Modulation de la douleur après stimulation cérébrale profonde dans la maladie de Parkinson : revue de la littérature

Pain is one of the most invalidating non motor symptoms in Parkinson’s disease (PD) patients and remains insufficiently diagnosed and treated. Deep brain stimulation of subthalamic nucleus (DBS-STN), that has been shown to be very effective in the treatment of motor symptoms, can also improve painful phenomenon in PD patients thanks to a central modulation of pain detection and tolerance thresholds.     

Prédiction de la douleur postopératoire sévère et de la persistance de la douleur postchirurgicale par des tests psychophysiques

Psychophysical testing has the potential to identify patients at risk for severe postsurgical pain and for developing persistent postsurgical pain. Identification of that risk should allow for better preemptive actions. However, the clinimetric characteristics of these tests are barely defined. Consequently, their predictive value remains limited and needs to be refined in order to be exploitable at the bedside with standardized protocols and normative data for surgical patients.     

Paralysie cérébrale : organisation de la transition enfant-adulte et spécificités de la prise en charge MPR de l’adulte

The increase in life expectancy due to improvements in the quality of care has meant that children with cerebral palsy reach adulthood despite the burden of their illness. The implementation of a child to adult transition and adult monitoring has proven necessary. Adolescence is a transitional period towards adult life that has specific risks associated with it, and which marks the progression of the condition. Preparing for the transition towards adult care must take place as early as possible. Providing the child and their family with all the relevant information is essential. A transition meeting and good quality information transfer ensures that appropriate adjustments can be made to monitoring in an adult environment. Adult level monitoring is required in PM & R to coordinate medical and rehabilitation follow-ups, ideally in an illness specific consultation appointment. For adult patients, we will discuss the specific problems of the seating position, the neurological effects of scoliosis, multi-stage surgical procedures, the treatment of axial dystonia and cervical myleopathy, early degenerative complications to the joints and the possibility of prosthetics to the lower limbs.     

Programme d’amélioration de la qualité de la prise en charge de la douleur des malades hospitalisés pour HIV ou cancer

Résumé  Nous présentons le rapport d’un programme d’assurance qualité réalisé dans deux services hospitaliers de médecine, maladies infectieuses et oncologie (appel d’offres ANDEM ANAES entre 96–98). Le programme a débouché sur des actions qui sont définis (évaluation systématique, élaboration d’un classeur douleur). Les observations réalisées peuvent être utiles pour des projets analogues. Rapport final ANDEM ANAES de Déc. 98     

Phytothérapie de la dépression

Editorial

Le changement     

Génétique de la migraine

The principal advances in understanding of the molecular genetics of migraine come from studies of familial hemiplegic migraine (FHM), a rare migraine variant with aura, which has autosomal dominant inheritance. Three genes have been identified, all of which code for ion transporters. In cellular models and in transgenic mice, mutations causing FHM result in neuronal hyperexcitability, thus facilitating the triggering of waves of cortical spreading depression, the phenomenon which underlies the migrainous aura. Large numbers of linkage analysis and association studies in the most common forms of migraine, whether with or without aura, have yielded inconclusive results. This is probably due to the clinical heterogeneity of migraine. New methods of phenotype analysis and of exploration of association over the whole genome now seem to offer the best chance of identifying the genes of migraine.