Uvéo-méningo-encéphalite

Résumé On réunit sous le terme général d'uvéo-méningo-encéphalite la maladie de Harada et le syndrome de Vogt-Koyanagi. Ce tableu nosologique est actuellement bien défini et on distingue trois phases dans son évolution: une phase méningée, une phase ophatalmique et une phase de convalescence qui s'étend sur des mois. Au cours de cette dernière on assiste à la régression des lésions oculaires et à l'apparition (fréquente, mais non obligatoire) de lésions de la peau et des muqueuses.Les auteurs rapportent un cas d'uvéo-méningo-encéphalite survenu chez une jeune Espagnole de 27 ans. Ce cas a présenté une évolution tout-à-fait caractéristique, mais s'est signalé par des particularités biologiques inhabituelles: on a constaté en effet une hyperleucocytose sanguine très marquée (avec polynucléose) ainsi qu'une forte prédominence de polynucléaires dans les premières rachicentèses.L'évolution, suraigue à la phase initiale, s'est terminée à la convalescence par une régression notable des lésions oculaires et auditives.

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Summary The term uveo-meningo-encephalitis associates two syndromes therefore considered different from each other: Harada's disease and Vogt-Koyanagi syndrome. As a clinical entity it is at the present time well defined and its evolution occurs in three phases; first meningeal involvement, later on ocular manifestations and finally a phase of recovery, which can extend over months. In the course of the last phase there is a regression of uveitis, and cutaneous and mucous lesions may often appear.In the present paper the authors report one case of uveo-meningo-encephalitis occurring in a 27 years old spanish woman. The evolution was typical but a biological peculiarity was represented by the very elevated white cells count with polymorphonuclear predominance, both in peripheral blood and cerebrospinal-fluid.Though the initial phase of meningitis was extremely dramatic, recovery was satisfactory and a marked regression of ear and eye lesions was observed.

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Zusammenfassung Das Krankheitsbild der Uveo-Meningo-Encephalitis vereinigt den Morbus Harada und das Vogt-Koyanagi Syndrom; es ist zur Zeit klar definiert und umfaßt 3 Phasen: Eine meningeale Phase, eine ophthalmische Phase und das Stadium der Rekonvaleszenz, das sich über Monate erstrecken kann. In dieser letzten Phase bilden sich die Augenläsionen zurück, während häufig—jedoch nicht obligat—Haut- und Schleimhautläsionen auftreten.Die Autoren berichten über einen Fall von Uveo-Meningo-Encephalitis bei einer jungen, 27jährigen Spanierin. Der Krankheitsverlauf war charakteristisch, zeichnete sich jedoch durch einige biologische Besonderheiten aus: so bestand im weißen Blutbild eine ausgesprochene Leukocytose (mit vorwiegend Neutrophilen), in der Cerebrospinalflüssigkeit überwogen anfänglich die neutrophilen Leukocyten gegenüber den Lymphocyten.Trotz initial perakutem Verlauf bildeten sich während der Rekonvaleszenz die Seh- und Hörstörungen weitgehend zurück.

     

Intérêt d’un traitement par scopolamine dans les troubles dépressifs

IntroductionThe number of patients with depression in the world is 350 millions according to estimates. The search for new treatments, particularly in forms of resistant depression, is necessary given the growing number of patients experiencing treatment failure and resistance. Scopolamine, an anticholinergic antimuscarinic molecule, is one of the treatments under evaluation. It falls within the assumptions of cholinergic disruption of the pathophysiology of depression, at different levels (genetic, receptorial [muscarinic and glutamate receptors], hormonal, synaptic…). In 2006, a pilot study made to evaluate the role of the cholinergic system in cognitive symptoms of depression found unexpected results regarding the antidepressant effect of scopolamine in depressive patients. Since that time other studies have been conducted to evaluate the benefits of treatment with intravenous injections of scopolamine.ObjectiveOur main objective was to evaluate the interest of scopolamine as an antidepressant treatment in depressed populations.MethodsWe conducted a literature review with the aim of assessing the effectiveness of treatment with scopolamine in uni- and bipolar patients with depressive symptoms. The protocol consisted of two injection blocks (each block consisting of three injections spaced fifteen minutes apart within three to five days) of active ingredient or placebo crossover. The selected patients were between 18 and 45 years and had the DSM-IV major depressive disorder or bipolar disorder criteria. Regarding the methods of measurement, the primary endpoint was the reduction in scores of the Montgomery Asberg Depression Rating Scale (MADRS) with a total response defined by a decrease of more than 50 % of the score and remission corresponding to a MADRS score < 10. Seven sessions of evaluations were performed.ResultsThe published results are promising in terms of efficiency with rapid antidepressant effect, a total response rate ranging from 59–64% and a remission rate of between 37 and 55% in uni- and bipolar patients, which persists at least 15 days. The treatment was well tolerated by patients with relatively mild and transient side effects the most common being the sensation of sleepiness that was also found in the placebo group. There were no serious side effects such as heart failure or confusion. In terms of mood, there was no becoming manic or hypomanic even for bipolar patients.ConclusionThe results are encouraging, but there is concern for the moment because of the few studies, so to date there is little data on the subject including medium and long term.