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Manunta A, Peyronnet B, Olivari-Philiponnet C, Chartier-Kastler E, Saussine C, Phé V, Robain G, Denys P, Even A, Samson E, Grise P, Karsenty G, Hascoet J, Castel-Lacanal E, Charvier K, Guinet-Lacoste A, Chesnel C, Amarenco G, Haffner F, Haddad M, Le Normand L, Perrouin-Verbe MA, Perrouin-Verbe B, De Seze M, Ruffion A, Gamé X. [Guidelines on the urological management of the adult patient with spinal dysraphism (spina bifida)]. Prog Urol 2023; 33:178-197. [PMID: 36609138 DOI: 10.1016/j.purol.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Improved life expectancy and prenatal screening have changed the demographics of spina bifida (spinal dysraphism) which has presently become a disease of adulthood. Urinary disorders affect almost all patients with spinal dysraphism and are still the leading cause of mortality in these patients. The aim of this work was to establish recommendations for urological management that take into account the specificities of the spina bifida population. MATERIALS AND METHODS National Diagnosis and Management Guidelines (PNDS) were drafted within the framework of the French Rare Diseases Plan at the initiative of the Centre de Référence Maladies Rares Spina Bifida - Dysraphismes of Rennes University Hospital. It is a collaborative work involving experts from different specialties, mainly urologists and rehabilitation physicians. We conducted a systematic search of the literature in French and English in the various fields covered by these recommendations in the MEDLINE database. In accordance with the methodology recommended by the authorities (Guide_methodologique_pnds.pdf, 2006), proposed recommendations were drafted on the basis of this literature review and then submitted to a review group until a consensus was reached. RESULTS Bladder dysfunctions induced by spinal dysraphism are multiple and varied and evolve over time. Management must be individually adapted and take into account all the patient's problems, and is therefore necessarily multi-disciplinary. Self-catheterisation is the appropriate micturition method for more than half of the patients and must sometimes be combined with treatments aimed at suppressing any neurogenic detrusor overactivity (NDO) or compliance alteration (anticholinergics, intra-detrusor botulinum toxin). Resort to surgery is sometimes necessary either after failure of non-invasive treatments (e.g. bladder augmentation in case of NDO resistant to pharmacological treatment), or as a first line treatment in the absence of other non-invasive alternatives (e.g. aponeurotic suburethral tape or artificial urinary sphincter for sphincter insufficiency; urinary diversion by ileal conduit if self-catheterisation is impossible). CONCLUSION Spinal dysraphism is a complex pathology with multiple neurological, orthopedic, gastrointestinal and urological involvement. The management of bladder and bowel dysfunctions must continue throughout the life of these patients and must be integrated into a multidisciplinary context.
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Affiliation(s)
- A Manunta
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - B Peyronnet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France.
| | | | - E Chartier-Kastler
- Service d'Urologie, GH Pitié-Salpétrière, APHP, Paris, France; Sorbonne Université, Paris, France; Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France
| | - C Saussine
- Service d'urologie, les hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - V Phé
- Service d'urologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - G Robain
- Service de médecine physique et réadaptation, Hôpital Rotschild, APHP, Paris, France
| | - P Denys
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - A Even
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - E Samson
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - P Grise
- Service d'urologie, CHU Rouen, Rouen, France
| | - G Karsenty
- Aix-Marseille Université, urologie et transplantation rénale, Hôpital La Conception, AP-HM, Marseille, France
| | - J Hascoet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - E Castel-Lacanal
- CHU Toulouse, service de médecine physique et de réadaptation et ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - K Charvier
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices civils de Lyon, Saint-Genis-Laval, France
| | - A Guinet-Lacoste
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - F Haffner
- ASBH, Association nationale Spina Bifida et Handicaps associés, 94420 Le Plessis Trevise, France
| | - M Haddad
- Service de chirurgie viscérale et urologie pédiatrique, AP-HM, Marseille, France
| | - L Le Normand
- Service d'urologie, CHU de Nantes, Nantes, France
| | | | - B Perrouin-Verbe
- Service de médecine physique et réadaptation, CHU de Nantes, Nantes, France
| | - M De Seze
- Spécialiste en médecine physique et de réadaptation, Clinique St.-Augustin, Bordeaux, France
| | - A Ruffion
- Service d'urologie, Hospices civils de Lyon, Lyon, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Université Paul-Sabatier, Toulouse, France
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Mazuet J, Cogné M, Robain G, Combrisson H, Maurey-Guenec C, Glize B, De Seze M. Effect of intrathecal botulinum toxin A injection on sheep's cystomanometric parameters: A comparative study. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Fok Cheong K Ah Wai T, Creuzé A, Bordes P, De Seze M. Interest of the botulinum toxin in adductor related groin pain. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bordes P, Laboute E, Bertolotti A, Dalmay JF, Puig P, Trouve P, Verhaegue E, Joseph PA, Dehail P, De Seze M. No beneficial effect of bracing after anterior cruciate ligament reconstruction in a cohort of 969 athletes followed in rehabilitation. Ann Phys Rehabil Med 2017; 60:230-236. [PMID: 28259710 DOI: 10.1016/j.rehab.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Compare the clinical outcomes of different knee braces in the early phase of rehabilitation after anterior cruciate ligament reconstruction (ACLR) in athletes. MATERIALS AND METHODS We conducted a retrospective database study of athletes during early rehabilitation in a tertiary referral hospital between 1 February 2008 and 30 October 2010 after ACLR using bone patellar tendon bone (BPTB) or hamstring autograft. Differences in mid-patellar knee circumference, pain, and range of motion were assessed at admission. All patients followed the same rehabilitation protocol. Patients who had complications preventing them from following the assigned rehabilitation program were analyzed separately. Patients who completed their rehabilitation program were also assessed for thigh muscle atrophy, extension deficit≥2°, quality of walking, PPLP1 and subjective IKDC scores. The type and frequency of complications and their frequency was documented. The above-mentioned parameters were analyzed in 3 different groups: rigid brace in full extension, articulated brace (0°-90° for first 3 weeks then 0-120°) or no brace. RESULTS The analysis included 969 patients. Rehabilitation started at 4.5±2.9 days after surgery and ended at 32.4±3.0 days postoperative. At the beginning, flexion was lower in patients with a rigid brace (P<0.01). There was no difference in the frequency or severity of complications between the three study groups, nor was there a significant difference in the clinical outcomes listed above. CONCLUSION Postoperative bracing after ACLR has not beneficial effect on clinical outcomes and the complication rate. Patients who wore the rigid brace had limited flexion early on.
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Affiliation(s)
- P Bordes
- Service de Médecine Physique et Réadaptation, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
| | - E Laboute
- CERS, 83, avenue Maréchal-de-Lattre-de-Tassigny, 40130 Capbreton, France
| | - A Bertolotti
- U897 Inserm, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France
| | - J F Dalmay
- UMR 1094, Inserm, faculté de médecine de Limoges, 2, rue du Docteur-Marcland, 87025 Limoges cedex, France
| | - P Puig
- CERS, 83, avenue Maréchal-de-Lattre-de-Tassigny, 40130 Capbreton, France
| | - P Trouve
- CERS, 83, avenue Maréchal-de-Lattre-de-Tassigny, 40130 Capbreton, France
| | - E Verhaegue
- CERS, 83, avenue Maréchal-de-Lattre-de-Tassigny, 40130 Capbreton, France
| | - P A Joseph
- Service de Médecine Physique et Réadaptation, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - P Dehail
- Service de Médecine Physique et Réadaptation, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - M De Seze
- Service de Médecine Physique et Réadaptation, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
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Peyronnet B, Even A, Verrando A, Capon G, De Seze M, Hascoet J, Lenormand C, Maurin C, Biardeau X, Monleon L, Castel-lacanal E, Marcelli F, Perrouin-Verbe M, Allenet C, Mouracade P, Baron M, Boutin J, Saussine C, Grise P, Lenormand L, Chartier-Kastler E, Cornu J, Karsenty G, Schurch B, Denys P, Manunta A, Amarenco G, Gamé X. Injections intra-détrusoriennes de toxine botulique chez l’adulte spina bifida : résultats d’une étude multicentrique. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roulette P, Castel-Lacanal E, Phé V, Bart S, Caremel R, De Seze M, Duchene F, Even A, Manunta A, Sanson S, Loche C, Mouracade P, Rey D, Scheiber-Nogueira M, Kastler EC, Ruffion A, Karsenty G, Gamé X. Grossesse et neuromodulation sacrée pour troubles vésico-sphinctériens : une étude nationale du comité de neuro-urologie de l’AFU. Prog Urol 2015; 25:848-9. [DOI: 10.1016/j.purol.2015.08.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bordes P, Laboute E, Puig P, Trouve P, Verhaegue E, De Seze M. Influence of immobilization mode on postoperative clinical data a month after an ACL reconstruction in athletes admitted to rehabilitation center. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jirot A, Hocquelet A, Reaux C, De Seze M. A comparative study between two different 3D reconstruction methods by bi-planar radiographic in upright posture: Biomod 3sand sterEOS®. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Creuzé A, Reboul G, Gassie P, De Seze M. Use of botulinum toxin in the groin pain. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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De Seze M, De Korvin G, Cugy E. Détection des scolioses radiologiquement évolutives par la topographie de surface numérisée (Biomod-L®) : étude prospective sur 100 patients. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Robain G, Reiss B, De Seze M. Urodynamic for PMR in MS, SCI, Stroke and Parkinson disease. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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De Seze M. Comment traiter les troubles vesico-sphincteriens chez les patients ayant des troubles cognitifs ? Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cugy E, Zauderer J, Dublanc S, De Seze M. Impact d’un corset type DTPA utilisé dans la camptocormie sur les paramètres respiratoires : à propos d’un cas. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Caremel R, Phe V, Scheiber Nogeira C, De Seze M, Karsenty G, Game X. Sémiologie et exploration des troubles urinaires chez les patients avec AVC. Rev Neurol (Paris) 2012. [DOI: 10.1016/j.neurol.2012.01.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Phe V, Game X, Caremel R, Carmélita Scheiber-Nogueira M, De Seze M, Karsenty G. Épidémiologie des troubles vésico-sphinctériens dans les accidents vasculaires cérébraux. Rev Neurol (Paris) 2012. [DOI: 10.1016/j.neurol.2012.01.530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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De Seze M, De Korvin G. Can scoliosis follow up by surface topography (Biomod-L®) securely predict Cobb angle progression? Longitudnal study; preliminary results on 60 patients. Scoliosis 2012. [PMCID: PMC3305154 DOI: 10.1186/1748-7161-7-s1-o20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brotier A, Chartier Kastler E, Denys P, Labat JJ, Ruffion A, De Seze M, Amarenco G. FLUE-MS (First Line Urological Evaluation in Multiple Sclerosis). Construction et validation par la méthode DELPHI d’un algorithme décisionnel de première ligne des troubles mictionnels de la sclérose en plaques (SEP). Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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De Korvin G, De Seze M. Topographie de surface 3D (Biomod-L®) dans le suivi des scolioses en période de croissance. Résultats d’une étude longitudinale comparant l’évolution des paramètres Biomod et l’évolution de l’angle de Cobb. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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De Seze M. Pelvic-perineal disorders in multiple sclerosis: The SIFUD-PP report. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Vesico-urethral dysfunction is a major problem in daily medical practice due to its psychological disturbances, its social costs and its high impact on quality of life. Recently, sacral neuromodulation, namely the electrical stimulation of the sacral nerves, appears to have become an alternative for radical bladder surgery particularly in cases of idiopathic bladder overactivity. The mechanism of action is only partially understood but it seems to involve a modulation in the spinal cord due to stimulation of inhibitory interneurons. Temporary sacral nerve stimulation is the first step. It comprises the temporary application of neuromodulation as a diagnostic test to determine the best location for the implant and to control the integrity of the sacral root. If test stimulation is successful, a permanent device is implanted. This procedure is safe in experienced hands. So-called idiopathic bladder overactivity still the major indication for this technique. Patients not likely to benefit from the procedure were those with complete or almost complete spinal lesions, but incomplete spinal lesions seemed to be a potential indication. This technique is now also indicated in the case of idiopathic chronic retention and chronic pelvic pain syndrome. When selection is performed, more than three-quarters of the patients showed a clinically significant response with 50% or more reduction in the frequency of incontinent episodes, but the results vary according to the author's mode of evaluation. From the economic point of view, the initial investment in the device is amortized in the mid-term by savings related to lower urinary tract dysfunction. Finally, this technique requires an attentive follow-up and adjustments to the electric parameters so as to optimize the equilibrium between the neurological systems.
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Affiliation(s)
- J R Vignes
- Department of Neurosurgery, Medical School Hospital, Hôpital Pellegrin, Bordeaux, France
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Soury S, Mazaux JM, Lambert J, De Seze M, Joseph PA, Lozes-Boudillon S, McCauley S, Vanier M, Levin HS. [The neurobehavioral rating scale-revised: assessment of concurrent validity]. ACTA ACUST UNITED AC 2005; 48:61-70. [PMID: 15748770 DOI: 10.1016/j.annrmp.2004.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Accepted: 08/26/2004] [Indexed: 11/29/2022]
Abstract
UNLABELLED Cognitive and behavioral impairment are a major source of disability in daily living of patients with traumatic brain injury (TBI). The Neurobehavioral Rating Scale-Revised (NRS-R) is a short, easy-to administer interview tool developed to improve assessment by clinicians. Data are available on its criterion validity and reliability, but the concurrent validity of the French NRS-R was not yet documented. OBJECTIVE To assess the concurrent validity of the NRS-R with current psychometric tests. METHOD One hundred and four patients with TBI enrolled in a community adjustment program underwent concurrent examination with the NRS-R, cognitive tests assessing memory, attention, and executive functions, and scales of anxiety (STAI) and depressive mood (CES-D). Intercorrelations were undertaken between these variables and the five factors of the NRS-R: F1, intentional behavior; F2, lowered emotional state; F3, survival-oriented behaviour/hightened emotional state; F4, arousal state; and F5, language. Patients were 82 men and 22 women, the mean age was 28.5 years, and 70% had severe TBI (Glasgow coma score [GCS] below 8 on admission). They were assessed 52 months on average after their injury. RESULTS Factor F1 was correlated with results on the GCS (P<0.05), the Tower of London test (TL, P<0.01), the Trail Making Test (TMT, P<0.01), divided attention (DA) and inhibition (IN) subscales of the Zimmermann and Fimm's Attention battery (TEA) (P<0.01) and reverse digit span (DS, P<0.05). Factor F2 was positively related to age at injury, time since injury (TSI) (P<0.05) and CESD and STAI scores (P<0.001). Factor F3 was related to DA (P<0.01) TL scores and TSI (P<0.05). Factor F4 was related to TL, TMT, DA, flexibility, DS (P<0.05), TSI, duration of post-traumatic amnesia, CES-D score (P<0.05) and STAI scores (P<0.01). Factor F5 was related to GCS, DA (P<0.05), and reaction time on the subscales IN and Go/nogo (GO) of the TEA battery (P<0.01). The NRS-R total score was related to CESD, STAI scores, TMT score, DA (P<0.01) and TL score, IN and GO scores and TSI (P<0.05). DISCUSSION As McCauley et al found with the English version of the NRS-R, significant relationships were found between NRS-R factor scores, cognitive tests and emotional scales. Relationships were also found between factor scores and indicators of injury severity and time since injury. These data suggest fair concurrent validity of the NRS-R.
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Affiliation(s)
- S Soury
- Unité UEROS, service MP réadaptation, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France
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Vignes JR, De Seze M, Sesay M, Barat M, Guerin J. [Anterior sacral root stimulation with dorsal rhizotomy (Brindley technique)]. Neurochirurgie 2003; 49:383-94. [PMID: 12746715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Patients with spinal cord lesions are exposed to vesico-sphincter dysfunctions which can aggravate the vital or functional prognosis. The pathophysiological characteristics of these neurogenic bladders explains the usefulness of surgical treatment. The objective of the Brindley technique is to improve both voiding and effective continence. Any patient with a stable supra-sacral spinal cord lesion (paraplegia, tetraplegia) with a reflex bladder (incontinence, vesico-sphincter dyssynergia resistant to medical treatment with the risk of upper urinary tract involvement) can benefit from the Brindley technique. The electrodes are placed on the anterior sacral roots in order to obtain the desired micturation. Posterior sacral rhizotomies are indispensable to the technique as they suppress detrusor and sphincter hyperreflexia and improve continence thereby protecting the upper urinary tract. About 90% of the patients considered have an improved quality of life after implantation of the Brindley stimulator. The bladder capacity was constantly improved and the majority of the patients become continent. Micturation was excellent with low residual volume and low rate of urinary tract infections. Complications are analyzed in this review of the literature. The Brindley technique is an excellent alternative to medical treatment in these highly distressed patients. It restores satisfactory continence and improves psychological as well as economical constraints related to auto/hetero catheterisations performed several times a day.
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Affiliation(s)
- J-R Vignes
- Service de Neurochirurgie Ouest, Hôpital Pellegrin, CHU de Bordeaux.
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