Coûts de la sclérose en plaques en France

Multiple sclerosis (MS) is one of the 30 chronic conditions specifically listed by the French healthcare system as a long-term disease (affections de longue duree [ALD]) for which the main health insurance fund (Caisse nationale d'assurance maladie des travailleurs salaries [CNAMTS]) provides full (100%) coverage of healthcare costs. The CNAMTS insures 87% of the French population (52,359,912 of the 60,028,292 inhabitants). The objectives of this study were to evaluate the direct and indirect medical costs of MS among the entire population insured by the CNAMTS in France in 2004. The CNAMTS provided us with access to the ALD database of patients with MS that contains different MS-related ex…

Longitudinal study of alexithymia and multiple sclerosis

Objective The aim of this study was to investigate the course of alexithymia and its relation with anxiety and depression in patients with multiple sclerosis (MS), over a period of 5 years. Methods Sixty-two MS patients were examined at two timepoints, 5 years apart, and they answered questionnaires collecting socio-demographic, medical, and psychological data (depression, anxiety, alexithymia). Results Our data show that emotional disorders remain stable over time in patients with MS, particularly as regards alexithymia and anxiety. Conversely, the rate of depression decreased between the two evaluations, falling from 40% to 26%. The two dimensions of alexithymia (i.e., difficulty describi…

High efficiency and clinical relevance of exome sequencing in the daily practice of neurogenetics

ObjectiveTo assess the efficiency and relevance of clinical exome sequencing (cES) as a first-tier or second-tier test for the diagnosis of progressive neurological disorders in the daily practice of Neurology and Genetic Departments.MethodsSixty-seven probands with various progressive neurological disorders (cerebellar ataxias, neuromuscular disorders, spastic paraplegias, movement disorders and individuals with complex phenotypes labelled ‘other’) were recruited over a 4-year period regardless of their age, gender, familial history and clinical framework. Individuals could have had prior genetic tests as long as it was not cES. cES was performed in a proband-only (60/67) or trio (7/67) st…

Les accidents vasculaires cérébraux : ce qui a changé au début du xxie siècle

Resume Introduction Les accidents vasculaires cerebraux (AVC) faisaient partie, il y a 20 ans, des pathologies medicales mobilisant peu de ressources techniques et humaines car atteignant les sujets âges et ne disposant pas de therapeutiques efficaces. Cette pathologie etait alors grevee d’une mortalite precoce elevee au-dela de 25 %. C’etait l’epoque de l’attitude contemplative face a un AVC. Le developpement de l’epidemiologie de populations des AVC a permis de demontrer qu’ils n’etaient pas l’apanage du sujet âge et que 25 % d’entre eux survenaient avant 60 ans et en periode d’activite professionnelle. L’arrivee de la fibrinolyse et la mise en place des unites neurovasculaires ont transf…

Les accidents vasculaires cérébraux du sujet âgé : ce que nous a appris l’épidémiologie du sujet jeune

Stroke in the elderly has more major differences compared to young people: it is the first complication of atherothrombosis disease associated with the following risk factors: hypertension, diabetes, hypercholesterolemia, tobacco consumption and sleep apnea syndrome; AVC is the first consequence of atrial fibrillation; from a clinical point of view, seizure at the onset of the stroke is more frequent; prognosis is characterized by a high risk of dementia (20%); primary and secondary prevention is very efficacious even in very old patients, not only on the risk of stroke, but also on the risk of dementia; time trends at Dijon show a slight decrease of incidence rates of stroke only over 85 y…

Le vécu des sujets atteints de sclérose en plaques : modalités intersubjectives et conjugalité, stratégies adaptatives

Supplément consacré aux Journées de Neurologie de langue française 2016; International audience; Introduction : Notre recherche porte sur l’illness, maladie du point de vue du malade, évènement corporel et psychique qui réorganise la vie psychique du sujet, influence son rapport à autrui.Objectifs : Nos objectifs consistent en l’évaluation et l’analyse de la perception des sujets quant à leur vécu émotionnel, leurs modalités intersubjectives, leurs stratégies adaptatives et leurs liens éventuels.Patients et méthodes : L’échantillon se compose de 79 sujets porteurs de SEP rémittente-récurrente (suivis EDMUS ; EDSS : m = 2,75[2,06] ; durée SEP : m = 10,47[6,08]). Sept auto-évaluations ont été…

Les accidents vasculaires cérébraux du nouveau-né et de l’enfant

The clinical presentation, risk factors, causes, vital or functional prognosis, and acute management options for stroke occurring in neonates and children are specific, differing from those observed in young adults. Compared with the adult population, less is known about the epidemiology of stroke in the under-18 population where the disease could become more frequent because of advances in both neonatal resuscitation techniques for cerebral disorders and neuroimaging techniques enabling the diagnosis of small lesions. Clinical features are often delayed, especially in neonates, and unlike epilepsy or dystonia of the affected limb, which are frequent complications, aphasia is rather rare. T…

Étude longitudinale sur 5 ans de la qualité de vie subjective de patients atteints de sclérose en plaques

Contribution of cholesterol and oxysterols to the pathophysiology of Parkinson's disease

International audience; Neurodegenerative diseases are a major public health issue worldwide. Some countries, including France, have engaged in research into the causes of Parkinson's disease, Alzheimer's disease, and multiple sclerosis and the management of these patients. It should lead to a better understanding of the mechanisms leading to these diseases including the possible involvement of lipids in their pathogenesis. Parkinson's disease is a progressive neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra and the accumulation of α-synuclein (Lewy bodies). Several in vivo studies have shown a relationship between the lipid profile [chole…

Interférences des traitements par biotine avec les immunodosages : il est temps de trouver une solution à long terme !

La Presse Medicale - In Press.Proof corrected by the author Available online since vendredi 22 decembre 2017

Alexithymie et liens avec la dépression et l’anxiété dans la sclérose en plaques

Resume Objectifs Cette etude evalue la prevalence de l’alexithymie dans la sclerose en plaques et ses liens avec la depression et l’anxiete. Methode Soixante et un sujets atteints de sclerose en plaques ont participe a cette etude. L’evaluation a compris un entretien avec une psychologue et trois questionnaires : l’echelle d’alexithymie de Toronto (TAS-20), l’inventaire d’anxiete trait–etat (STAI) et l’inventaire de depression de Beck (BDI). Resultats Les resultats ont montre une prevalence de 42,5 %, pour l’alexithymie, de 34,4 % de troubles depressifs et de 44,3 % de troubles anxieux (intensite moyenne et severe). Les sujets alexithymiques etaient plus anxieux et plus deprimes. Il existai…

Comparative epidemiology of stroke and acute myocardial infarction: the Dijon Vascular Project (DIVA)

Despite a common pathophysiological mechanism (ie, atherosclerosis) and similar vascular risk factors, few reliable studies have compared the epidemiology of stroke and acute myocardial infarction (AMI).All first ever cases of stroke and AMI in Dijon, France (151 846 inhabitants) from 2001 to 2006 were prospectively recorded. The 30 day case fatality rates (CFRs) and vascular risk factors were assessed in both groups.Over the 6 years, 1660 events (1020 strokes and 640 AMI) were recorded. Crude incidence of stroke was higher than that of AMI (112 vs 70.2/100 000/year; p0.001). With regard to sex, the relative incidence of stroke compared with AMI was 0.88 (95% CI 0.60 to 1.29; p = 0.51) in w…

Une neuroprotection possible précédant l’infarctus cérébral : l’Accident Ischémique Transitoire (AIT)

Psychopathology of Alexithymia and Multiple Sclerosis

The notion of alexithymia was introduced by Sifneos (Psychother Psychosom 22:255–62, 1973) to define a set of affective and cognitive characteristics observed in patients with psychosomatic diseases. Alexithymia appears to be a multidimensional and transnosographic concept ranging from normal to pathological, and it is important to regard alexithymia as a disorder of emotional regulation, which can be found in different populations and not only in somatic diseases.

Migraine history and migraine-induced stroke in the Dijon stroke registry.

Two thousand three hundred and eighty-nine patients with first-ever stroke were registered in the population-based Dijon Stroke Registry over an 11-year period. There was a history of migraine in 49 cases (2%), with a majority of women (2.8% versus 1.1% men) with the following distribution: 27 cases among 1,380 large-artery cerebral infarctions (1.9%), 6 cases among 358 small-artery cerebral infarctions (1.6%), 6 cases among 412 cerebral infarctions due to cardiac embolism (1.4%), 7 cases among 191 cerebral hemorrhages (3.6%) and 3 cases among 47 subarachnoid hemorrhages (6.3%). The male/female ratio was 0.58 for the 49 strokes with a history of migraine versus 1.27 for the 2,340 strokes wi…

Clinical spectrum of movement disorders after stroke in childhood and adulthood.

Although rare, many different types of hyperkinetic and hypokinetic movement disorders have been described after both ischemic and hemorrhagic stroke in children and in adults. Current knowledge about these disorders comes from single case reports or small series of cases compiled from retrospective studies. Data from hospital-based studies suggest a prevalence of poststroke movement disorders ranging from 1.1 to 3.9%. However, despite the development of emergency care for stroke, these clinical syndromes remain insufficiently recognized. Poststroke movement disorders take place in the acute phase or following a variable delay after stroke onset, and could be transient or persistent. Dyston…

Favorable evolution post hematologous stem cell transplant after primary central nervous system lymphoma in a multiple sclerosis under natalizumab

International audience

Impact of recommendations on the initial therapy of Parkinson’s disease: A population-based study in France

International audience; Levodopa induces long-term motor complications in Parkinson's disease (PD). Therapeutic strategies that prevent motor complications are needed. Our aim was to evaluate the impact of recommendations of a French consensus conference published in 2000 on initial PD therapy. We identified 308 PD patients as part of a population-based study performed within the Mutualité Sociale Agricole in five French districts (2007). Neurologists confirmed PD diagnosis. We compared initial therapy in 102 patients treated before 12/31/2000 to that of 206 patients treated afterwards. Initial treatment was in agreement with the recommendations if dopamine agonists were used in patients <6…

Link of the mechanisms of action of glatiramer acetate to its long-term clinical data

A consequence of the long-term nature of progression in multiple sclerosis is that treatment needs to be provided over the long term. Gathering evidence for long term clinical efficacy, safety and patient acceptance of immunomodulatory therapies is thus a critically important issue. However, pivotal trials, which generally last no more than two years, cannot address this issue. Glatiramer acetate is the only immunomodulatory treatment for which prospective data is available covering a treatment period of over a decade. In the long-term extension of the pivotal trial of glatiramer acetate, 108 patients have been followed for a mean treatment duration of 10.1 years. At the end of the treatmen…

P09.084C - Strong interest of exome sequencing in progressive neurological diseases

International audience; Introduction: Neurogenetics represents a vast, complex, ever changing discipline whose diagnosis currently remains challenging, since clinical and/or imaging features frequently appear very unspecific, especially early in the evolution (cerebellar ataxia, tremor, dystonia...). In molecular diagnosis, current strategies usually include sequential investigations that may lead to long, tedious, expensive and disappointing patients care. Exome sequencing (ES) appears a promising approach for neurogenetics, apart from when nucleotide motif expansion disorders can be suspected. Materials and Methods: We recruited 48 individuals without cognitive development impairment, ref…

Protective function of autophagy during VLCFA-induced cytotoxicity in a neurodegenerative cell model

Abstract In recent years, a particular interest has focused on the accumulation of fatty acids with very long chains (VLCFA) in the occurrence of neurodegenerative diseases such as Alzheimer's disease, multiple sclerosis or dementia. Indeed, it seems increasingly clear that this accumulation of VLCFA in the central nervous system is accompanied by a progressive demyelination resulting in death of neuronal cells. Nevertheless, molecular mechanisms by which VLCFA result in toxicity remain unclear. This study highlights for the first time in 3 different cellular models (oligodendrocytes 158 N, primary mouse brain culture, and patient fibroblasts) the types of cell death involved where VLCFA-in…

Profil de qualité de vie subjective chez les sujets atteints de sclérose en plaques

Resume Objectifs Cette etude evalue la qualite de vie subjective chez des personnes atteintes de sclerose en plaques (SEP) en tenant compte des criteres de satisfaction et d’importance accordee a differents domaines de vie. Methode Soixante et un sujets atteints de SEP de forme remittente et progressive ont participe a une evaluation psychologique comprenant un entretien et trois questionnaires : le profil de qualite de vie subjective (PQVS), l’inventaire d’anxiete Trait-Etat (STAI) et l’inventaire de depression de Beck (BDI). Resultats Les resultats montrent un niveau bas de satisfaction generale de la qualite de vie subjective. La fatigue et la douleur sont les domaines de vie les plus in…