most frequent diagnosis, followed by mood disorders (19.0%). These mental disorders started during the month before first psychiatric hospitalization at Bingerville (47.2%). The majority (74.5%) of these patients were hospitalized 30 days at most. They were discharged with medical advice (85.8%) and less than two drugs prescribed (66.3%). The aftercare treatment did not last more than 26 weeks for most of the patients (79.6%). Readmission occurred at least a fold in 22.5% of the subjects, in majority during the first 2 years after being discharged in 2001 (68.4%). Patients characteristics related to readmission during the 6 years of study period were: being less than 21 years old (p = 9 × 10⁻⁴), younger in the siblings of mother's children (p = 10⁻³), having both mother and father alive (p = 3 × 10⁻³), a mood disorder diagnosis (p = 0.046) and a length of aftercare treatment exceeding 26 weeks (p = 4 × 10⁻³).

Conclusion

When they are repeated and closer, readmissions can worsen patients’ social reinsertion. The knowledge of factors related to these rehospitalizations is useful to prevent this consequence.     

Corrélations anatomocliniques des neuropathies périphériques cryoglobulinémiques secondaires à l’hépatite C. Série consécutive de 22 cas

Introduction

Cryoglobulinemic neuropathies caused by hepatitis C virus are frequent and may have severe clinical outcomes. The aim of this study was to clarify the clinical and anatomical correlations of these neuropathies.

Methods

Between 1992 and 2007, 22 consecutive patients with cryoglobulinemic neuropathies caused by hepatitis C virus were retrospectively included. Patients were evaluated clinically, electrophysiologically and underwent a neuromuscular biopsy. The group of patients with vasculitis on nerve biopsy was compared with the group without vasculitis.

Results

All the neuropathies were axonal with 11 polyneuropathies and 11 mononeuropathies multiplex. The seven patients with medium-sized vasculitis on the nerve biopsy presented an acute sensorimotor mononeuropathy multiplex in six cases (85%), with ischemic conduction block in three cases (42%) and wallerian degeneration in four cases (57%). Among the four patients with small-sized vasculitis, two had a mononeuropathy multiplex (50%) without conduction block (0%) and with wallerian degeneration in one case (25%). The 11 patients without vasculitis (nine lymphocytic perivascular infiltrates and two non inflammatory biopsies) had a polyneuropathy in eight cases (72%) without conduction block and wallerian degeneration (0%). The type of neuropathy was different in the group of patients with vasculitis compared with the group without vasculitis. The neuropathies with vasculitis were significantly different with more frequent mononeuropathies multiplex (p < 0.05), acute early stage (p < 0.01), disability (p < 0.05) and wallerian degeneration (p = 0.01).

Conclusion

Among hepatitis C patients with cryoglobulinemia, neuropathies with small-sized vasculitis show a pattern between severe mononeuropathies multiplex with medium-sized vasculitis and moderate polyneuropathies with lymphocytic perivascular infiltrates. In cryoglobulinemic vasculitis with hepatitis C, the severity of the neuropathy depends on the nature of the cellular inflammation and the size of the vessel involvement.     

Évaluation d’un programme de psychoéducation individuel chez des patients hospitalisés pour un trouble bipolaire

Objective

To assess the effectiveness of an individual program of psychoeducation in inpatients hospitalized for the first time with bipolar disorder, by comparing the acquired knowledge of patients who have received the program and that of patients who did not.

Methods

Patients who followed psychoeducation program were hospitalized in a bipolar disorder unit and control patients were hospitalized in other units of the same psychiatric department. At the end of hospitalization, personal questionnaires assessed knowledge with respect to bipolar disorder and its treatment; allowing us to calculate a “knowledge score”.

Results

The psychoeducation group had a better knowledge of bipolar disorder and of its treatment than that of the control group [39.3 (ET 3) versus 29.8 (ET 6,8); p < 0.0001], independently of other demographic and clinical characteristics.

Discussion

Structured and formalized psychoeducation appeared useful in inpatients in order to familiarize them with their disorder and their treatment.     

Aspects cliniques, radiologiques, pronostiques et thérapeutiques des lésions démyélinisantes extensives

Background

Demyelinating diseases presenting with a tumefactive demyelinating lesion (TDL) raise questions about classification, diagnosis, prognosis, and treatment. Their long-term course is not well described in literature.

Patients/methods

In a retrospective study, we describe the main characteristics of 29 patients with TDLs. In a case control study, we compared two cohorts of multiple sclerosis (MS) patients: 24 MS patients with TDL versus a reference cohort of patients with relapsing remitting MS. We compared the extended disability status score (EDSS) concerning the first demyelinating event (DE) with TDL, EDSS score at the end of follow-up and treatment intake. The objective was to discuss the prognosis and the management of TDL.

Results

In our study, the prognosis was better for patients with non-prevalent TDL (first DE without TDL) compared with patients with prevalent TDL (first DE with TDL) and was not different compared with the MS reference cohort. At the end of follow-up, there was no significant difference between patients treated with immunosuppressors after a first DE with TDL and patients with classical MS. The EDSS at the end of follow-up was statistically more severe for untreated patients after a first DE with TDL than for classical MS patients (P = 0.0047).

Discussion

The prognosis of patients with TDL is difficult to assess because of its multifactorial nature (underlying disease and treatment impact). In our cohort, outcome of MS patients whose first severe DE involved a TDL was better when they received an early immunosuppressive treatment.     

Caractéristiques psychologiques des patients coronariens en situation de gestion de la frustration

Objectives

The aim of the present study is to investigate psychological characteristics of frustration management and their consequences in coronary patients.

Methods

A sample of N = 58 myocardial infarction patients completed questionnaires measuring self-efficacy (Schwarzer), negative affectivity and social inhibition (type D, Denollet), coping strategies (Coping Questionnaire for Coronary Patients [CQCP], Maës); Anxiety and depression (Hospital Anxiety and Depression Scale [HADS], Zigmond and Snaith), quality of life after myocardial infarction (MacNew Heart Disease Health-related Quality of Life Questionnaire, Hillers) and frustration management (Picture Frustration Study [PFS], Rosenzweig).

Results

The results show that frustration management in coronary patients differs significantly from that of the reference population. During frustration management the coronary patients present comparatively higher levels of culpability (high I answers) or denial of the responsibility of others (high M answers), as well as lower levels of aggressiveness (low E answers) than the reference population. Furthermore, myocardial infarction patients tend to rather repress their feelings (few ED answers) and to look for active solutions (high NP answers) (Table 1). Patients with a high self-efficacy score look significantly more for active solutions in their frustration management (NP) (r = 0.27), whereas patients with negative affectivity and social inhibition look for fewer solutions (respectively r = -0.31, r = -0.26). The social inhibition is significantly associated with answers of “Obstacle Dominance” (OD) (r = 0.28). Within the four coping strategies studied, only the focusing on the problem resolution one is significantly linked to the frustration management responses. Patients using a problem-focused strategy show lower levels of “Ego Defence” for frustration management (r = -0.31) and higher levels of “Need-Persistence” (NP) (r = 0.31). Furthermore, results show that “Ego Defence” (ED) is positively related to anxiety (r = 0.27), whereas “Need persistence” (NP) is negatively linked to anxiety (r = -0.28) and negatively to depressive affects (r = -0.29). Patients indicating more extrapunitive answers (E) report significantly lower levels of quality of life (r = -0.29), whereas non-punitive answers (M) are associated with higher degrees of quality of life (r = 0.31). No other significant associations were found between frustration answers and quality of life.

Conclusions

Emotional repression may be a short-term efficient strategy for the patients, allowing a distancing from the myocardial infarction trauma and increasing the quality of life. In the long-term, however, high levels of emotional repression could have negative effects on the global quality of life and the health of the patients.     

Venlafaxine and mirtazapine treatment lowers serum concentrations of dehydroepiandrosterone-sulfate in depressed patients remitting during the course of treatment

Objectives

The adrenal androgen dehydroepiandrosterone-sulfate (DHEA-S) seems to be involved in the pathophysiology of depression, although its precise role in the etiology and remission of depression remains unclear. In the present study we intended to examine possible differential effects of venlafaxine and mirtazapine in a randomised open trial with regard to DHEA-S serum concentrations in patients suffering from major depressive episode compared to healthy controls.

Methods

We assessed DHEA-S concentrations both at baseline and after a 4-week treatment period in 70 depressed patients (n = 33 for venlafaxine and n = 37 for mirtazapine) and 33 matched healthy controls.

Results

We describe the decrease of DHEA-S levels in depressive patients who remitted after treatment with both venlafaxine or mirtazapine. Patients without remission of depression did not show a significant decline in DHEA-S concentrations.

Conclusions

Our results suggest an effect of treatment outcome upon DHEA-S concentrations rather than a direct drug effect. The change of plasma DHEA-S levels as a marker of treatment-response of depression warrant further investigation.     

Évolution clinique de la dépression post-accident vasculaire cérébral à Kinshasa

Objectives

To describe the evolution of the clinical profile of post-stroke depression over a period of one year and to determine factors associated with changes in post-stroke depression.

Methods

Prospective cohort study with a follow-up of 1 year including 30 consecutive eligible patients. The severity of depression was assessed with the patient health questionnaire (PHQ9).

Results

The mean age was 55.87 ± 12.67 years. Seventy percent of patients were men. The two assessments for neurological status, perceived health status and test results of attention were not statistically different. The rate of depressive symptoms was 26.67% in 2011 and 20% in 2012. Disability and apathy were significantly improved. The average for disability increased from 2.77 ± 1.19 to 2.46 ± 2.19 (P = 0.002). From 66.7% in 2011, the proportion of patients able to walk without assistance rose to 93.3% in 2012 (P = 0.03). In addition, the proportion of patients apathetic decreased from 43.3% to 13.3% (P = 0.01). Greater age, female sex, sleep disorders and post-stroke apathy remained associated with DPAVC between the two assessments, with an increase in the strength of the association for apathy.

Conclusions

The frequency of post-stroke depression is high and remains stable over time. Disability is the clinical feature that evolved more favorably. The association with apathy, present at the beginning, of the study was strengthened one year later.     

Cerebrovascular reactivity over time-course - From major depressive episode to remission

Introduction

Depression is a prospective risk factor for stroke. Little is known, however, about the pathophysiologic links leading to this association. Cerebrovascular reactivity (CVR) reflects the compensatory dilatory capacity of cerebral arterioles to a dilatory stimulus and is an important mechanism to provide constant cerebral blood flow. In the absence of major arterial stenosis, an impaired CVR has been associated with a higher risk of stroke. We hypothesized that CVR might be continuously reduced in patients with major depression even after successful remission thus contributing to the association between depression and stroke.

Materials and methods

We investigated CVR in a group of patients (N = 29) in the acute episode of depressive illness and after 21 months under euthymic condition. A healthy control group (N = 33) was investigated at comparable time intervals. All patients and controls were otherwise healthy. CVR was investigated by calculating the increase in cerebral blood flow velocity after stimulation with acetazolamide. Blood flow velocities were measured by transcranial doppler ultrasound.

Results

A group of acutely depressed patients presented a significantly reduced CVR compared to controls. On follow-up 21 months later after treatment and remission, CVR in the patient group had significantly improved, whereas CVR in the control group remained unchanged. Confounding factors had no significant influence.

Discussion

CVR is impaired during major depression. Since CVR seems to improve after treatment of depression, the contribution to an increased stroke risk among depressive patients may be true for a subgroup only and needs to be further investigated.     

Tuberculomes cérébraux : à propos de six cas

Introduction

Despite the resurgence of tuberculosis, partly due to HIV infection, central nervous system involvement remains rare, accounting for only 2 to 5% of all tuberculosis forms.

Patients et method

We report six cases of brain tuberculomas occurring in patients free of HIV infection and hospitalized between 2001 and 2006 in the internal medicine department of a Tunisian military hospital (Tunis).

Results

Four patients had an underlying defect. Headache, fever, consciousness disorders, deficit disorder or cerebellar syndrome are the main symptoms. Tuberculomas were multiple and disseminated in four cases and localized in the brain stem in two cases. Positive diagnosis could be established in two cases on the basis of the pathology results of a brain biopsy or detection of Mycobacterium tuberculosis in the cerebrospinal fluid; the diagnosis was presumptive in the other cases. Five patients recovered under antituberculosis treatment maintained on average 13 months (11 to 16 months). Steroid treatment was associated in five patients and tapered off for four to six weeks. One 78-year-old diabetic patient died in a context of cachexia with multiple organ failure.     

Étude longitudinale de la qualité de vie dans la sclérose en plaques : corrélation aux paramètres morphométriques de l’imagerie

Introduction

Health related quality of life (HRQOL) is often affected in multiple sclerosis (MS). Nevertheless, to our knowledge, there is no longitudinal study in the literature about the correlation between MRI parameters and HRQOL in MS patients.

Methods

We included 28 patients with clinically definite relapsing remitting MS. All patients initiated subcutaneous interferon beta-1a therapy. To assess HRQOL, we used the SEP-59 scale, the French validated translation of MSQOL-54, and the MusiQoL scale. Conventional MRI was performed every year. Lesion load (LL) and brain atrophy were automatically measured using SepINRIA, a free software developed by INRIA in Sophia Antipolis.

Results

The mean EDSS score was 1.7 and disease duration was 2.5 years. Our results revealed that HRQOL was significantly correlated to T1 and T2-LL with both SEP-59 and MusiQoL scales. T1-LL was better correlated with physical dimensions and T2-LL was better correlated with mental components. At 1-year follow-up, patients whose MRI showed either an increase of T1 LL or at least one gadolinium enhancing lesion had a worse HRQOL at the end of the study. Initial brain parenchymal fraction (BPF) measure was also correlated with the long-term follow-up HRQOL. EDSS scored at the end of the study had not significantly changed (1.3; P > 0.05).

Conclusion

Our study revealed pertinent clinicoradiological correlations between HRQOL and MRI parameters in our cohort.