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Farge D, Pugnet G, Allez M, Castilla-Llorente C, Chatelus E, Cintas P, Faucher-Barbey C, Labauge P, Labeyrie C, Lioure B, Maria A, Michonneau D, Puyade M, Talouarn M, Terriou L, Treton X, Wojtasik G, Zephir H, Marjanovic Z. French protocol for the diagnosis and management of hematopoietic stem cell transplantation in autoimmune diseases. Rev Med Interne 2024; 45:79-99. [PMID: 38220493 DOI: 10.1016/j.revmed.2023.12.008] [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: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
Hematopoietic stem cell transplantation (HSCT) for severe ADs was developed over the past 25years and is now validated by national and international medical societies for severe early systemic sclerosis (SSc) and relapsing-remitting multiple sclerosis (MS) and available as part of routine care in accredited center. HSCT is also recommended, with varying levels of evidence, as an alternative treatment for several ADs, when refractory to conventional therapy, including specific cases of connective tissue diseases or vasculitis, inflammatory neurological diseases, and more rarely severe refractory Crohn's disease. The aim of this document was to provide guidelines for the current indications, procedures and follow-up of HSCT in ADs. Patient safety considerations are central to guidance on patient selection and conditioning, always validated at the national MATHEC multidisciplinary team meeting (MDTM) based on recent (less than 3months) thorough patient evaluation. HSCT procedural aspects and follow-up are then carried out within appropriately experienced and Joint Accreditation Committee of International Society for Cellular Therapy and SFGM-TC accredited centres in close collaboration with the ADs specialist. These French recommendations were performed according to HAS/FAI2R standard operating procedures and coordinated by the Île-de-France MATHEC Reference Centre for Rare Systemic Autoimmune Diseases (CRMR MATHEC) within the Filière FAI2R and in association with the Filière MaRIH. The task force consisted of 3 patients and 64 clinical experts from various specialties and French centres. These data-derived and consensus-derived recommendations will help clinicians to propose HSCT for their severe ADs patients in an evidence-based way. These recommendations also give directions for future clinical research in this area. These recommendations will be updated according to newly emerging data. Of note, other cell therapies that have not yet been approved for clinical practice or are the subject of ongoing clinical research will not be addressed in this document.
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Affiliation(s)
- D Farge
- AP-HP, hôpital St-Louis, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France MATHEC (FAI2R), unité de Médecine Interne (UF 04) : CRMR MATHEC, maladies auto-immunes et thérapie cellulaire (UF 04), 1, avenue Claude-Vellefaux, 75010 Paris, France; Université de Paris, IRSL, Recherche clinique appliquée à l'hématologie, URP-3518, 75010 Paris, France; Department of Medicine, McGill University, H3A 1A1, Montreal, Canada.
| | - G Pugnet
- Service de médecine interne et immunologie clinique, pôle hospitalo-universitaire des maladies digestives, CHU Rangueil, 1, avenue du Pr-Jean-Poulhès, 31059 Toulouse cedex 9, France
| | - M Allez
- AP-HP, hôpital Saint-Louis, service d'hépato-gastro-entérologie, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Castilla-Llorente
- Gustave-Roussy cancer center, département d'hématologie, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - E Chatelus
- Département de rhumatologie, hôpitaux universitaires de Strasbourg, Strasbourg, France; Centre de référence des maladies auto-immunes systémiques rares de l'Est et du Sud-Ouest, Strasbourg, France
| | - P Cintas
- CHU Toulouse Purpan, service de neurologie, place du Dr-Baylac, 31059 Toulouse cedex 9, France
| | - C Faucher-Barbey
- Direction prélèvements et greffes de CSH, Direction médicale et scientifique, Agence de la biomédecine, 93212 St-Denis/La Plaine, France
| | - P Labauge
- CRC SEP, service de neurologie, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - C Labeyrie
- AP-HP, CHU de Bicêtre, service de neurologie, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - B Lioure
- Département d'onco-hématologie, université de Strasbourg, ICANS, Strasbourg, France
| | - A Maria
- Médecine interne & immuno-oncologie (MedI2O), Institute for Regenerative Medicine & Biotherapy (IRMB), hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, Montpellier, France; IRMB, Inserm U1183, hôpital Saint-Éloi, CHU de Montpellier, 34295 Montpellier, France
| | - D Michonneau
- Université de Paris, IRSL, Recherche clinique appliquée à l'hématologie, URP-3518, 75010 Paris, France; Service d'hématologie-greffe, AP-HP, hôpital Saint-Louis, institut de recherche Saint-Louis, Paris, France
| | - M Puyade
- CHU de Poitiers, service de médecine interne, 2, rue de La-Miletrie, 86021 Poitiers, France
| | - M Talouarn
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - L Terriou
- CHU de Lille, département de médecine interne et immunologie clinique, 59000 Lille, France; Centre de référence des maladies auto-immunes et auto-inflammatoires rares (CERAINO), 59000 Lille, France
| | - X Treton
- Université de Paris, hôpital Beaujon, service de gastro-entérologie, MICI et assistance nutritive, DMU DIGEST, 100, boulevard Leclerc, 92110 Clichy, France
| | - G Wojtasik
- Université de Lille, Inserm, CHU de Lille, service de médecine interne et immunologie clinique, Centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institut de recherche translationnelle sur l'inflammation, Lille, France
| | - H Zephir
- CHU de Lille, université de Lille, pôle des neurosciences et de l'appareil locomoteur, Lille Inflammation Research International Center (LIRIC), UMR 995, rue Émile-Laine, 59000 Lille, France
| | - Z Marjanovic
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Alam MZ. A review on plant-based remedies for the treatment of multiple sclerosis. Ann Pharm Fr 2023; 81:775-789. [PMID: 36963654 DOI: 10.1016/j.pharma.2023.03.005] [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: 03/06/2022] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 03/26/2023]
Abstract
Multiple sclerosis (MS) is a complex autoimmune disease of central nervous system, which is degenerative in nature usually appears between 20-40years of age. The exact cause of MS is still not clearly known. Loss of myelin sheath and axonal damage are the main features of MS that causes induction of inflammatory process and blocks free conduction of impulses. Till date FDA has approved 18 drugs to treat or modify MS symptoms. These medicines are disease-modifying in nature directed to prevent relapses or slow down the progression of disease. The use of the synthetic drug over an extended period causes undesirable effects that prompt us to look at Mother Nature. Complementary and alternative medicine involves the use of medicinal plants as an alternative to the existing modern medical treatment. However, modern drugs cannot be replaced completely with medicinal plants, but the two types of drugs can be used harmoniously with later one can be added as an adjuvant to the existing treatment. These medicinal plants have the potential to prevent progression and improve the symptoms of MS. Various plants such like Nigella sativa, ginger, saffron, pomegranate, curcumin, resveratrol, ginsenoside have been tested as therapeutics for many neurodegenerative diseases. The purpose of this write-up is to make information available about medicinal plants in their potential to treat or modify the symptoms of MS. Chronically ill patients tend to seek medicinal plants as they are easily available and there is a general perception about these medicines of having fewer undesirable effects.
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Affiliation(s)
- Mohammad Zubair Alam
- Pre-Clinical Research Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
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Tan E, Turmel N, Kerdraon J, Guinet-Lacoste A, Prévinaire JG, Castel-Lacanal E, Even A, Chesnel C, Hentzen C, Amarenco G. A new tool to investigate anorectal disorders in patients with multiple sclerosis: STAR-Q. Prog Urol 2023:S1166-7087(23)00060-X. [PMID: 36906431 DOI: 10.1016/j.purol.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Bowel symptoms are commonly experienced by patients with Multiple sclerosis (PwMS), but no specific questionnaire validated in this population allows a rigorous assessment. OBJECTIVE Validation of a multidimensional questionnaire assessing bowel disorders in PwMS. METHODS A prospective, multicenter study was conducted between April 2020 and April 2021. The STAR-Q (Symptoms' assessmenT of AnoRectal dysfunction Questionnaire), was built in 3 steps. First, literature review and qualitative interviews were performed to create the first version, discussed with a panel of experts. Then, a pilot study assessed comprehension, acceptation and pertinence of items. Finally, the validation study was designed to measure content validity, internal consistency reliability (alpha coefficient of Cronbach) and test-retest reliability [intraclass correlation coefficient (ICC)]. The primary outcome was good psychometric properties with Cronbach's α>0.7 and ICC>0.7. RESULTS We included 231 PwMS. Comprehension, acceptation and pertinence were good. STAR-Q showed a very good internal consistency reliability (Cronbach's α=0.84) and test-retest reliability (ICC=0.89). Final version of STAR-Q was composed of 3 domains corresponding in symptoms (Q1-Q14), treatment and constraints (Q15-Q18) and impact on quality of life (Q19). Three categories of severity were determined (STAR-Q≤16: minor, between 17 and 20: moderate, and≥21: severe). CONCLUSIONS STAR-Q presents very good psychometric properties and allows a multidimensional assessment of bowel disorders in PwMS. LEVEL OF EVIDENCE: 2
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Pascual-Santiago MA, Burgos-Blasco BP, Enríquez-Fuentes JE, Fernandez-Vigo JI. Multiple sclerosis and glatiramer acetate: Risk factors for central retinal vein occlusion? J Fr Ophtalmol 2023; 46:235-238. [PMID: 36774312 DOI: 10.1016/j.jfo.2022.09.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 02/11/2023]
Abstract
Multiple sclerosis may present an increased risk for venous thromboembolism. Ophthalmological symptoms include loss of vision, visual field loss, changes in color vision, diplopia and nystagmus. First-line treatments for multiple sclerosis are beta-interferon, glatiramer acetate, dimethyl fumarate and teriflunomide. To the best of our knowledge, no ophthalmologic side effects have been reported with glatiramer acetate. We present a woman with multiple sclerosis on glatiramer acetate therapy with a central retinal vein occlusion in the absence of other risk factors.
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Affiliation(s)
- M A Pascual-Santiago
- Servicio de Oftalmología, Hospital Clínico San Carlos, Calle Profesor Martin Lagos s/n, 28040 Madrid, Spain.
| | - B P Burgos-Blasco
- Servicio de Oftalmología, Hospital Clínico San Carlos, Calle Profesor Martin Lagos s/n, 28040 Madrid, Spain
| | - J E Enríquez-Fuentes
- Servicio de Oftalmología, Hospital Clínico San Carlos, Calle Profesor Martin Lagos s/n, 28040 Madrid, Spain
| | - J I Fernandez-Vigo
- Servicio de Oftalmología, Hospital Clínico San Carlos, Calle Profesor Martin Lagos s/n, 28040 Madrid, Spain
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Ziadeh T, Mjaess G, El Helou J, Zalaket J, Mouawad C, Azar C, Abboud H, Koussa S, Nemr E, El Helou E. Impact on quality of life in multiple sclerosis patients: Which urinary symptoms are to blame? Prog Urol 2022; 32:711-716. [PMID: 35715252 DOI: 10.1016/j.purol.2022.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/16/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the correlation between the Expanded Disability Status Scale (EDSS) in multiple sclerosis (MS) subjects, and the severity of lower urinary tract symptoms (LUTS), the bother caused by these symptoms and subjects' quality of life (QoL). MATERIAL AND METHODS This cross-sectional study included 50 subjects with persistent LUTS secondary to MS who were recruited from the registry of a national NGO, between October 2017 and November 2019. Subjects with a history of any disease besides MS that could otherwise explain the presence of LUTS, as well as those with other neurological conditions were excluded. Information including MS duration, subjects' EDSS, voiding and storage LUTS, voiding symptoms' subscore of the International Prostate Symptom Score (IPSS-V), Overactive Bladder Symptom Scores (OABSS), Urinary Bothersome Questionnaire in Multiple Sclerosis (UBQMS), and urologic QoL (SF-Qualiveen) was gathered. Correlations between these scores were assessed using Spearman's bivariate correlations. Wilcoxon's signed rank test was used to evaluate the difference of impact between voiding and storage LUTS on bother of subjects. RESULTS The median disease duration was 7±5.8years and the predominant lower urinary symptom was urgency (82%). Median OABSS and IPSS-V were respectively 8±3.8 and 8±3. Subjects were significantly more bothered from storage than voiding symptoms (2 vs. 1.6; P=0.03), and their QoL was directly affected by storage LUTS. Urgency urinary incontinence had the highest positive correlation with SFQ (r=0.542; P<0.01). MS duration and urologic QoL measured by SF-Q were negatively correlated (r=-0.345; P=0.01). CONCLUSION In MS patients with LUTS, urologic QoL is mainly affected by storage urinary symptoms. Physicians should use a holistic approach to reduce the risk of complications in these patients, by controlling both voiding and storage symptoms, in particular urgency urinary incontinence that mostly affects patient's QoL. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- T Ziadeh
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - G Mjaess
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Department of Urology, Université Libre de Bruxelles, Brussels, Belgium
| | - J El Helou
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - J Zalaket
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - C Mouawad
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - C Azar
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - H Abboud
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - S Koussa
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - E Nemr
- Department of Urology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - E El Helou
- Department of Urology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Declemy A, Haddad R, Chesnel C, Charlanes A, Le Breton F, Sheikh Ismael S, Amarenco G. Prevalence of comorbidities in multiple sclerosis patients with neurogenic bladder. Prog Urol 2021; 31:732-738. [PMID: 33941463 DOI: 10.1016/j.purol.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/24/2020] [Revised: 10/11/2020] [Accepted: 10/30/2020] [Indexed: 01/22/2023]
Abstract
AIMS The aim of this study was to define the prevalence of comorbidities among multiple sclerosis patients with lower urinary tract symptoms. METHODS A retrospective study of data collected prospectively from January 2000 to March 2016 was carried out using a database. Comorbidities were divided into several classes according to the International Classification of Diseases (ICD-10). RESULTS One hundred and fifty-five patients were included. All had a neurogenic bladder with 150 (96%) overactive bladder. EDSS score was≥6 in 44 patients (28%). Comorbidities were present in 79 (50,9%) and the most frequent ones were cardiovascular (14,2%), endocrinological (10,3%), urological (8,4%), abdominal (7,7%). Overweight (BMI≥25) was observed in 63 (40%). A strict relationship was found for BMI and stress urinary incontinence (P<0.001) as well as voiding dysfunction (P=0.003) without significant association for BMI and overactive bladder. CONCLUSION Prevalence of comorbidities is important in MS (more than 50%). A significant association is found between overweight, stress urinary incontinence and voiding dysfunction. Knowledge of these comorbidities in MS is important since the presence of these urinary symptoms not related to neurogenic bladder must lead to a specific treatment. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- A Declemy
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France.
| | - R Haddad
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - C Chesnel
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - A Charlanes
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - F Le Breton
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - S Sheikh Ismael
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - G Amarenco
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
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Declemy A, Chesnel C, Charlanes A, Le Breton F, Sheikh Ismael S, Amarenco G. Short-term reproducibility of cystometry in multiple sclerosis patients. Prog Urol 2020; 31:169-174. [PMID: 33309471 DOI: 10.1016/j.purol.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/22/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the reproducibility of detrusor activity cystometric pattern in multiple sclerosis (MS) patients, which is poorly documented in the medical literature, by means of successive filling. METHODS We conducted a prospective study in MS patients; cystometry was repeated twice at 5minutes of interval if a detrusor overactivity before 300mL of filling was observed. Thus, 3 successive cystometries were analysed. The following characteristics were recorded: detrusor maximum pressure (Pmax), volume at the first involuntary detrusor contraction (IDC), maximum cystometric capacity (MCC), pressure at the first IDC, the existence of an overactive detrusor classified as phasic or terminal. RESULTS We included 31 patients (19 women and 12 men); only 6 patients were naïve-treatment, the mean EDSS was: 5.3 (±1.6) and the mean age was 48.4 (±12.5) years. All the patients had an overactive detrusor for each cystometry. The reproducibility was good for all the parameters (range ICC between 0.7 and 0.83). CONCLUSION Quantitative and qualitative cystometric data have a good reproducibility in MS patients with detrusor overactivity before 300mL of filling. LEVEL OF PROOF 3.
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Affiliation(s)
- A Declemy
- Sorbonne université, GRC 01, GREEN - groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, 75020 Paris, France; Department of neuro-urology, Tenon hospital, AP-HP, 75020 Paris, France.
| | - C Chesnel
- Sorbonne université, GRC 01, GREEN - groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, 75020 Paris, France; Department of neuro-urology, Tenon hospital, AP-HP, 75020 Paris, France
| | - A Charlanes
- Sorbonne université, GRC 01, GREEN - groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, 75020 Paris, France; Department of neuro-urology, Tenon hospital, AP-HP, 75020 Paris, France
| | - F Le Breton
- Sorbonne université, GRC 01, GREEN - groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, 75020 Paris, France; Department of neuro-urology, Tenon hospital, AP-HP, 75020 Paris, France
| | - S Sheikh Ismael
- Sorbonne université, GRC 01, GREEN - groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, 75020 Paris, France; Department of neuro-urology, Tenon hospital, AP-HP, 75020 Paris, France
| | - G Amarenco
- Sorbonne université, GRC 01, GREEN - groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, 75020 Paris, France; Department of neuro-urology, Tenon hospital, AP-HP, 75020 Paris, France
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Jacq C, Hubeaux K, Ramanantsitonta J. [Multiple sclerosis and intermittent self-catheterization]. Prog Urol 2020; 31:195-203. [PMID: 33277166 DOI: 10.1016/j.purol.2020.11.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/24/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Lower urinary tract dysfunctions are frequent in patients with multiple sclerosis (MS). These disorders impair quality of life and can cause urological complications. In cases of urinary retention or incomplete bladder emptying, clean intermittent self-catheterization is the preferred option where possible. OBJECTIVE To identify data concerning the use of intermittent self-catheterization by patients with MS. BIBLIOGRAPHIC SOURCE A review was done using Medline/Pubmed with selection of articles in either English or French. The key words were: « multiple sclerosis and intermittent catheterization, self-catheterization, neuro-urology/urinary guidelines, continent stoma, continent vesicostomy». STUDY SELECTION Studies were selected if they concerned either multiple sclerosis exclusively or with a majority of cases concerning MS. RESULTS Intermittent self-catheterization is recommended and commonly used in patients with MS. Studies are rare in this specific population. Questions still remain about indications and practicalities in this disease. Indications must be individually evaluated according to symptoms and complications. The use of self-catheterization can improve symptomatology or quality of life, however, global urinary management is necessary. Urinary infection is the most frequently reported side effect. The teaching of self-catheterization should take into account physical and cognitive impairment. Due to the developing nature of the pathology, indications and the patients' ability to carry out self-catheterization should be regularly assessed. LIMITATIONS The search was limited to a single bibliographic source and studies are rare. CONCLUSION Further studies are necessary to increase knowledge of self-catheterization specificities in MS patients compared to other neurogenic patients.
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Affiliation(s)
- C Jacq
- Service de MPR, site d'Auray, Centre hospitalier Bretagne Atlantique, 20, boulevard du Général-Maurice-Guillaudot, BP 70555, 56017 Vannes cedex, France.
| | - K Hubeaux
- Service d'explorations fonctionnelles, site de Perharidy, Fondation Ildys, route de Perharidy, 29680 Roscoff, France
| | - J Ramanantsitonta
- Service de MPR, site d'Auray, Centre hospitalier Bretagne Atlantique, 20, boulevard du Général-Maurice-Guillaudot, BP 70555, 56017 Vannes cedex, France
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Delaune M, Desprez C, Leroi AM. [Anorectal disorders in patients with multiple sclerosis: Physiopathology, prevalence, impact, and management]. Prog Urol 2019; 29:1011-1020. [PMID: 31521507 DOI: 10.1016/j.purol.2019.08.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Neurogenic bowel disorders (NBD) are frequently observed in patients with multiple sclerosis (MS); the prevalence of constipation is estimated to be 35-54 % and fecal incontinence between 29 and 51 % (LE 4). They contribute to the deterioration of patients' quality of life (LE 4). The aim of this article is to review the literature on the physiopathology, prevalence, impact, and management of bowel disorders in patients with MS in order to educate caregivers about their existence and thus help them to optimize therapeutic choices. MATERIALS AND METHODS A bibliographic search was conducted between 2000 and 2019 and 31 relevant scientific articles were selected. Relevant references were subsequently added, bringing the total to 50 articles. A level of scientific evidence (LE) was assigned to each article, except for literature reviews. RESULTS The origin of NBD is multifactorial and includes impairment of neurological pathways, polypharmacy, behavioural disorders, and loss of autonomy (LE 4). Patients with MS should be questioned about their bowel habits and, in cases of proven NBD, specific management options should be offered. The first step concerns the dietary and lifestyle rules associated with the use of laxatives, suppositories, and/or enemas (LE 4). In the event of failure, therapies such as abdominal massages (LE 1 and 2), biofeedback and transanal irrigation can be proposed (LE 4). Anterograde colonic irrigation may also be an option (LE 4). The efficacy of stimulating the posterior tibial nerve needs to be proven (LE 4). The implantation of a sacral neuromodulation device is, for the moment, difficult due to the impossibility of performing a spinal magnetic resonance imaging during follow-up. A stoma improves the quality of life of patients and should not be proposed too late. CONCLUSION Effective treatment of NBD improves the quality of life of patients and reduces the incidence of bladder disorders (LE 4).
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Affiliation(s)
- M Delaune
- Service de physiologie digestive, urinaire, respiratoire et de l'exercice, CHU de Rouen, 76000 Rouen, France.
| | - C Desprez
- Service de physiologie digestive, urinaire, respiratoire et de l'exercice, CHU de Rouen, 76000 Rouen, France
| | - A M Leroi
- Inserm 1073, CIC-CRB 1404, Service de physiologie urinaire, digestive, respiratoire et de l'exercice, UNIROUEN, Normandie université, CHU de Rouen, 76000, Rouen, France
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Soust I, Filiette A, Blanchard A, Biardeau X. [Non continent urinary diversion and other bladder managements in patients with multiple sclerosis]. Prog Urol 2019; 29:572-578. [PMID: 31495496 DOI: 10.1016/j.purol.2019.08.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/03/2019] [Accepted: 08/12/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To compare non-continent urinary diversion (NCUD) and other bladder managements in patients with multiple sclerosis (MS), in terms of satisfaction and burden of care. MATERIAL AND METHODS All patients with MS that were proposed a NCUD in our center for refractory lower urinary tract disorders between January 2005 and March 2018 were eligible. Patients were attributed to two distinct groups: "NCUD" and "Other bladder management". The primary endpoint was the satisfaction related to the bladder management quoted by a numerical rating scale (NRS) from 0 to 10. The secondary endpoints included, among other things, the evaluation of the burden of care associated with the bladder management. RESULTS Twenty-three patients were included in the "NCUD" group and 11 in the "Other bladder management" group, with 4 patients pursuing with spontaneous voiding, 3 with intermittent catheterization, 2 that have undergone a sphincterotomy, 1 still performing self-intermittent catheterization and 1 with a supra-pubic catheter. The "NCUD" group had a significant higher NRS than the "Other bladder management" group (8.22±1.78 vs. 6.27±2.45; P=0.0056). The daily average duration of care was 16.42minutes in the "NCUD" group and 35.6minutes in the "Other bladder management" group (P=0.1111) CONCLUSION: This exploratory study, even if not conclusive, brings to light the preliminary results needed to elaborate a high level of evidence protocol regarding the satisfaction and the burden of care associated with NCUD in MS patients. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- I Soust
- Service affections neurologiques chroniques, CHU de Lille, université Lille, hôpital Pierre-Swynghedauw, 59000 Lille, France.
| | - A Filiette
- Service affections neurologiques chroniques, CHU de Lille, université Lille, hôpital Pierre-Swynghedauw, 59000 Lille, France
| | - A Blanchard
- Service affections neurologiques chroniques, CHU de Lille, université Lille, hôpital Pierre-Swynghedauw, 59000 Lille, France
| | - X Biardeau
- Service d'urologie, andrologie et transplantation rénale, CHU de Lille, université Lille, hôpital Claude-Huriez, 59000 Lille, France
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Miget G, Hentzen C, Turmel N, Chesnel C, Charlanes A, Le Breton F, Amarenco G. [Impact of body mass index on lower urinary tract disorders in multiple sclerosis]. Prog Urol 2019; 29:366-370. [PMID: 31133495 DOI: 10.1016/j.purol.2019.04.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS), and principally overactive bladder, are common in multiple sclerosis (MS). However, their origin is not necessarily unique. Obesity is widely recognized as a risk factor for stress urinary incontinence (SUI) and overactive bladder (OAB) in the general population. We wanted to evaluate the influence of body mass index (BMI) on LUTS in the MS population. MATERIALS AND METHODS We conducted an uncontrolled monocentric retrospective study in 260 subjects classified into 4 BMI groups: underweight, normal weight, overweight, obese people. Comparisons by Mann-Whitney test were made between different BMI groups, in the overall population and then by gender. LUTS (SUI, OAB, BOO (bladder outlet obstruction) were assessed using USP questionnaire. RESULTS In women, the mean OAB score was higher for obese women, 10.27 (SD=4.5) than for normal weight women, 7.96 (SD=4.58), P=0.024. The SUI score was lower for normal weight, 1.69 (SD=2.38) than for overweight, 3.19 (SD=2.91), P=0.002 and obese subjects, 3.80 (SD=3.23), P=0.0005. As in the overall population, the BOO score was higher in subjects with normal weight, 4.09 (SD=3.33) than in subjects with overweight, 1.91 (SD=2.03), P=0.0003 and in obese subjects, 2.33 (SD=2.37), P=0.013. The same comparisons in men were not significant. CONCLUSION In this series, increased BMI was associated with higher OAB and SUI USP questionnaire scores, in women presenting with MS. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- G Miget
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France.
| | - C Hentzen
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - N Turmel
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - C Chesnel
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - A Charlanes
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - F Le Breton
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - G Amarenco
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
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Vacher P, Charlanes A, Chesnel C, Pagès A, Malot C, Le Breton F, Amarenco G, Manceau P. [Interest of transcranial stimulation in pelvic and perineal disorders]. Prog Urol 2019; 29:349-59. [PMID: 31036483 DOI: 10.1016/j.purol.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/26/2019] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this article was to describe the diagnostic and therapeutic value of transcranial stimulation in pelvic and perineal disorders. METHODS A literature review (Medline database and Google scholar) with no time limit was performed using keywords: "transcranial direct stimulation", "transcranial magnetic stimulation", "neurogenic bladder", "urinary incontinence", "Parkinson disease", "multiple sclerosis", "stroke", "muscle spasticity", "pelvic pain", "visceral pain". RESULTS Twelve articles have been selected. Transcranial magnetic or electrical stimulation is a noninvasive neuromodulation technique widely used to establish brain maps to highlight causal relationships between brain and function. Regarding pelvic-perineal disorders, repeated transcranial stimulation has shown significant effects for the treatment of overactive bladder in Parkinson's disease (P<0.05) and multiple sclerosis, but also for the treatment of refractory chronic pelvic pain (P=0.026). Finally, therapeutic effects have also been demonstrated in irritable bowel syndrome. No evidence of efficacy was found on genito-sexual disorders. CONCLUSION Data from the literature suggest that transcranial stimulation is a noninvasive treatment that may have a role in the management of pelvic and perineal disorders. Its promising field of action would require prospective and randomized studies on a larger scale.
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Blum C, Chesnel C, Hentzen C, Turmel N, Lacroix P, Manceau P, Amarenco G. [Ejaculation disorders in multiple sclerosis: Prospective study of 44 patients]. Prog Urol 2019; 29:385-90. [PMID: 30819632 DOI: 10.1016/j.purol.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION To analyze in a descriptive way the ejaculation disorders during MS and to study the correlations between dysejaculations, other sexual, urinary and anorectal disorders. MATERIAL Prospective, monocentric, non-interventional study. Ejaculation disorders were assessed by Premature Ejaculation Profile (PEP) scores, intravaginal latency, and the Male Sexual Health Questionnaire - Ejaculation (MSHQ-Ej). The sexual disorders were evaluated by the International Index of Erectile Function (IIEF15) and the Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ). RESULTS Forty-four men of mean age 46.8 (±10.3) years, with an average EDSS of 5.0 (±1.5) were included. According to the MSHQ-Ej score, ejaculation disorders were present in 28 out of 44 patients included (64%); 26/44 (59%) had an orgasm disorder, 23/44 (52%) a delay in ejaculation, 26/44 (59%) a decrease in ejaculation flow, 24/44 (55%) decreased ejaculated volume, 18/44 (41%) decreased ejaculation frequency, 15/44 (33%) ejaculatory pain and 11 34 (25%) showed systematic non ejaculation. The PEP score showed premature ejaculation in 14 patients (32%). The intra-vaginal latency time was less than 1minute in 6 patients (13.6%). There was a statistically significant correlation between ejaculation disorders and erectile dysfunction (P<0.05, correlation coefficient at 0.53) but no statistically significant correlation between ejaculation disorders and urinary or ano-rectal disorders. CONCLUSIONS Dysejaculation was present in 64% of MS. These disorders were mainly characterized by a decrease in the volume of the ejaculation, the strength of ejaculation and the delay in ejaculation. LEVEL OF EVIDENCE 4.
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Zephir H, Puyade M, Gueguen A, Michel L, Terriou L, Dive D, Laureys G, Mathey G, Labauge P, Marjanovic Z, Pugnet G, Badoglio M, Lansiaux P, Yakoub-Agha I, Béguin Y, Farge D. [Indications and follow-up for autologous hematopoietic stem cell transplantation in multiple sclerosis: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) in association with the Francophone Society of Multiple Sclerosis]. Bull Cancer 2018; 106:S92-S101. [PMID: 30527815 DOI: 10.1016/j.bulcan.2018.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 12/16/2022]
Abstract
The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) organized the 8th allogeneic hematopoietic stem cell transplantation clinical practices harmonization workshop series in September 2017 in Lille, France. In this article we give the indications of autologous stem cell transplantation in multiple sclerosis as well as recommendations regarding post-transplant follow-up of patients under the hospice of the SFGM-TC and the Francophone Society of Multiple Sclerosis.
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Affiliation(s)
- Helène Zephir
- CHU de Lille, université de Lille, pôle des neurosciences et de l'appareil locomoteur, LIRIC (Lille Inflammation Research International Center) UMR 995, rue Emile-Laine, 59000 Lille, France.
| | - Mathieu Puyade
- CHU de Poitiers, service de médecine interne, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - Antoine Gueguen
- Fondation A.-de Rothschild, service de neurologie, 25, rue Manin, 75940 Paris cedex 19, France
| | - Laure Michel
- CHU de Nantes, hôpital Laennec, service de neurologie, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - Louis Terriou
- CHRU, hôpital Claude-Huriez, service des maladies du sang, rue Michel-Polonovski, 59037 Lille cedex, France
| | - Dominique Dive
- CHU de Liège, unité de neuro-immunologie clinique, boulevard de l'Hôpital, 4000 Liège, Belgique
| | - Guy Laureys
- University hospital Ghent, department of neurology, De Pintelaan 185, 9000 Ghent, Belgique
| | - Guillaume Mathey
- CHRU de Nancy, hôpital Central, service de neurologie, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France
| | - Pierre Labauge
- CHU de Montpellier, hôpital Gui-de-Chauliac, centre de ressources et de compétences sclérose en plaques, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - Zora Marjanovic
- AP-HP, hôpital Saint-Antoine, hématologie clinique et thérapie cellulaire, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - Grégory Pugnet
- CHU de Toulouse, hôpital Purpan, service de médecine interne, 1, place Baylac, 31059 Toulouse, France
| | - Manuela Badoglio
- Hôpital Saint-Antoine, EBMT Data Office, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - Pauline Lansiaux
- Hôpital Saint-Louis, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France, filière FAI2R, IUH EA-3518, UF04, unité de médecine interne, maladies auto-immunes et pathologie vasculaire, 1, avenue Claude-Vellefaux, 75475 Paris, France
| | | | - Yves Béguin
- CHU de Liège, université de Liège, service d'hématologie, 1, avenue de l'Hôpital, 4000 Liège, Belgique
| | - Dominique Farge
- Hôpital Saint-Louis, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France, filière FAI2R, IUH EA-3518, UF04, unité de médecine interne, maladies auto-immunes et pathologie vasculaire, 1, avenue Claude-Vellefaux, 75475 Paris, France.
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Blein C, Chamoux C, Reynaud D, Lepage V. [Care pathway diversity of patients with multiple sclerosis between French regions]. Rev Epidemiol Sante Publique 2018; 66:385-394. [PMID: 30309672 DOI: 10.1016/j.respe.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 06/15/2018] [Accepted: 08/31/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The aim of this study is to analyze and to compare data from 2015, focusing on hospital care for patients with multiple sclerosis from three French regions with different characteristics in terms of prevalence, size and number of multiple sclerosis competencies and resource centers. METHODS All hospital admissions from the PMSI MCO 2015 database, with a principal or related diagnosis (PD-RD) of G35* ("multiple sclerosis") were extracted. We also extracted chemotherapy treatments administered in hospital, during admissions with a significant associated diagnosis (SAD) of G35*, if the PD or RD was coded Z512 ("non-tumor chemotherapy"). The analyzed regions corresponded to those of 2015, some of which have since merged. RESULTS There were 95,359 hospital admissions for multiple sclerosis in France in 2015 among a total cohort of 21,102 patients, resulting in a total cost of € 54.1m. Patients with MS were managed mainly in the ambulatory setting, which accounted for 88.5 % of all admissions. The Rhône-Alpes region represented 7.6 % of national admissions for MS, 9.6 % of patients, and 14 % of inpatient days, contributing 10.4 % of the national cost of MS care. 58.4 % of stays were managed by the two main multiple sclerosis centers. The Nord-Pas-de-Calais region represented 9.8 % of national admissions, 10 % of patients, 6.6 % of inpatient days, and 9.1 % of the national cost. 29.8 % of stays were managed by the main multiple sclerosis center. The Centre region represented 2.7 % of stays, 2.8 % of patients, 3.1 % of inpatient days, and 2.8 % of the national cost. 28.4 % of stays were managed by the main multiple sclerosis center. CONCLUSION This study highlights the diversity of multiple sclerosis hospital management and care between these three regions.
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Affiliation(s)
- C Blein
- HEVA, 186, avenue Thiers, 69465 Lyon, France.
| | | | | | - V Lepage
- BIOGEN France, 75000 Paris, France
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16
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Masmoudi R, Aissi M, Halouani N, Fathallah S, Louribi I, Aloulou J, Amami O, Frih M. [Female sexual dysfunction and multiple sclerosis: A case-control study]. Prog Urol 2018; 28:530-535. [PMID: 30076093 DOI: 10.1016/j.purol.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To compare the scores of the different dimensions of sexual function of women with multiple sclerosis to a group of control women and to identify possible factors associated with sexual dysfunction in women with multiple sclerosis. METHODS This is a descriptive and analytical case-control study. Twenty-six women with multiple sclerosis were compared to 26 control women matched for age and socioeconomic status. The evaluation focused on demographic and clinical data. Patients with multiple sclerosis were evaluated by Expanded Disability Status Scale (EDSS) for functional status, by Female Sexual Function Inventory (FSFI) for sexual function and by Beck Depression Inventory-Short Form (BDI-DF) for severity of depression. RESULTS Our results confirmed the high prevalence of sexual dysfunction among patients with multiple sclerosis (69.2%) compared to controls (26.9%) (P=0.002). Sexual desire, arousal and orgasm were the most altered sexual phases in our study. Total FSFI, and FSFI subscale scores (sexual desire, arousal, lubrication, orgasm and satisfaction) were lower in women with multiple sclerosis compared with controls. The analytical study showed that in women with multiple sclerosis, the total FSFI score was correlated with age (rs=-0.68; P<0.001), duration of marriage (rs=-0.57; P=0.002), level of disability (rs=-0.45; P=0.021) and BDI-SF score (rs=-0.51; P=0.008). FSFI score was also associated to low education level (P=0.02) and urinary dysfunction (P=0.04). CONCLUSION Our study highlighted the importance of sexual dysfunction in women with multiple sclerosis. The inclusion of this aspect in the clinical assessment will improve the quality of life of these patients. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- R Masmoudi
- Service de psychiatrie « B », CHU Hedi-Chaker, route El Ain 0,5km, 3000 Sfax, Tunisie.
| | - M Aissi
- Service de neurologie, CHU Fattouma-Bourguiba, Monastir, Tunisie
| | - N Halouani
- Service de psychiatrie « B », CHU Hedi-Chaker, route El Ain 0,5km, 3000 Sfax, Tunisie
| | - S Fathallah
- Service de psychiatrie, CHU Fattouma-Bourguiba, Monastir, Tunisie
| | - I Louribi
- Service de neurologie, CHU Fattouma-Bourguiba, Monastir, Tunisie
| | - J Aloulou
- Service de psychiatrie « B », CHU Hedi-Chaker, route El Ain 0,5km, 3000 Sfax, Tunisie
| | - O Amami
- Service de psychiatrie « B », CHU Hedi-Chaker, route El Ain 0,5km, 3000 Sfax, Tunisie
| | - M Frih
- Service de neurologie, CHU Fattouma-Bourguiba, Monastir, Tunisie
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Classen S, Krasniuk S, Knott M, Alvarez L, Monahan M, Morrow S, Danter T. Interrater reliability of Western University's on-road assessment. Can J Occup Ther 2018; 83:317-325. [PMID: 28050933 DOI: 10.1177/0008417416663228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little empirical support exists for interrater reliability between evaluators from different backgrounds when assessing on-road outcomes of drivers. PURPOSE We quantified interrater reliability of on-road outcomes between a certified driving school instructor (DI) and an occupational therapist and certified driver rehabilitation specialist (CDRS). METHOD Both raters used the Global Rating Score (GRS) with two levels (pass, fail), the GRS with four levels (pass, pass with recommendations, fail remediable, fail), and the priority error rating score (PERS; most frequently occurring on-road errors in priority order) to assess 35 drivers (age, M = 48.31 years, SD = 9.76 years; 40% male; 86% with multiple sclerosis). FINDINGS The DI and occupational therapist CDRS had excellent agreement on the GRS with two levels (κ = .892, p < .0001), GRS with four levels (κ = .952, p < .0001), and the PERS (κ = .847-.902, p < .0001), indicating interrater reliability. IMPLICATIONS This research contributes to empirical support for the on-road assessment.
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Menoux D, Chesnel C, Charlanes A, Hentzen C, Motavasseli D, Charoenwong F, Le Breton F, Amarenco G. [Reproducibility of bladder diary in patients with multiple sclerosis]. Prog Urol 2018; 28:387-395. [PMID: 29370967 DOI: 10.1016/j.purol.2018.01.001] [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: 04/25/2017] [Revised: 12/20/2017] [Accepted: 01/01/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a neurological condition characterized by variable levels of symptoms. This variability could also affect bladder dysfunction and impact on the reproducibility or stability of bladder diary (BD). The aim of the study is to investigate the reproducibility and reliability of BD in MS, and then determine its linked factors. METHODS The MS patient provided a 21 days BD and they documented the time of every void. The main criterion was assessed by voiding frequency, represented by the coefficient of variation (CV=average/standard deviation), expressed as a percentage. Two groups were described: stable BD group (CV≤15 %) and instable BD group (CV>15 %). Secondary criteria were completion of BD (complete or not) and the difference of voiding frequency variation between weekend and week. RESULTS Thirty-one patients were included (mean age 51.06 years, SD 11.33) with 65 % of women. Mean CV is 23 % (SD 0.11). The mean completion of BD was 19.35 days (SD 3.99). 8 patients had a CV≤15 %. Stable group was older than instable group (P=0.03). There was no other difference between the 2 groups. There is a strong correlation between mean voiding frequency weekend and week (ρ=0.94, P<0.05). The longer duration of BD, the less reliability is notified. CONCLUSION BD is not a stable reproducible in MS population. Both lack of compliance or variability of LUTS in MS may explain the unreliability of BD. However, BD utility should be discussed in this population. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- D Menoux
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - C Chesnel
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Charlanes
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Hentzen
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - D Motavasseli
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Charoenwong
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Le Breton
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - G Amarenco
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Pugnet G, Castilla-Llorente C, Puyade M, Terriou L, Badoglio M, Deligny C, Guillaume-Jugnot P, Labeyrie C, Benzidia I, Faivre H, Lansiaux P, Marjanovic Z, Bourhis JH, Faucher C, Furst S, Huynh A, Martin T, Vermersch P, Yakoub-Agha I, Farge D. [Indications and follow-up for autologous hematopoietic stem cell transplantation in autoimmune and autoinflammatory diseases: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2017; 104:S169-S180. [PMID: 29173974 DOI: 10.1016/j.bulcan.2017.06.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/27/2017] [Indexed: 12/15/2022]
Abstract
The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) organized the 7th allogeneic hematopoietic stem cell transplantation clinical practices harmonization workshop series in September 2017 in Lille, France and updated recommendations for indications and follow-up in autologous hematopoietic stem cell transplantation in autoimmune and autoinflammatory diseases, previously published under the auspices of SFGM-TC.
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Affiliation(s)
- Grégory Pugnet
- CHU de Toulouse, hôpital Purpan, service de médecine interne, 1, place Baylac, 31059 Toulouse, France
| | | | - Mathieu Puyade
- Cité hospitalière de la Milétrie, hôpital Jean-Bernard, service d'hématologie, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - Louis Terriou
- CHRU, hôpital Claude-Huriez, service des maladies du sang, rue Michel-Polonovski, 59037 Lille cedex, France
| | - Manuela Badoglio
- Hôpital Saint-Antoine, EBMT data office, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - Christophe Deligny
- CHU de Fort-de-France, service de médecine interne-rhumatologie, 97261 Fort-de-France, Martinique
| | - Perrine Guillaume-Jugnot
- Hôpital Pitié-Salpêtrière, service de médecine interne, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Céline Labeyrie
- CHU Bicêtre, centre de référence national NNERf, service de neurologie, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Ilham Benzidia
- Hôpital Saint-Louis, UF04, unité de médecine interne, maladies auto-immunes et pathologie vasculaire, centre de référence des maladies auto-immunes systémiques rares d'Ile-de-France, Filière 'FAI2R', 1, avenue Claude-Vellefaux, 75475 Paris, France
| | - Hélène Faivre
- Hôpital Saint-Louis, UF04, unité de médecine interne, maladies auto-immunes et pathologie vasculaire, centre de référence des maladies auto-immunes systémiques rares d'Ile-de-France, Filière 'FAI2R', 1, avenue Claude-Vellefaux, 75475 Paris, France
| | - Pauline Lansiaux
- Hôpital Saint-Louis, UF04, unité de médecine interne, maladies auto-immunes et pathologie vasculaire, centre de référence des maladies auto-immunes systémiques rares d'Ile-de-France, Filière 'FAI2R', 1, avenue Claude-Vellefaux, 75475 Paris, France
| | - Zora Marjanovic
- AP-HP, hôpital Saint-Antoine, hématologie clinique et thérapie cellulaire, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - Jean-Henri Bourhis
- Institut Gustave-Roussy, service d'hématologie, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Catherine Faucher
- Institut Paoli-Calmettes, unité de transplantation et de thérapie cellulaire (U2t), service oncologie et hématologie, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Sabine Furst
- Institut Paoli-Calmettes, unité de transplantation et de thérapie cellulaire (U2t), service oncologie et hématologie, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Anne Huynh
- Oncopole, institut universitaire du cancer Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - Thierry Martin
- Hôpital civil, service de médecine interne et immunologie clinique, 1, place de l'hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Patrick Vermersch
- CHRU de Lille, service de neurologie générale et pathologie neuro-inflammatoire, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - Ibrahim Yakoub-Agha
- CHU de Lille, université de Lille 2, LIRIC Inserm U995, 59000 Lille, France.
| | - Dominique Farge
- Hôpital Saint-Louis, UF04, unité de médecine interne, maladies auto-immunes et pathologie vasculaire, centre de référence des maladies auto-immunes systémiques rares d'Ile-de-France, Filière 'FAI2R', 1, avenue Claude-Vellefaux, 75475 Paris, France.
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Twomey R, Aboodarda SJ, Kruger R, Culos-Reed SN, Temesi J, Millet GY. Neuromuscular fatigue during exercise: Methodological considerations, etiology and potential role in chronic fatigue. Neurophysiol Clin 2017; 47:95-110. [PMID: 28434551 DOI: 10.1016/j.neucli.2017.03.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The term fatigue is used to describe a distressing and persistent symptom of physical and/or mental tiredness in certain clinical populations, with distinct but ultimately complex, multifactorial and heterogenous pathophysiology. Chronic fatigue impacts on quality of life, reduces the capacity to perform activities of daily living, and is typically measured using subjective self-report tools. Fatigue also refers to an acute reduction in the ability to produce maximal force or power due to exercise. The classical measurement of exercise-induced fatigue involves neuromuscular assessments before and after a fatiguing task. The limitations and alternatives to this approach are reviewed in this paper in relation to the lower limb and whole-body exercise, given the functional relevance to locomotion, rehabilitation and activities of daily living. It is suggested that under some circumstances, alterations in the central and/or peripheral mechanisms of fatigue during exercise may be related to the sensations of chronic fatigue. As such, the neurophysiological correlates of exercise-induced fatigue are briefly examined in two clinical examples where chronic fatigue is common: cancer survivors and people with multiple sclerosis. This review highlights the relationship between objective measures of fatigability with whole-body exercise and perceptions of fatigue as a priority for future research, given the importance of exercise in relieving symptoms of chronic fatigue and/or overall disease management. As chronic fatigue is likely to be specific to the individual and unlikely to be due to a simple biological or psychosocial explanation, tailored exercise programmes are a potential target for therapeutic intervention.
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Gallini A, Moisan F, Maura G, Carcaillon-Bentata L, Leray E, Haesebaert J, Bruandet A, Moutengou E, Luciano L, Weill A, Marin B, Gardette V. [Identification of neurodegenerative diseases in administrative databases in France: A systematic review of the literature]. Rev Epidemiol Sante Publique 2017; 65 Suppl 4:S183-97. [PMID: 28341166 DOI: 10.1016/j.respe.2017.01.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/10/2017] [Accepted: 01/20/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Given the health, social and economic burden of neurodegenerative diseases (ND), the development of epidemiologic studies is required. Administrative databases, such as the French national health insurance database (SNIIRAM) could represent an opportunity for researchers. ND could be presumed from drug reimbursement data, hospital stays or registration of a chronic condition. The aim of this study was to describe, in French administrative databases, algorithms used to identify Alzheimer's disease and associated disorders (ADAD), Parkinson's disease and associated disorders (PDAD), multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS). METHODS A systematic literature review was performed in Medline and gray literature through December 31th, 2015. French studies focusing on ADAD, PDAD, MS or ALS as a primary health outcome, conducted among one of the SNIIRAM data sources (outpatient reimbursements, chronic condition registration, hospital discharge) were included. RESULTS Thirty-four studies were included (ADAD, n=18, PDAD, n=9, MS, n=4, ALS, n=3), leading to 36 algorithms. For each studied ND, there was an important variability in the algorithms, concerning (i) the type of criteria used (administrative database versus multi-source systems); (ii) the number of criteria used; (iii) the definition used for each criteria. The extent and level of drug exposure highly varied. Identification through hospitalizations showed variations in terms of type of stay (short stay, long-term stay, psychiatric ward…), extent of diagnosis codes used, diagnosis type (principal, related, associated diagnosis) and period used. A validation study was conducted for 2 out of 36 algorithms (PDAD), and criteria completeness was estimated for 3 algorithms (MS, ALS). CONCLUSION Despite the increase in ND identification among French administrative databases, few algorithms have been validated. Validation studies should be encouraged.
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Weglinski L, Manceau P, Thomas-Pohl M, Le Breton F, Amarenco G. [Prospective evaluation of mouth and eye dryness induced by antimuscarinic drugs used for neurogenic overactive bladder in 35 patients with multiple sclerosis]. Prog Urol 2016; 27:253-260. [PMID: 27955902 DOI: 10.1016/j.purol.2016.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Mouth and eye dryness are frequently reported by patients with multiple sclerosis (MS) as side effects of antimuscarinic drugs used for neurogenic overactive bladder. We evaluated the impact of antimuscarinic drugs prescription on these symptoms. METHODS MS patients consulting for overactive bladder were included. Xerostomia were evaluated at baseline and thirty days after treatment by self-reporting questionnaires (Xerostomia Quality of Life [X-Qol] and Xerostomia Questionnaire [XQ]), by salivary flow rate and sugar test. Xerophtalmia were evaluated by a self-reporting questionnaire (Ocular Surface Disease Index [OSDI]) and Schirmer test. Iatrogenic anticholinergic impregnation was evaluated by the Anticholinergic Drug Scale. RESULTS From January to December 2014, 35 patients were included. Mean age was 50.1±10.2 years, mean EDSS=4.9. Mean anticholinergic impregnation was 0.6±1.0. Before treatment, none correlation was found between anticholinergic impregnation and other parameters. Twenty-two patients were evaluated after treatment. At baseline and thirty days after treatment, mean scores were respectively: 0.78±0.51 and 0.73±0.43 (P=0.67) for X-Qol, 9.22±11.8 and 7.03±11.4 (P=0.32) for XQ, 18.8±14.9 and 13.9±11.6 (P=0.06) for OSDI. Mean salivary flow rates were respectively 1.54±1.11 and 1.22±1.3 (P=0.53), positive sugar tests concerned respectively 68% and 55% of patients (P=0.53), and positive Schirmer test concerned 50% before and after treatment. CONCLUSION Eye and mouth dryness exist in our MS population, even before prescription of antimuscarinic treatment, and is not getting worse after prescription. Those symptoms should not be the reason to stop an efficient treatment, but should be the reason to find and treat their aetiology. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- L Weglinski
- Service de neuro-urologie, hôpital Tenon, groupe de recherche clinique en neuro-urologie (GREEN), UPMC université Paris 06, Sorbonne universités, AP-HP, GRC 01, 4, rue de la Chine, 75020 Paris, France.
| | - P Manceau
- Service de neuro-urologie, hôpital Tenon, groupe de recherche clinique en neuro-urologie (GREEN), UPMC université Paris 06, Sorbonne universités, AP-HP, GRC 01, 4, rue de la Chine, 75020 Paris, France
| | - M Thomas-Pohl
- Service de neuro-urologie, hôpital Tenon, groupe de recherche clinique en neuro-urologie (GREEN), UPMC université Paris 06, Sorbonne universités, AP-HP, GRC 01, 4, rue de la Chine, 75020 Paris, France
| | - F Le Breton
- Service de neuro-urologie, hôpital Tenon, groupe de recherche clinique en neuro-urologie (GREEN), UPMC université Paris 06, Sorbonne universités, AP-HP, GRC 01, 4, rue de la Chine, 75020 Paris, France
| | - G Amarenco
- Service de neuro-urologie, hôpital Tenon, groupe de recherche clinique en neuro-urologie (GREEN), UPMC université Paris 06, Sorbonne universités, AP-HP, GRC 01, 4, rue de la Chine, 75020 Paris, France
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Prévinaire JG, Soler JM, Bordji H, Fiolet MC, Navaux MA, Mortier PE. [Assessment of severity of neurogenic bowel dysfunction in chronic patients with a simple 1-item questionnaire (PGI-S)]. Prog Urol 2016; 26:573-81. [PMID: 27450748 DOI: 10.1016/j.purol.2016.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/03/2016] [Revised: 06/06/2016] [Accepted: 06/17/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Bowel symptoms (constipation and incontinence) are frequent in patients with a neurologic disease, but rarely assessed in rehabilitation centres. AIM To study the prevalence of neurogenic bowel dysfunction (NBD) in those patients, and to assess its severity with the Patient Global Impression of Severity (PGI-S). MATERIAL Prospective study by questionnaires, with the Neurogenic Bowel Dysfunction Score (0-47) and the PGI-S, a 1-item questionnaire (absent, mild, moderate, severe) for the severity of the bowel symptoms, and the Bristol Stool Chart for stool consistency. All patients presenting a chronic (>2months) neurological disease were included. RESULTS Inclusion of 169 patients, 97 with spinal cord injury, 42 with multiple sclerosis and 30 with hemiplegia. In each population, prevalence of constipation was 67 %, 45 % and 17 %, of pelvic floor dyssynergia 82 %, 45 % and 27 %, and leakages (gas or stools) de 74 %, 48 % and 43 %, respectively. Moderate to severe bowel symptoms were seen in 61 % of spinal cord injury, 43 % of multiple sclerosis and 23 % of hemiplegic patients, with NBD scores of 11.9±6.5, 5.7±4.9 and 3.7±4.2, respectively (P<0.01). There was a significant relation between PGI-S and NBD score (P<0.01). Significant lower NBD scores were associated with normal stool consistency (Bristol type 3 or 4) (P<0.01). In case of severe bowel symptoms, the use of transanal irrigation was hampered by patients' motivation and acceptation, and their autonomy. CONCLUSION PGI-S and Bristol Stool Chart are reliable tools to assess the presence of bowel symptoms in clinical practice.
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Affiliation(s)
- J G Prévinaire
- Centre Calvé, fondation Hopale, 62600 Berck-sur-Mer, France.
| | - J M Soler
- Centre Bouffard-Vercelli, 66690 Cerbère, France
| | - H Bordji
- Centre Calvé, fondation Hopale, 62600 Berck-sur-Mer, France
| | - M C Fiolet
- Centre Calvé, fondation Hopale, 62600 Berck-sur-Mer, France
| | - M A Navaux
- Centre Bouffard-Vercelli, 66690 Cerbère, France
| | - P E Mortier
- Hôpital Calot, fondation Hopale, 62600 Berck-sur-Mer, France; Service des maladies digestives, CHRU de Lille, 59037 Lille cedex, France
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Bensa C. [Desire for pregnancy of a young women with multiple sclerosis]. Rev Prat 2016; 66:519-523. [PMID: 30512575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Caroline Bensa
- Service de neurologie, Fondation ophtalmologique Rothschild, Paris, France
- Unité de neurologie, GHI Le Raincy- Montfermeil, Montfermeil, France
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Abstract
Even prior to the introduction of criteria defining the radiologically isolated syndrome (RIS), longitudinal clinical data from individuals with incidentally identified T2 lesions suggestive of multiple sclerosis (MS) were described. Healthy individuals who do not exhibit signs of neurological dysfunction may have a brain MRI performed for a reason other than suspicion of MS that reveals unexpected anomalies highly suggestive of demyelinating plaques given their size, location, and morphology. These healthy subjects lack a history or symptomatology suggestive of MS and fulfill formal criteria for RIS, a recently described MS subtype that shares the phenotype of at-risk individuals for future demyelinating events. A formal description of RIS was first introduced in 2009 by Okuda et al., and defines a cohort of individuals who are at risk for future demyelinating events. European or North American observational studies have found that up to 30-45% of patients presenting with RIS will present with neurological symptoms, either acute or progressive. The median time to clinical conversion differs between studies. It was 2.3 years for a series of French patients and 5.4 years for an American cohort. Most patients who developed clinical symptoms had prior radiological progression. The presence of asymptomatic lesions in the cervical cord indicated an increased risk of progression, either to relapsing or to progressive MS. The consortium studying the epidemiology of RIS worldwide (RISC) presented their first retrospective cohort last year. Data were available for 451 RIS subjects (F: 354 [78.5%]). The mean age at RIS diagnosis was 37.2 years with a mean clinical follow-up time of 4.4 years. The observed 5-year conversion rate to the first clinical event was 34%. Of the converters within this time period, 9.6% fulfilled criteria for primary progressive MS. In the multivariate model, age, sex (male), and lesions within the cervical or thoracic spinal cord were identified as significant predictors for the development of a first clinical event. Cognitive impairment is observed in RIS patients, and two studies demonstrated a significant proportion of patients with cognitive decline compared with healthy controls. Despite progress into the characterization of RIS subjects and into our understanding of risk factors for initial symptom development, the natural course of such cases and risk-profiles for a seminal neurological event, from prospectively acquired data, remain unclear. A prospective study is mandatory to increase our knowledge about these asymptomatic patients and individual therapeutic initiatives cannot be undertaken until a prospective clinical study demonstrates the benefit of introducing a disease modifying treatment for this very early stage of a chronic demyelinating disease.
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Ongagna JC, Passadori A, Pinelli J, Isner-Horobeti ME, Zaenker C, De Seze J. [Difficulties experienced at work by patients with multiple sclerosis]. Rev Neurol (Paris) 2015; 171:782-6. [PMID: 26343923 DOI: 10.1016/j.neurol.2015.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/16/2015] [Accepted: 06/23/2015] [Indexed: 11/28/2022]
Abstract
AIM Multiple sclerosis (MS) is a disease of the central nervous system that affects young adults at a time when they launch into the workforce. The disease often has a great impact on working life. The objective of this survey was to identify the problems faced by people with multiple sclerosis in the context of their work. METHODS To describe the difficulties experienced at work by patients with multiple sclerosis, we carried out in 2010 a regional survey including neurology and functional rehabilitation centers. RESULTS Two hundred and seven MS patients of working age responded to the survey. The employment rate was 67.6%. Among difficulties expressed by patients, physical and mental fatigue appeared as the issues affecting work. For 41% of respondents, preventive measures at work could help maintain or resume employment. CONCLUSION Problems of fatigability put forward by MS patients are elements that can predict a loss of employment.
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Affiliation(s)
- J C Ongagna
- Réseau sclérose en plaques Alsace (alsacEP), hôpitaux civils de Colmar, 39, avenue de la Liberté, 68024 Colmar, France.
| | - A Passadori
- Centre de réadaptation fonctionnelle, 57, rue Albert-Camus, 68093 Mulhouse, France
| | - J Pinelli
- Institut universitaire de réadaptation Clémenceau (IURC), 45, boulevard Clémenceau, 67082 Strasbourg, France
| | - M E Isner-Horobeti
- Institut universitaire de réadaptation Clémenceau (IURC), 45, boulevard Clémenceau, 67082 Strasbourg, France
| | - C Zaenker
- Réseau sclérose en plaques Alsace (alsacEP), hôpitaux civils de Colmar, 39, avenue de la Liberté, 68024 Colmar, France
| | - J De Seze
- Service de neurologie, hôpitaux universitaires, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
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Pelletier J. [Is it always useful to perform lumbar puncture for the diagnosis of multiple sclerosis? No]. Rev Neurol (Paris) 2015; 171:607-10. [PMID: 26343922 DOI: 10.1016/j.neurol.2015.05.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
In the absence of a specific test for the diagnosis of multiple sclerosis (MS), cerebrospinal fluid analysis (CSF) remains discussed. There are robust evidences which demonstrated that an early diagnosis of MS must be done, due to the availability of disease-modifying drugs that could influence the natural history of the disease. However, several arguments can be put forward to assert that CSF analysis is not useful for the diagnosis of MS and thus should not be realized in a systematic way. First, MRI remains the most sensitive and specific marker to validate dissemination in space and in time and CSF analysis is not recommended by the 2010 McDonald criteria. The second argument is related to the low sensitivity and specificity of abnormalities detected in CSF analysis to confirm the diagnosis of MS. Moreover, there is currently no evidence that the presence of oligoclonal bands could represent a surrogate marker on an individual prognostic way. Furthermore, lumbar puncture could be traumatic, may entail some infrequent risks and represents unnecessary expense. Thus, there are strong reasons to not recommend systematic CSF examination to diagnose MS.
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Affiliation(s)
- J Pelletier
- Service de neurologie, pôle de neurosciences cliniques, hôpital de la Timone, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Lairy G, Zephir H, Ouallet JC, Le Page E, Laplaud D, Bensa C, De Seze J. Targeted clinical audits immediately following the establishment of clinical practice guidelines for multiple sclerosis in 17 neurology departments: A pragmatic and collaborative study. Rev Neurol (Paris) 2015; 171:407-14. [PMID: 25912471 DOI: 10.1016/j.neurol.2015.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/26/2015] [Accepted: 03/16/2015] [Indexed: 11/22/2022]
Abstract
UNLABELLED Following the publication practice guidelines for multiple sclerosis by a group of neurologists (multiple sclerosis study group [GRESEP]), the primary objective of this study was to compare the reality of practice to the guidelines according to the targeted clinical audit (TCA) method. The study was conducted at 17 neurology sites and was administered during two periods of MS care (diagnostic - TCA-DIAG, and disease course - TCA-EVOL). Two complementary surveys were done on the record keeping and the root causes of the deviations. The percentages of compliance ranged from 8 to 98% for the TCA-DIAG, and from 15 to 99% for the TCA-EVOL, with wide disparity between sites. The audits were able to identify causes of the flaws in traceability or accessibility. At the end of the study, despite its limitations, we think that the sharing of the results from different sites provided interesting approaches for the use of the assessment criteria defined by GRESEP in a complete audit cycle. This study is to our knowledge the first report of an experiment in which guidelines were created, and subsequently followed by the development of assessment criteria and then the performance of targeted clinical audits using them, all by the same participants. CONTEXT Clinical practice guidelines (CPGs) are intended to help practitioners and patients make informed treatment choices, but their integration into actual practice remains problematic. This study was done immediately following the publication of CPGs for multiple sclerosis (MS) by the multiple sclerosis study group [GRESEP]. The primary objective was to generate quality criteria, to test them within the same group, and to analyze the observed deviations. MATERIALS AND METHODS The study was conducted in the 17 voluntary departments that had participated in the development of the CPGs. The targeted clinical audit method was administered during two periods of MS care (diagnostic - TCA-DIAG, and disease course - TCA-EVOL). All the files were evaluated by a clinical research technician using digital format, which ensured thoroughness of the collection. Two complementary surveys were done on the record keeping and the potential causes of the deviations. RESULTS The percentages of compliance to the criteria ranged from 8 to 98% (out of 240 files) for the TCA-DIAG, and from 15 to 99% (221 files) for the TCA-EVOL, with wide disparity between sites (interquartile distance ranges: TCA-DIAG between 0% and 55%; TCA-EVOL between 0% and 70%). The mean percentage of compliance with all the criteria as measured by the TCA-DIAG was 83.9% for the sites with digital files vs. 76.4% for those with only paper files (P<0.01). For the TCA-EVOL, the difference was not significant. Explanations for the observed deviations were suggested (1 to 9 according to the participants). DISCUSSION AND CONCLUSION The quantified results could not be compared to other studies given the unique nature of the experiment. The importance of the traceability of practices in the patient files was discussed and assessed with regard to continuity and safety of care, as well as the medical-legal perspectives. Causes of lack of compliance were suggested (particularly the absence of reminders, the lack of means and/or time). Despite the limitations of the study, we think it is advisable that when a group becomes involved in the development of CPGs that they follow with the development of assessment criteria in order to evaluate the validity as well as their character as intermediate indicators of the quality of practices.
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Lebrun C, Forzy G, Collongues N, Cohen M, de Seze J, Hautecoeur P. Tear analysis as a tool to detect oligoclonal bands in radiologically isolated syndrome. Rev Neurol (Paris) 2015; 171:390-3. [PMID: 25613196 DOI: 10.1016/j.neurol.2014.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although radiologically isolated syndrome (RIS) is a newly defined entity, incidental findings of T2 hypersignals on brain MRI can lead to misdiagnosis or useless investigations. The detection of oligoclonal bands (OCBs) in cerebrospinal fluid (CSF) is a major indicator that helps in diagnosis of subclinical inflammatory disease of the central nervous system, but lumbar puncture still remains an invasive option. METHODS We have prospectively included patients with RIS, have compared the results of CSF and tear OCB detection by isoelectric focusing (IEF) and assessed concordance between OCB detection in tears and in CSF. Tears were collected using a Schirmer strip. RESULTS In 45 recruited RIS patients, OCBs were detected in CSF for 55% (25/45) and in tears for 50% (21/42) of samples. CONCLUSIONS We suggest that tear OCB detection may replace CSF OCB detection as a diagnostic tool in patients with RIS and be useful in follow-up.
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Affiliation(s)
- C Lebrun
- Service de neurologie, hôpital Pasteur, CHU de Nice, 30, voie Romaine, 06002 Nice, France.
| | - G Forzy
- Centre catholique de Lomme, université catholique de Lille, 56, rue du Port, 59046 Lille, France
| | - N Collongues
- Neurologie, CHU de Strasbourg, 1, place de L'hôpital, BP 426, 67091 Strasbourg cedex, France
| | - M Cohen
- Service de neurologie, hôpital Pasteur, CHU de Nice, 30, voie Romaine, 06002 Nice, France
| | - J de Seze
- Neurologie, CHU de Strasbourg, 1, place de L'hôpital, BP 426, 67091 Strasbourg cedex, France
| | - P Hautecoeur
- Centre catholique de Lomme, université catholique de Lille, 56, rue du Port, 59046 Lille, France
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Walusinski O. 1903 manuscript revived: Cerebral disturbances in multiple sclerosis (Des troubles cérébraux dans la sclérose en plaques) by Raymond Cestan (1872-1933) and Claudien Philippe (1866-1903). Rev Neurol (Paris) 2015; 171:333-40. [PMID: 25577947 DOI: 10.1016/j.neurol.2014.09.012] [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: 08/04/2014] [Revised: 09/14/2014] [Accepted: 09/16/2014] [Indexed: 11/19/2022]
Abstract
Philanthropy aimed at helping medical research has been around for a long time. In the 19th century, cash awards were distributed by the French Academy of Medicine according to criteria determined by each generous donor. It was thus that Mrs. Bernard de Civrieux endowed the Academy each year with the task of supporting one or more laureates whose work furthered understanding of "nervous diseases". In 1903, Raymond Cestan (1872-1933) and Claudien Philippe (1866-1903) were selected for their dissertation on "cerebral disturbances" during multiple sclerosis with clinical as well as anatomical-pathological effects. Never published, this innovative manuscript, taken from the library of Fulgence Raymond (1844-1910), will be analysed here after a brief biography of each author.
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Bonnan M. [Meningeal tertiary lymphoid organs: Major actors in intrathecal autoimmunity]. Rev Neurol (Paris) 2014; 171:65-74. [PMID: 25555848 DOI: 10.1016/j.neurol.2014.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 07/24/2014] [Accepted: 08/29/2014] [Indexed: 12/29/2022]
Abstract
Multiple sclerosis (MS) is characterized by an intrathecal synthesis of immunoglobulins synthesized by B-cell clones and by a brain infiltrate of clonal T-cells. The clonal maturation of these lymphocytes takes place in tertiary lymphoid organs (TLO) developed in the intrathecal compartment. TLO are acquired lymphoid organs able to develop in the vicinity of the inflammatory sites, where they mount a complete antigen-driven immune response. We here review TLO pathophysiology in animal models of MS and human MS. Several pieces of evidence suggest that intrathecal TLO may play a major role in the clinical impairment. Potential therapeutic applications are examined.
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Affiliation(s)
- M Bonnan
- Service de neurologie, hôpital F.-Mitterrand, 4, boulevard Hauterive, 64000 Pau, France.
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Dubessy AL, Zujovic V, Papeix C, Stankoff B. Biotherapies in multiple sclerosis: a step toward remyelination and neuroprotection? Rev Neurol (Paris) 2014; 170:770-8. [PMID: 25459127 DOI: 10.1016/j.neurol.2014.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 10/01/2014] [Accepted: 10/08/2014] [Indexed: 12/18/2022]
Abstract
Multiple sclerosis (MS) is a complex disease of the central nervous system (CNS), characterized by CNS-restricted inflammation with subsequent demyelination and neurodegeneration. Current disease-modifying therapies efficiently reduce relapse rate and new lesions appearance, but still fail to impact the progressive course of the disease. There is a great need for the avenue of new therapies aimed at promoting myelin repair or reducing neurodegeneration that should result in the prevention of neurological disability in this chronic disease. This review will focus on the potentials and limitations of biotherapies that are currently developed for the promotion of CNS repair in MS, either monoclonal antibodies targeting axonal growth and remyelination, or cell therapies aimed at replacing the depleted myelinating cells within the CNS. As other researches aimed at promoting neuroprotection or remyelination are following a classical pharmacological approach, they will not be described in this review, which will focus on antibody-based therapies and cell therapies.
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Affiliation(s)
- A-L Dubessy
- Sorbonne universités, UPMC Univ Paris 06, UMR S 1127, and Inserm U 1127, and CNRS UMR 7225, and ICM, 4, place Jussieu, 75013 Paris, France; 75005 Paris, France
| | - V Zujovic
- Sorbonne universités, UPMC Univ Paris 06, UMR S 1127, and Inserm U 1127, and CNRS UMR 7225, and ICM, 4, place Jussieu, 75013 Paris, France; 75005 Paris, France
| | - C Papeix
- Sorbonne universités, UPMC Univ Paris 06, UMR S 1127, and Inserm U 1127, and CNRS UMR 7225, and ICM, 4, place Jussieu, 75013 Paris, France; 75005 Paris, France; 75005 Paris, France
| | - B Stankoff
- Sorbonne universités, UPMC Univ Paris 06, UMR S 1127, and Inserm U 1127, and CNRS UMR 7225, and ICM, 4, place Jussieu, 75013 Paris, France; 75005 Paris, France; Université Pierre-et-Marie-Curie, hôpital Tenon-HUEP, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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Gaspard L, Tombal B, Opsomer RJ, Castille Y, Van Pesch V, Detrembleur C. [Physiotherapy and neurogenic lower urinary tract dysfunction in multiple sclerosis patients: a randomized controlled trial]. Prog Urol 2014; 24:697-707. [PMID: 25214451 DOI: 10.1016/j.purol.2014.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 11/21/2022]
Abstract
AIM This randomized controlled trial compare the efficacy of pelvic floor muscle training vs. transcutaneous posterior tibial nerve stimulation. PATIENTS AND METHODS Inclusion criteria were EDSS score<7 and presence of lower urinary tract symptoms. Exclusion criteria were multiple sclerosis relapse during the study, active urinary tract infection and pregnancy. The primary outcome was quality of life (SF-Qualiveen questionnaire). Secondary outcomes included overactive bladder (USP questionnaire) score and frequency of urgency episodes (3-day bladder diary). Sample size was calculated after 18 patients were included. Data analysis was blinded. Each patient received 9 sessions of 30 minutes weekly. Patients were randomized in pelvic floor muscles exercises with biofeedback group (muscle endurance and relaxation) or transcutaneous posterior tibial nerve stimulation group (rectangular alternative biphasic current with low frequency). RESULTS A total of 31 patients were included. No difference appeared between groups for quality of life, overactive bladder and frequency of urgency episodes (respectively P=0.197, P=0.532 et P=0.788). These parameters were significantly improved in pelvic floor muscle training group (n=16) (respectively P=0.004, P=0.002 et P=0.006) and in transcutaneous posterior tibial nerve stimulation group (n=15) (respectively P=0.001, P=0.001 et P=0.031). CONCLUSIONS Pelvic floor muscle training and transcutaneous posterior tibial nerve stimulation improved in the same way symptoms related to urgency in MS patients with mild disability. LEVEL OF EVIDENCE 2.
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Amarenco G, de Sèze M, Ruffion A, Sheikh Ismael S. Clinical and urodynamic evaluations of urinary disorders in multiple sclerosis. Ann Phys Rehabil Med 2014; 57:277-287. [PMID: 24980885 DOI: 10.1016/j.rehab.2014.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 11/17/2022]
Abstract
Urinary dysfunction is a major clinical problem and a significant cause of disability in multiple sclerosis (MS) patients. Indeed, the bothersome symptom of urinary dysfunction may adversely affect social relationships and activities in MS patients. Since many causes of urinary dysfunction are described, a thorough evaluation including history, clinical examination and evaluation of quality of life is necessary. Generally, diagnosis of urinary disorders is complex with intricated pathophysiologic factors. In these cases, urodynamic investigations are necessary to better understand symptoms pathophysiology and choose the best treatment.
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Affiliation(s)
- G Amarenco
- Sorbonne universités, UPMC université Paris-6, GRC n(o) 01 GREEN (Group of Clinical Research in Neuro-Urology), 4, place Jussieu, 75252 Paris cedex 05, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - M de Sèze
- Clinique Saint-Augustin, 114, avenue d'Ares, 33000 Bordeaux, France
| | - A Ruffion
- Service d'urologie, CNRS, Inra, institut de génomique fonctionnelle de Lyon, centre hospitalier Lyon Sud, hospices civils de Lyon, université de Lyon, 69229 Lyon cedex 02, France
| | - S Sheikh Ismael
- Sorbonne universités, UPMC université Paris-6, GRC n(o) 01 GREEN (Group of Clinical Research in Neuro-Urology), 4, place Jussieu, 75252 Paris cedex 05, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Abstract
OBJECTIVES Summarize the data on sexual disorders in women with multiple sclerosis (MS). METHOD Review of 99 Pubmed articles covering sexual dysfunction in women with MS. RESULTS Prevalence of dysfunction in women with MS varies from 34% to 85%. They include poor vaginal lubrication, poor clitoral erection, and anorgasmia, which correlate with level of disability. Specific brain stem and pyramidal lesions appear to correlate with anorgasmia. Age and duration of the disease correlate with sexual disorders, but not age at onset. Secondary consequences of MS, including bladder and bowel dysfunction, spasticity, pain, fatigue, depression, anxiety, and side effects of medication contribute to sexual dysfunction. Treatments can involve alpha-blockers or phosphodiesterase-5 inhibitors to increase smooth muscle relaxation, while lubricants and oestrogen therapy can help vaginal dryness, burning and dyspareunia. Antidepressants can delay (or abolish) orgasm, suggesting reducing dosage or combining them with PDE5 inhibitors. Counselling should emphasize planning sexual activities, reducing fatigue, managing positions, preventing incontinence, promoting sexual aids, extra-genital and other sexual options to achieve pleasurable and intimacy. Psychosocial interventions should include couples' relationship and communication skills to increase satisfaction. CONCLUSION Sexual dysfunctions in women with MS are amenable to treatments covering primary, secondary and tertiary consequences of the disease.
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Affiliation(s)
- D Cordeau
- Department of sexology, université du Québec, CP 8888 succursale centre ville, H3C 3P8 Montreal, Quebec, Canada
| | - F Courtois
- Department of sexology, université du Québec, CP 8888 succursale centre ville, H3C 3P8 Montreal, Quebec, Canada.
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Abstract
Lower urinary tract dysfunction is present in two of three patients with multiple sclerosis five years after the diagnosis. Most frequent symptoms are related to neurogenic detrusor overactivity, often associated with detrusor-sphincter dyssynergia. From the end of the 1990s, there is growing evidence that neurogenic detrusor overactivity can be effectively managed by intradetrusorial injections of botulinum toxin type A. This treatment has shown, in different randomised placebo-controlled trials, to be safe and effective on clinical and urodynamic parameters with significant improvement in quality of life. The median duration of effect is in mean nine months. The vast majority of studies have been conducted with onabotulinumtoxinA. The dose of onabotulinumtoxinA commonly used to treat neurogenic detrusor overactivity in patients with multiple sclerosis is 200 UI, even if in selected patients lower doses can be preferred. To be considered eligible for treatment, all patients should accept and be instructed to perform clean intermittent self-catheterisation, since the risk of increased post-void residual volume and/or urinary retention after injection is high, especially with 200 UI of onabotulinumtoxinA. However, quality of life and patient satisfaction seem not to be affected by the need of intermittent catheterisation. The risk of urinary infection after the procedure is to be kept in mind, mainly in patients with multiple sclerosis, so that adequate antibiotic prophylaxis is highly recommended.
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Affiliation(s)
- B Schurch
- Neurourology, Service of Physical Medicine and Neurorehabilitation, CHU Vaudois, 5, avenue Pierre-Decker, 1011 Lausanne, Switzerland
| | - S Carda
- Neurourology, Service of Physical Medicine and Neurorehabilitation, CHU Vaudois, 5, avenue Pierre-Decker, 1011 Lausanne, Switzerland.
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Denys P, Phe V, Even A, Chartier-Kastler E. Therapeutic strategies of urinary disorders in MS. Practice and algorithms. Ann Phys Rehabil Med 2014; 57:297-301. [PMID: 24958444 DOI: 10.1016/j.rehab.2014.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Review the literature on therapeutic strategies and guidelines for the treatment of neurogenic bladder in multiple sclerosis. MATERIAL AND METHOD A search on available articles on consensus, recommendations guidelines and algorithm of treatment of urinary tract dysfunction in multiple sclerosis. RESULTS Five national consensus guidelines were recently published and proposed guidelines for the first and second line treatments. CONCLUSION Multiple sclerosis patients suffering from lower urinary tract disorders must benefit from an early diagnosis and simple first line evaluation and treatment. More complex and invasive evaluation in the neuro-urology unit is appropriate for patients who failed to first line treatment or in case of complications.
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Affiliation(s)
- P Denys
- Unité de neuro-urologie, service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, université Versailles - Saint-Quentin, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
| | - V Phe
- Service d'urologie, hôpital de la Pitié-Salpêtrière, université Pierre-et-Marie-Curie - Paris 6, 75013 Paris, France
| | - A Even
- Unité de neuro-urologie, service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, université Versailles - Saint-Quentin, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - E Chartier-Kastler
- Service d'urologie, hôpital de la Pitié-Salpêtrière, université Pierre-et-Marie-Curie - Paris 6, 75013 Paris, France
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Andersson KE. Current and future drugs for treatment of MS-associated bladder dysfunction. Ann Phys Rehabil Med 2014; 57:321-8. [PMID: 24954496 DOI: 10.1016/j.rehab.2014.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 11/23/2022]
Abstract
A majority of patients diagnosed with multiple sclerosis (MS) will develop lower urinary tract symptoms (LUTS) during the course of the disease. Even if antimuscarinic (anticholinergic) treatment is currently the mainstay of conservative treatment of neurogenic detrusor overactivity (NDO), including MS-induced NDO, extensive data regarding their effectiveness and safeness are lacking. When antimuscarinic medications fail to prove efficacious, a further option is intradetrusor injections of onabotulinumtoxin A. In several studies, more than half (and up 76%) of the patients treated with onabotulinumtoxin A experienced significant improvement in symptoms or even achieved complete continence. Cannabis extracts have shown some promise but has still not gained wide acceptance as an effective treatment. Over the last few years many new disease-modifying drugs that have been approved and introduced for treatment of MS. These drugs may have effects not only on the MS disease process, but also on the disease symptoms, including LUTS. However, MS is not primarily a bladder disease and treatment of the underlying pathophysiology should be the main goal of treatment. Since most of the urology drugs are targeting LUTS, these drugs should be regarded as "adds on" to treatments modifying the underlying disorder. Considering that most of these drugs have not been studied specifically with respect to efficacy on LUTS, and since they are not without significant side effects, it seems important that if and when they are going to be used for treatment of bladder symptoms should be a joint decision between the neurologist and urologist taking care of the patient.
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de Sèze M, Gamé X. [Multiple sclerosis and pelviperineology: Urinary and sexual dysfunctions and pregnancy]. Prog Urol 2014; 24:483-94. [PMID: 24875567 DOI: 10.1016/j.purol.2014.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 02/23/2014] [Accepted: 02/24/2014] [Indexed: 11/16/2022]
Abstract
GOAL The aim was to review the literature on genito-urinary dysfunction in multiple sclerosis (MS). MATERIAL A literature review through the PubMed library until August, 31 2013 was carried out using the following keywords: multiple sclerosis and neurogenic bladder, neuropathic bladder, bladder, management, follow-up, urological complications, urological treatment, sexual dysfunction, female sexual function, male sexual function, erectile dysfunction, anorectal, faecal, constipation, bowel, pregnancy, parturition, delivery, breast-feeding. RESULTS Genito-urinary dysfunction is frequent in MS (35-90%) and may happen soon in the disease. Urinary symptoms (10-90%) are manifold resulting in a quality of life alteration and the onset of complications in 30% of the cases requiring a long-term follow-up. Sexual dysfunctions (35-87%) are also manifold affecting all the sexuality domains in men and women. Except the phosphodiesterase V inhibitors, few treatments have been assessed in this population. Pregnancy is nowadays considered as beneficial resulting in a disease slow-down and the lack of disease worsening despite an increase in disease relapse during the post-partum first quarter. It seems to be better to consider getting pregnant after at least one year without any relapse and to emphasize an exclusive breast-feeding. CONCLUSION Urinary and sexual dysfunctions are frequent in MS. A transdisciplinary approach including the neurologist and pelviperineology specialists facilitates a disability adapted early management.
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Affiliation(s)
- M de Sèze
- Cabinet de neurourologie, urodynamique et pelvipérinéologie, clinique Saint-Augustin, 33000 Bordeaux, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France.
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Bodiguel E, Bensa C, Brassat D, Laplaud D, Le Page E, Ouallet JC, Zephir H, De Seze J. Multiple sclerosis and pregnancy. Rev Neurol (Paris) 2014; 170:247-65. [PMID: 24684929 DOI: 10.1016/j.neurol.2013.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 07/26/2013] [Accepted: 09/26/2013] [Indexed: 10/25/2022]
Abstract
The question of pregnancy in patients with multiple sclerosis is regularly raised due to the prevalence of the disease in middle age women. The multiple sclerosis think tank (Groupe de Réflexion sur la Sclérose en Plaques [GRESEP]) decided to develop recommendations on this issue, with consideration to both the impact of multiple sclerosis on pregnancy, and that of pregnancy on the disease. As with topics of previous works, the formal expert consensus method was used. The working group was composed of hospital-based and private practice neurologists. The reading group was composed of neurologists, anaesthetists and obstetricians. Each recommendation is presented with the relevant level of consensus.
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Affiliation(s)
- E Bodiguel
- Hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Service de neurologie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École de Médecine, 75270 Paris cedex 06, France.
| | - C Bensa
- Service de neurologie, fondation Rothschild, 25, rue Manin, 75019 Paris, France
| | - D Brassat
- Inserm U1043, pôle des neurosciences, hôpital Purpan, université Toulouse-3, place du Dr-Baylac, BP 3028, 31024 Toulouse cedex 3, France
| | - D Laplaud
- Inserm UMR643, service de neurologie, pavillon Jean-Monnet, hôtel-Dieu, CHU de Nantes, 30, boulevard Jean-Monnet, 44093 Nantes 01, France; Faculté de médecine de Nantes, 1, rue Gaston-Veïl, 44000 Nantes, France
| | - E Le Page
- CIC-P 0203 Inserm, pôle des neurosciences cliniques, CHU Pontchaillou, pavillon Clemenceau, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - J-C Ouallet
- Pôle des neurosciences cliniques, université de Bordeaux Segalen, CHU de Bordeaux Pellegrin Tripode, 1, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - H Zephir
- Pôle de neurologie, hôpital Roger-Salengro, CHRU de Lille, avenue du Pr-Émile-Laine, 59037 Lille, France
| | - J De Seze
- Service de neurologie, laboratoire d'imagerie et de neurosciences cognitives (LINC), CNRS, centre d'investigation clinique (CIC) de Strasbourg, université de Strasbourg, CHU de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
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Gaspard L, Tombal B, Castille Y, Opsomer RJ, Detrembleur C. [Pelvic floor muscles training, electrical stimulation, bladder training and lifestyle interventions to manage lower urinary tract dysfunction in multiple sclerosis: a systematic review]. Prog Urol 2014; 24:222-8. [PMID: 24560290 DOI: 10.1016/j.purol.2013.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 11/22/2022]
Abstract
AIM To assess the effectiveness of conservative therapeutic approaches in a multiple sclerosis population. MATERIAL Review was performed in PubMed, PEDro, Scopus and Cochrane Library using combinations of the following keywords: multiple sclerosis; bladder dysfunction; overactive bladder; detrusor hyperreflexia; urge incontinence; urgency; stress incontinence; pelvic floor muscle; biofeedback; PTNS; tibial nerve; bladder training; physical therapy; physiotherapy; conservative treatment and behavioral therapy. RESULTS Six randomized articles including 289 patients were selected. Four papers exhibited strong scores for the methodological quality assessment. The parameters always significantly improved concerned: number of incontinence episodes (decreased from 64% to 86% after treatment versus before treatment), quality of life (P≤0.001), severity of irritative symptoms (decreased by more than 50% after treatment versus before treatment), and nocturia (P=0.035 to P<0.001). Activities and participation, maximum flow rate, mean voided volume and daytime frequency were not significantly improved in all trials. CONCLUSIONS The physical therapy techniques could be effective for the treatment of urinary disorders in multiple sclerosis populations with mild disability. However, the analyses are based on six studies within only four showed good methodological quality. No strong conclusions regarding treatment approaches can be drawn from this review.
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El Otmani H, Benmansour Y, Araqi-Houssaini A, Benkirane N, Dany F, Abdoh Rafai M, El Moutawakil B, Slassi I. [Paroxysmal dystonia and multiple sclerosis]. Rev Neurol (Paris) 2014; 170:119-23. [PMID: 24267950 DOI: 10.1016/j.neurol.2013.07.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 07/13/2013] [Accepted: 07/18/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Movement disorders are uncommon in multiple sclerosis, except for tremor. Patients rarely have paroxysmal dystonia (or tonic spasm), which can be the presenting manifestation of the disease. OBSERVATIONS Two videotaped observations are presented. The first patient was a 27-year-old woman, treated for relapsing-remitting multiple sclerosis, who presented daily several short (<1minute) paroxysms of right hemibody dystonia. Brain MRI revealed several areas of cerebral demyelination, including the posterior limb of the left internal capsule with gadolinium enhancement. These events disappeared 7 days after corticosteroid infusion. The second patient was a 62-year-old man who presented brief episodes (<1minute) of daily painful left hemibody dystonia. Three months later, similar paroxysms affecting the right hemibody including the face occurred. At times, the two hemibodies were affected simultaneously. The brain MRI showed multiple areas of white matter hyperintensity, including two symmetrical areas in the posterior limb of the internal capsules. Multiple sclerosis was diagnosed on clinical, MRI and biological data. Four days after starting corticosteroids, these paroxysmal phenomena disappeared totally. CONCLUSION Dystonia is an under-recognized aspect of paroxysmal events during multiple sclerosis. It might involve ephaptic transmission among abnormal demyelinated neurons; this ectopic excitation can arise at variable levels of the corticospinal tract, but the analysis of reported cases and those described in this study shows that impairment of the posterior limb of the internal capsule seems to be a prevalent topography. Inflammation is likely to play a role because steroids often improve these phenomena. In this article, we review the clinical aspects, pathophysiology and outcome of paroxysmal dystonia in multiple sclerosis.
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Mosson M, Peter L, Montel S. [Impact of physical activity level on alexithymia and coping strategies in an over-40 multiple sclerosis population: a pilot study]. Rev Neurol (Paris) 2013; 170:19-25. [PMID: 24238784 DOI: 10.1016/j.neurol.2013.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 04/02/2013] [Accepted: 04/17/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the impact of physical activity on alexithymia and coping strategies among people with multiple sclerosis aged over 40. The hypotheses were that physical activity should have a protective effect on alexithymia, and more particularly, on "emotional identification" and could influence coping strategies because it can be considered as a distractive coping strategy. METHODS Thirty-seven patients aged 40 years or older were asked to complete a form including an identification sheet and standardized questionnaires: the Bermond-Vorst Alexithymia Questionnaire (version B), the Coping with Health Injuries and Problem Questionnaire, the Fatigue Impact Scale, and the Hospital Anxiety and Depression Scale. RESULTS The participants with a high or moderate level of physical activity used "information research" as a coping strategy better than those who had a lower level of physical activity. They also analyzed their emotions better. The results revealed an association between these variables and anxiety, depression and fatigue. DISCUSSION This study provides insight for future research about the impact of physical activity on multiple sclerosis.
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Affiliation(s)
- M Mosson
- Département de psychologie, université de Lorraine, site de Metz, Ile-du-Saulcy, BP 30309, 57006 Metz cedex 1, France.
| | - L Peter
- Département de psychologie, université de Lorraine, site de Metz, Ile-du-Saulcy, BP 30309, 57006 Metz cedex 1, France; Laboratoire de psychologie de la santé de Metz, UFR sciences humaines et arts, Ile-du-Saulcy, BP 30309, 57006 Metz cedex 1, France
| | - S Montel
- UFR de psychologie, université de Paris 8, Vincennes-Saint-Denis, 2, rue de la Liberté, 93526 Saint-Denis cedex, France; EA 2027, laboratoire de psychopathologie et de neuropsychologie, université Paris 8, UFR psychologie, 2, rue de la Liberté, 93526 Saint-Denis cedex, France
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Créange A, Lefaucheur JP, Balleyguier MO, Galactéros F. Iron depletion induced by bloodletting and followed by rhEPO administration as a therapeutic strategy in progressive multiple sclerosis: a pilot, open-label study with neurophysiological measurements. Neurophysiol Clin 2013; 43:303-12. [PMID: 24314757 DOI: 10.1016/j.neucli.2013.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/30/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the concept that iron depletion (ID) induced by bloodletting and followed by recombinant human erythropoietin (rhEPO) administration could be a therapeutic strategy in progressive multiple sclerosis (PMS) and that it could be assessed by neurophysiological measurements. PATIENTS AND METHODS In four patients with PMS, bloodletting was performed until ID was induced, and then rhEPO was administered (300 UI/kg/week). The changes induced by the treatment were assessed by clinical scores, biological tests, and neurophysiological study of cortical excitability using transcranial magnetic stimulation techniques. RESULTS The treatment was well tolerated except for muscle cramps and one popliteal vein thrombosis in a patient confined to chair. ID was obtained within 28 weeks and was associated with endogenous production of EPO. No bloodletting was further required during a six-month period after introduction of rhEPO. At the end of the follow-up (up to one year), fatigue and walking capacities tended to improve in two patients. Neurophysiological changes were characterized by an increased cortical excitability, including a decrease of motor thresholds and an enhancement of intracortical facilitation and cerebellothalamocortical inhibition. CONCLUSIONS The combined ID-rhEPO therapy could authorize a prolonged administration of rhEPO in PMS patients, able to modify cortical excitability of the glutamatergic and gabaergic circuits. These preliminary data are encouraging to design a larger, controlled therapeutical trial to assess the value of such a strategy to improve functional symptoms in PMS patients, and maybe to prevent axonal degeneration. Neurophysiological measurements based on cortical excitability studies could provide sensitive parameters to evaluate treatment-induced changes in this context.
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Corlobé A, Renard D, Goizet C, Berger E, Rumbach L, Robinson A, Dupuy D, Touzé E, Zéphir H, Vermersch P, Brochet B, Edan G, Deburghgraeve V, Créange A, Castelnovo G, Cohen M, Lebrun-Frenay C, Boespflug-Tanguy O, Labauge P. [Cavitary lesions in multiple sclerosis: multicenter study on twenty patients]. Rev Neurol (Paris) 2013; 169:965-9. [PMID: 24139243 DOI: 10.1016/j.neurol.2013.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 01/03/2013] [Accepted: 02/04/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Cavitary white matter changes are mainly described in leukodystrophies and especially in vanishing white matter disease. Large cavitary lesions are not typical for multiple sclerosis (MS). METHODS We studied MS patients with large cavitary brain lesions. Patient characteristics, disease onset/duration/subtype, expanded disability status scale (EDSS), mini mental state (MMS), vanishing white matter disease genetic analysis, and MRI characteristics of the cavitary lesions were analyzed. RESULTS Twenty patients were analyzed (6 men and 14 women). Mean age at disease onset was 37.6 (range 17-58). Mean disease duration was 10 years (range 2-20). Five patients had initial relapsing-remitting MS and nine patients had primary-progressive MS. Mean EDSS was 5.5 (range 2-8). Mean MMS was 20/30. Vanishing white matter disease genetic analysis was performed and negative in seven patients. Inferior corpus callosum lesions were seen in all patients with available sagittal FLAIR sequences. Cavitary lesions were strictly supratentorial, and located inside the diffuse leukoencephalopathy, with often a posterior predominance. CONCLUSION MS patients with large cavitary lesions seem to represent a MS subgroup, predominantly women, with relatively late disease onset, predominantly primary-progressive type, relatively high EDSS scores, and severe cognitive dysfunction.
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Affiliation(s)
- A Corlobé
- Service de neurologie, hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
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Edan G. [Is MRI monitoring useful in clinical practice in patients with multiple sclerosis? No]. Rev Neurol (Paris) 2013; 169:864-8. [PMID: 24125462 DOI: 10.1016/j.neurol.2013.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 11/16/2022]
Abstract
Is regular MRI monitoring useful in clinical practice in multiple sclerosis patients treated with disease modifying therapy (DMT) drugs? My answer is no. Tacking a DMT drug is not by itself a pertinent criterion for requiring a systematic MRI monitoring in MS patients. Five clinical criteria should be taken into consideration before prescribing regular MRI examinations. The clinical form of the disease: MRI monitoring in DMT treated patients, has been demonstrated as useful only in pure relapsing-remitting MS patients. Up to now, there is no convincing demonstration of therapeutic efficacy with any DMT drug, neither first-line nor second-line drugs in patients with primary or secondary progressive MS disease. The duration of the disease, epidemiological data leading to the concept of a two-stage disability progression in MS, emphasizes the importance of treating as early as possible RRMS patients in order to stop accumulation of new focal MRI CNS lesions. In this regard, an annual monitoring for the 5 first years of the disease looks reasonable in order to better personalize the treatment choice among the few approved DMT drugs. The duration of the treatment: a first MRI assessment at month 6 after initiating a new DMT drug is adequate in order to better distinguish responder versus no responder. The persistence of Gado+lesions at 6 months is a strong indication for considering alternative treatment. The disease activity: both criteria, clinical and MRI, are needed to recognized very active or aggressive relapsing MS patients, leading to decide a rapid use of second-line treatment therapy. The treatment choice: in JC positive MS patients treated with natalizumab, the risk of PML is as high as more than 1 % in those JC+MS patients that are treated continuously more than 24 months. A regular MRI monitoring (3 or 6months) is recommended in order to detect as early as possible MRI abnormalities suggesting PML.
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Affiliation(s)
- G Edan
- CIC-P 02 03 Inserm, service de neurologie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
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Brochet B. [Is MRI monitoring useful in clinical practice in patients with multiple sclerosis? Yes]. Rev Neurol (Paris) 2013; 169:858-63. [PMID: 24094530 DOI: 10.1016/j.neurol.2013.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
Abstract
The place of magnetic resonance imaging (MRI) in the monitoring of patients with multiple sclerosis (MS) is not codified except during the diagnostic phase. Several studies in the literature have shown that lesion load measured on an MRI done at the beginning of the disease or its increase during the first years had a predictive value, although moderate, on the occurrence of long-term disability as measured by the EDSS. Early worsening of brain atrophy during the early stages of the disease is predictive of worsening cognitive impairment in the following years. Perform an MRI is not required when setting up a first-line disease-modifying therapy (DMT) such as an immunomodulatory treatment but it is useful because it can be used as a reference scan in case of treatment failure. The indications of second-line DMTs, whether prescribed in naive patients with an active disease or after failure of a first-line DMT, are based on combined criteria incorporating MRI data acquired in the previous 3 months compared with a recent MRI. Thus the practical criteria for failure of first-line DMTs are partly based on MRI. During interferon therapy, identification of disease activity on an MRI conducted 1 year after the start of the treatment can predict treatment failure in combination with clinical criteria, such as relapses occurring during the first year. Finally, MRI is essential to the safety monitoring of patients on natalizumab to detect progressive multifocal leukoencephalopathies (PML). In patients at high risk for PML, tested positive for JC virus antibodies and having received natalizumab for more than 2 years, it could be proposed to do a short MRI with FLAIR and diffusion weighted imaging sequences every 3 months to detect preclinical PML.
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Affiliation(s)
- B Brochet
- Service de neurologie, centre hospitalier Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Amarenco G, Raibaut P, Hubeaux K, Jousse M, Sheikh Ismaël S, Lapeyre E. [Autonomic nervous system alteration in multiple sclerosis patients with urinary symptoms. Clinical, urodynamic and cardiovascular study]. Prog Urol 2013; 23:1505-10. [PMID: 24286553 DOI: 10.1016/j.purol.2013.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 06/18/2013] [Accepted: 06/19/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess symptoms related to autonomic nervous system alteration in a population of patients suffering from multiple sclerosis (MS) and presenting with urinary symptoms. PATIENTS AND METHODS We investigated 65 patients (mean age 47.5 years) suffering from MS, and presenting with urological dysfunction by means of symptom scores, urodynamic investigation, cardiovascular autonomic function tests (orthostatic hypotension testing, Valsalva test, deep breath test, cold pressor test) and sympathetic skin responses. RESULTS Forty-five (69%) patients suffered from overactive bladder, 48 (73%) from voiding dysfunction, 14 (21%) from urinary retention and 13 (20%) from fecal incontinence. Urodynamic investigation demonstrated overactive detrusor in 46 (70%) cases, and underactive detrusor in four (6%) cases. Twenty-five (38%) patients had dysautonomia without correlation neither with clinical or urodynamic data, nor gravity of multiple sclerosis (EDSS). CONCLUSION In this series, the prevalence of dysautonomia was high in patients suffering from MS and presenting with urinary disorders.
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Affiliation(s)
- G Amarenco
- GRC 01 UPMC GREEN groupe de recherche clinique en neuro-urologie, service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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