Les critères d’Awaji : les nouveaux critères diagnostiques de la sclérose latérale amyotrophique

Amyotrophic lateral sclerosis is the most common motor neuron disorder in adults. Although the diagnosis appears obvious in theory, clinical practice shows the contrary as diagnosis is delayed in many patients; the average time between symptom onset and diagnosis can reach 12 months. The delay can be explained by the variability of the clinical presentation and by the absence of diagnostic markers. In order to standardize diagnosis for enrolment in clinical research, diagnostic criteria for ALS were created and revisited during the last 20 years. In 2006, the Awaji criteria for the diagnosis of ALS were proposed, adding two major points to the diagnostic criteria: electromyography is considered equivalent to clinical examination for the identification of LMN signs and fasciculation potentials resume their prominent place in the diagnosis. Comparisons of the accuracy of the revisited El Escorial and Awaji criteria support improved diagnostic sensitivity without any effect on specificity with the new classification. The only weakness of the new classification involves patients with UMN signs in one region and LMN in two regions; these patients were previously classified as laboratory-supported probable ALS and currently as possible ALS, a lower level of diagnostic certainty. In all other instances the accuracy appears to be improved by the Awaji criteria. Nevertheless, there is a body of evidence suggesting the need for a revision of these new criteria, giving more weight to clinical and complementary findings of UMN involvement. The need to diagnose and treat ALS quickly could be facilitated by the inclusion of complementary investigations that detect UMN signs.     

La mondialisation de la psychiatrie et la Société Médico-Psychologique

Ever since the first World Congress of Psychiatry was organized in Paris in 1950, the French Société Médico-Psychologique, who played an important part in its organization, has kept profitable exchanges of views with national societies who are members of the World Psychiatric Association. These exchanges revolved around the main issues which have marked the history of psychiatry in the second half of the twentieth century and the beginning of the twenty-first: The rise of pharmacology in psychiatry, ethics, classifications of mental diseases, protest movements, clinical research, family and mental patients associations, legislation, medicine of the person and so on. These questions were debated in following world meetings, including the sixteenth congress which recently took place in Buenos Aires, but also during symposia organized by national societies in their own capital cities. Minutes of such meetings were often published in the Annales Médico-Psychologiques. It is to be hoped that the Société Médico-Psychologique, being one of the world's oldest psychiatry societies, will be able to make present French psychiatry known in the world, since it carries the legacy of a long tradition of research in psychopathology. The present circulation of the Annales Médico-Psychologiques shows that readers in distant and often unexpected countries are curious to discover it.     

Eugène Dally (1833–1887) et les liens historiques entre la Société Médico-Psychologique et la Société d’Anthropologie de Paris

The Société Médico-Psychologique (SMP) was founded in 1852, while the Société d’Anthropologie, with the later addition “de Paris” (SAP), was founded in 1859 under the auspices of Broca. Several of its members, including some of the more eminent ones, came from the SMP. These two societies remain very active to this day.ObjectivesThe objectives of these two societies and the issues, which concerned the scientific world, are researched in the work and philosophical options of Dr. Dally (1833–1887), who was an active member and president of the two societies.Materials and methodsThe work of Eugène Dally has been compiled in the collections of the Annales Médico-Psychologiques and in the Bulletins et mémoires de la Société d’Anthropologie de Paris.ResultsEugène Dally followed in the footsteps of his father Nicolas Dally as both physiotherapist – propagating in France the benefits of gymnastics – and polygraph. A disciple of Littré and an intransigent defender of the positivist doctrine, he was also a convinced anticlerical and he defended his ideas within these two societies which he joined the same year, at the age of 27 years. His career in the SAP was brilliant (he held its chair in ethnology) in the footsteps of Broca, of whom he was a fervent disciple. After his translation of Man's Place in Nature by Th Huxley, which allowed him to defend Darwin's ideas, he introduced the concept of transformism to France and shifted Broca's anti-evolutionist stance. He defended the close links between Man and the higher apes more consequently than Huxley, anticipating the modern works of the primatologists (Frans de Waal). At the SAP he was also a critical adversary of the extrapolations made from dubious anomalies discovered upon examining the brains of criminals with the aim of considering them ill and thus explaining their acts. His arrival in the SMP coincided with the opening, which had been agreed (in sign of goodwill to the new conservative power) to non-medical members from the fields of philosophy, law, history and even religion. His work and his interventions were those of a polemicist battling in the clan of physiologists and materialists against the spiritualists and metaphysicians. Hence he took clear-cut, violently anticlerical positions when the issue of the soul was put on the agenda. The deadlock in the debates on such subjects most likely explains the gradual abandoning of multidisciplinarity within the SMP membership. During discussions in 1863, which brought together all the leading lights of the SMP on the issue of criminal responsibility, Dally equally supported an unequivocal position, setting hardened criminals alongside the ill. Thus he defended – in a conscious manner – a theoretical position which considered social defence only.ConclusionsEugène Dally is the most committed representative of a generation of anticlerical doctors obstinately pursuing the Voltairien combat. His positivist, scientific convictions most likely met with the approval of several members of the SMP who found in him their spokesman. He can be considered to be a forerunner of the movement for social defence and his position on the close ties between Man and the higher apes has more recently proved its relevance.     

Le syndrome post-ponction lombaire. Revue de la littérature et expérience des urgences céphalées

Post-lumbar puncture headache (PLPH) is a well-known syndrome resulting from spinal fluid leakage and delayed closure of a dural defect. The main symptom of PLPH is headache in upright posture relieved by lying down. Outcome is usually benign and complications are uncommon. The functional impact can however be important, leading to delayed discharge, sick leave and, if information delivery is ineffective, iterative consultations. Preventive measures have been published, but the prevalence of PLPH remains high (15 to 40% after diagnostic lumbar puncture). Needle size and type are probably the most important factors for reducing the risk of PLPH. Recovery can be rapid, within a few days. If PLPH persists after four days, an epidural blood patch should be discussed. The objective of this review is to summarize the literature on PLPH, and share the experience of our emergency headache center with an atraumatic 25-gauge needle (pencan, 0.5 × 90 mm or 0.5 × 103 mm, Braun, Germany).     

Place de la réalité virtuelle dans la prise en charge des enfants paralysés cérébraux : synthèse bibliographique

Cerebral palsy is the main cause of disability in children. It leads to motor, postural and/or sensory dysfunctions for which care is required from birth. This care must be diversified in order to avoid monotony and to maintain good adherence to care. Virtual reality, which has been in full expansion for several years, appears to be an interesting tool for maintaining motivation and diversifying the exercises and modalities offered in rehabilitation to children with cerebral palsy.MethodA bibliographical research carried out in different search engines (CINAHL, PubMed) with the addition of filters allowed the selection of 21 articles. Five of these articles were selected for their close link with the key words and analyzed in the article below.DiscussionFrom the upper limb to balance, virtual reality seems to have an impact on many areas of rehabilitation management. If it appears interesting on the motivation for all the authors, its use meets certain criticisms and the interpretation of the results must be taken with parsimony.ConclusionVirtual reality seems to be an interesting tool to use for the rehabilitation of children with cerebral palsy. However, other studies are necessary with less heterogeneity, the use of adapted and validated tools for cerebral palsy and a higher level of proof.     

Installations en position assise de l’enfant atteint de paralysie cérébrale. Évaluation : critères à retenir

The realization of a sitting device for a child with cerebral palsy raises many questions. When should it be offered? Based on which criteria? Which purposes, for the child and his family, should be targeted? Which pitfall should be avoided? After performing a complete clinical evaluation, we have to analyse precisely the standards relevant to the functional aspects of the seated position, and we have to dissociate those relevant to the postural function of those purely orthopaedics. In this analysis, the purpose is to understand the nature and the location of the disorders, coming either from the lower limbs or the dorso, and how they interact. Besides these major factors in the assessment approach, we must not overlook other important criteria, such as breathing or relatives’concerns, and some tricky practical problems have to be solved. Consider also the consequences of the seating facility on the daily life activities: diets, handling… The resulting comfort we obtain also has an impact on the quality of interactions, communication and learning processes. Based on Pr Guy Tardieu and Mr Le Métayer's factor and clinical evaluation approach, as well as our own experience at the medico-social centre, we expose how the design of a seat is part of the neuromotor rehabilitation and the multidisciplinary support.     

Gheel et la Société Médico-Psychologique : relecture d’une controverse

The controversy around the village Gheel, also known as the “village of fools”, which occurred between 1860 and 1870 to the Société Médico-Psychologique has been the subject of several analyzes at different periods of history. In these years of political turmoil, corresponding to liberal turn of the Second Empire, the leading names in French alienism compete around the mode of assistance to insane. Since the seventh century, Gheel host the insane throughout Europe, because the place is reputate to healing. From the early nineteenth century, it is subject to many reforms in order to make a real foster family care. Several psychiatrists therefore see it as a plausible alternative to asylums, increasingly overloaded. In France, the debate is particularly important. The study of the debates held in the Société Médico-Psychologique between 1860 and 1865 and published in the major journals of the day French texts reveals major issues for the discipline. These include consolidating its expertise vis-à-vis lawyers and religious in particular. This also echoes the current issues. Indeed, our period saw the emergence of the concept of experiential knowledge of users, which is proposed as a complementary and not competitive concept of medical knowledge, but this notion is contested even within the profession.     

L’image de la Société Médico-Psychologique auprès des étudiants en psychologie

We aim to grasp students’ representations of the Société Médico-Psychologique and of the teaching of the psychopathological science. We used cross-methodological tools using first a questionnaire in a sample of 34 bachelor's degree students and 69 Master of Clinical Psychology students. Secondly we used semi-structured interviews with 10 students having attended sessions of scientific communications at the Société Médico-Psychologique in order to collect more qualitative data about the representations and appraisals of these scientific sessions. Results show that the Société Médico-Psychologique is perceived as a setting of exchange and scientific formation between the theoretical formation delivered at the University and the practical formation delivered in training places. Moreover, the students expressed a kind of inhibition in attending the Société Médico-Psychologique sessions and in asking questions to these speakers’ sessions linked to some prestigious representations of the Saint-Anne hospital where the sessions take place and of the great figures intervening in these sessions. This study pushes for a reflexion about the way we can help students to meet scientific knowledge and to become integrated in the psychologists’ community.