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.     

Manejo de la enfermedad de Parkinson y otros trastornos del movimiento en mujeres en edad fértil: parte 2

IntroductionMany diseases associated with hyperkinetic movement disorders manifest in women of childbearing age. It is important to understand the risks of these diseases during pregnancy, and the potential risks of treatment for the fetus.ObjectivesThis study aims to define the clinical characteristics and the factors affecting the lives of women of childbearing age with dystonia, chorea, Tourette syndrome, tremor, and restless legs syndrome, and to establish guidelines for management of pregnancy and breastfeeding in these patients.ResultsThis consensus document was developed through an exhaustive literature search and a discussion of the content by a group of movement disorder experts from the Spanish Society of Neurology.ConclusionsWe must evaluate the risks and benefits of treatment in all women with hyperkinetic movement disorders, whether pre-existing or with onset during pregnancy, and aim to reduce effective doses as much as possible or to administer drugs only when necessary. In hereditary diseases, families should be offered genetic counselling. It is important to recognise movement disorders triggered during pregnancy, such as certain types of chorea and restless legs syndrome.     

Place de la psychothérapie intégrative dans la prise en charge des problématiques de radicalisation

Recent waves of attacks in France have led health and justice professionals to meet, exchange and work together, with a goal that is common: the care of people with radicalization issues. The operationalization of this objective macro makes it possible to distinguish the missions of the different actors at stake. Thus, the question of care requires the definition of the object of intervention, the purpose, rehabilitative and/or therapeutic, and the means available. In this interview, members of the ARCA, Erwan Dieu and Olivier Sorel evoke the place of integrative psychotherapy in the management of radicalization issues. The purpose of this discussion is to clarify the functions and objectives of each of the actors at the interface of people presenting this form of radicalism.     

Efficacité de la médecine thermale en psychiatrie

Objectives

Relatively little known in psychiatry, spa psychiatric medicine is an original approach, which has started to form the subject of thorough assessments. It concerns 3 week spa therapy stays in practice, the patient being totally free and self-sufficient, though having to go to 3 to 4 prescribed daily bathing sessions and to the medical and psychotherapy follow-up provided within the scope of their medical care. Since the beginning of the years 2000, Spa Medicine has been subject to studies that have better shown the outline and its potential application areas. We present you here, through a review of the literature from these past 30 years, the main elements of scientific proof of its therapeutic activity and as a result, its best documented indications in psychiatry. Therefore, the article is stated by chapter, indication by indication.

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.

Expériences et enjeux de la psychiatrie militaire en opération

For the French army, Afghanistan is a new challenge, especially for the French health service. That theatre is very different from other which the army knows better like Africa or Yugoslavia. The threat is constant, provided by fight, improvised explosive device, terrorism in the cities and rockets aiming the bases. Since 2009, a French military psychiatrist is based with the NATO Hospital at Kabul Airport. The mains problems are the consequences of three threats: fight with Talibans, risk of explosion on the road by improvised devices and attack by rockets on the camps. For each, the psychic reactions are different. Combats provide among the men postoperational stress and for some of them a risk of moral disengagement. But for the most part of them theses symptoms disappears quickly. The improvised explosives devices are the threat feared the most by troops, especially for the logistic convoy. The frequent symptoms are burn out, exhaustion and stress. Rockets like explosives devices are a blind threat and aren’t feared. But when some of them fall on a camp, the people presents sleep troubles, continual stress and PTSD. Alcohol or moral disengagement are not specific of Afghanistan but constitute other challenges. Each of the cases we described is an illustration of these observations of our experience during three months in Afghanistan.     

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.     

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.     

Variabilidad en la exploración motora de la enfermedad de Parkinson entre el neurólogo experto en trastornos del movimiento y la enfermera especializada

Introduction and objectiveIn clinical practice, assessing patients with Parkinson's disease (PD) is a complex, time-consuming task. Our purpose is to provide a rigorous and objective evaluation of how motor function in PD patients is assessed by neurologists specialising in movement disorders, on the one hand, and by nurses specialising in PD management, on the other.MethodsWe conducted an observational, cross-sectional, single-centre study of 50 patients with PD (52% men; mean age: 64.7  ±  8.7 years) who were assessed between 5 January 2016 and 20 July 2016. A neurologist and a nurse evaluated motor function in the early morning hours using the Unified Parkinson's Disease Rating Scale (UPDRS) parts III and IV and Hoehn & Yahr (H&Y) scale. Tests were administered in the same PD periods (in 48 patients during the ‘off’ time and in 2 patients during the ‘on’ time). Inter-rater variability was estimated with the intraclass correlation coefficient (ICC).ResultsForty-nine patients (98%) were classified in the same H&Y stage by both raters. Assessment times were similar for both raters. ICC for UPDRS-IV and UPDRS-III total scores were 0.955 (P<.0001) and 0.954 (P<.0001), respectively. The greatest variability was found for UPDRS-III item 29 (gait; ICC = 0.746; P<.0001) and the lowest, for item 30 (postural stability; ICC = 0.918; P<.0001).ConclusionsMotor function assessment of PD patients by a trained nurse is equivalent to that made by an expert neurologist and takes the same time to complete.     

Efectividad y seguridad de la cirugía para la epilepsia en niños. Experiencia de un hospital terciario en Ecuador

IntroductionThere is sufficient evidence on the usefulness of surgery as a therapeutic alternative for patients with drug-resistant epilepsy; however this treatment is underutilized, especially in developing countries.MethodsWe describe the outcomes of epilepsy surgery in 27 paediatric patients at Hospital Baca Ortiz in Quito, Ecuador. Our analysis considered the following variables: reduction in seizure frequency, surgery outcome according to the Engel classification, improvement in quality of life, and serious complications due to surgery.Results21 corpus callosotomies and 6 resective surgeries were performed. The mean seizure frequency decreased from 465 per month before surgery to 37.2 per month thereafter (p<.001); quality of life scale scores increased from 12.6 to 37.2 (p<.001), and quality of life improved in 72.7% of patients. Regarding resective surgery, 2 patients with temporal lobe epilepsy and one with posterior quadrant epilepsy achieved Engel class IA, and one patient undergoing hemispherotomy due to Rasmussen encephalitis achieved Engel class IIA. Two patients underwent surgery for hypothalamic hamartoma: one achieved Engel III and the other, Engel IA; however, the latter patient died in the medium term due to a postoperative complication. The other major complication was a case of hydrocephalus, which led to the death of a patient with refractory infantile spasms who underwent corpus callosotomy.ConclusionsFavourable outcomes were observed in 92.5% of patients.     

Perfil clínico y sociodemográfico de la epilepsia en adultos de un centro de referencia de Colombia

ObjectivesTo describe the sociodemographic and clinical characteristics of a cohort of patients with epilepsy from a reference centre in Colombia.MethodsCross-sectional study including patients diagnosed with epilepsy who attended our epilepsy centre (Neurocentro) between 2013 and 2016. Data were gathered from patients’ medical histories.ResultsWe gathered data from a total of 354 patients diagnosed with epilepsy. Median age was 37 years; 52% were men. Seizures were focal in 57% of the patients and generalised in 38%; seizure type was not determined in 6% of the sample. The most frequent aetiology was cryptogenic (21%), followed by traumatic (14%). Median time of disease progression and age at onset were 23 and 11 years, respectively. Psychiatric comorbidities were found in 18% of the patients and 40% had some degree of cognitive impairment. Around 40% of our sample reported adverse reactions to antiepileptic drugs at some point during treatment. Antiepileptic drugs were administered in monotherapy in 36% of the patients. Around 37% had drug-resistant epilepsy and 14% underwent surgery.ConclusionsPsychiatric comorbidities, cognitive impairment, adverse drug reactions, and drug-resistant epilepsy are common among epileptic patients in Colombia. Knowledge of the factors with an impact on epilepsy may lay the foundations for improving management of these patients on the administrative level and improving quality of life.     

L’évaluation des bains thérapeutiques dans la prise en charge de la douleur des enfants polyhandicapés en SSR pédiatrique

Pain management for children who have severe neurological diseases (polyhandicap), in a pediatric post-acure care and rehabilitation, is daily and work frequently with palliative approach. Cares for these children, with complex illness are a multidisciplinary approach. Treatments establishment or equipment, intervention, adaptation take place with respect and comfort concern about child or adolescent dignity. For this, drug free techniques are more and more integrated in the pain management in hospitals. Balneotherapy is one of them, essentially used for orthopaedic, rhumatological or neurological diseases (hemiplegia for example). Caregivers doesn’t have specific bath for balneotherapy in our establishment, that why we put in place some bath, called “therapeutic bath” or “relaxation bath”. The impression was a better feeling of comfort and better-being on these children. This encourages us to pursue the study to evaluate the real benefits.     

Corrélats anatomocliniques au cours de la démence de la maladie de Parkinson

IntroductionCognitive disorders such as deficit of attention and executive and visuoconstructive dysfunctions occur in Parkinson's disease dementia (PDD). Memory impairment is not an early feature and statement not well delimited.Case reportA 78-year-old man with PDD underwent neuropsychological assessment and moreover demonstrated memory decline. After death, pathology examination of the brain and immunohistochemy analysis confirmed PD and showed Lewy body pathology (LBP) in the insula, limbic and especially in CA3 hippocampus areas. Hippocampus and gyrus parahippocampic also exhibited neurofibrillary tangles. Lack of senile plaque and lack of beta A4 amyloid deposition were noticeable in the whole brain examination.ConclusionSevere executive dysfunctions are probably related to LBP and dysfunction in memory process may be related to DNF lesions in medial temporal area.     

Evidencias actuales sobre la estimulación magnética transcraneal y su utilidad potencial en la neurorrehabilitación postictus: Ampliando horizontes en el tratamiento de la enfermedad cerebrovascular

Introduction

Repetitive transcranial magnetic stimulation (rTMS) is a therapeutic reality in post-stroke rehabilitation. It has a neuroprotective effect on the modulation of neuroplasticity, improving the brain's capacity to retrain neural circuits and promoting restoration and acquisition of new compensatory skills.