关键词： Neurological disease   Multiple disabilities   Paediatric palliative care  

摘要： How can we associate these entities: neurological disease, multiple disabilities and paediatric palliative care? How can these realities, marked by the hypothetical, the rupture, coexist? How do we do when a crushing reality bursts? When the temporality comes to a standstill, when there is a gap between desire and potentiality, when the symbolization is lacking? These questions and their foundations obviously do not call for an unequivocal answer;multiple fields of reflection and thoughts - philosophical, ethical, social, etc. - are attached to them, which unfortunately cannot be developed here. Instead, in this article, the author takes examples from her clinical practice to try to illustrate that, beyond palliative care, what is at stake, what is at the forefront is the disease and its potentially devastating effects on the bond and meeting with the child. (C) 2018 Elsevier Masson SAS. All rights reserved.

关键词： autoimmune encephalitis   NMDA   history   autoimmune diseases of the nervous system  

摘要： Autoimmune encephalitis is a group of neurological diseases characterized by brain damage by autoantibodies towards extra- or intracellular structures of the nervous system that act as antigens. The combination of neurological and mental disorders, as well as the ability to identify a specific antigen and antibody axis, makes these diseases extremely interesting from the standpoint of molecular psychiatry and the creation of new experimental models of cognitive processes, clinical diagnosis and targeted treatment. However, despite active research in this direction and a large number of specific antibodies, the diagnosis of autoimmune encephalitis is often extremely difficult and can be made only by clinical criteria. This study provides an overview of the available data on the history of discovery and study of autoimmune encephalitis, describes the methods for searching of antibodies that exist today and the further prospects for studying this group of diseases.

关键词： stroke   ethics   capacity   consent   prognostication  

摘要： There are ethical aspects to each of the three phases of cerebrovascular disease: hyperacute management, acute prognostication and management of early complications, and long-term recovery and reintegration with the community. This article addresses ethical concerns pertinent to each phase. First, we discuss ethical issues regarding consent for thrombolysis and endovascular treatment for acute ischemic stroke, including a review of considerations regarding the provision of acute stroke treatment advice over the telephone. Next, we discuss capacity for consent and prognostication after ischemic stroke and intracranial hemorrhage, with a focus on the problems of the self-fulfilling prophecy. Finally, we discuss residual disability and patients' return to driving. Consideration of these ethical dimensions of cerebrovascular disease will assist neurologists in caring for patients and families suffering from this complex condition.

关键词： Palliative care   Early palliative care   Paediatric neurology   Anticipation  

摘要： Purpose - Neurologic and metabolic paediatric departments often deal with children with complex chronic conditions. The main objective of the study was to analyse the requests made to palliative care team in a paediatric hospital. The secondary objectives were to collect the evaluation carried out and the roles of a such team. Material and methods - This was a retrospective study from files from the palliative care team between November 1, 2014 and October 31, 2015. Results - Requests for interventions concerned 32 children. The request at the first call was a global assessment in 24 cases (75%), participation in ethical meetings in 12 cases (37%) and help for terminal palliative symptoms in nine cases (28%). The palliative care team was solicited for nine children, 28% terminally ill and all of whom died. Among these nine children, 6 or 67% were seen for the first time during the first terminal phase intervention. Conclusion - This is a concrete example of acculturation in palliative medicine. We must continue setting up the palliative approach by identifying situations upstream of the terminal phase to better anticipate the different problems of these complex chronic situations. (C) 2018 Published by Elsevier Masson SAS.

关键词： Acenocoumarol   Vitamin K antagonists   Anticoagulation   Atrial fibrillation   Internal Medicine   Neurology   Warfarin  

摘要： Objective: To identify factors associated with poor anticoagulation control with vitamin K antagonists (VKA) among outpatients with nonvalvular atrial fibrillation (NVAF) attended in Neurology and Internal Medicine in Spain. Methods: Cross-sectional and multicenter study, from the ALADIN database, of outpatients with NVAF treated with VKA and attended in Internal Medicine and Neurology in Spain. Rates of anticoagulation control were determined with the direct and Rosendaal methods, considering data from the 6 months before the inclusion. Results: Out of 1,337 patients included in the ALADIN study, 750 were taking VKA, and complete information about INR values in the last 6 months was available in 383 patients. Mean scores of Charlson Index, CHADS(2), CHA(2)DS(2)-VASc and HAS-BLED were 1.94 +/- 1.54;3.10 +/- 1.26;4.63 +/- 1.54, and 2.20 +/- 0.90, respectively. 46.2% and 47.0% of patients had an adequate anticoagulation control according to the direct and Rosendaal methods, respectively. Inadequate anticoagulation control according to the direct method was associated with diabetes (OR: 2.511;95% CI: 1.144-5.659), prior labile INR (OR: 35.371;95% CI: 15.058-83.083) and the determination of > 6 INR controls in the last 6 months (OR: 4.747;95% CI: 2.094-10.759), and according to the Rosendaal method, with prior labile INR (P<.001) and HAS-BLED score (OR: 1991;95% CI: 2.520-6.319). Conclusions: Despite the high thromboembolic risk, only a little more than a half of patients were well controlled. Factors associated with poor anticoagulation control were diabetes, labile INR, > 6 INR controls and HAS-BLED. (C) 2018 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.

关键词： Methoxetamine   Ketamine   Phencyclidine   Dissociative drugs   Behavioral alterations  

摘要： Novel psychoactive substances are intoxicating compounds developed to mimic the effects of well-established drugs of abuse. They are not controlled by the United Nations drug convention and pose serious health concerns worldwide. Among them, the dissociative drug methoxetamine (MXE) is structurally similar to ketamine (KET) and phencyclidine (PCP) and was created to purposely mimic the psychotropic effects of its "parent" compounds. Recent animal studies show that MXE is able to stimulate the mesolimbic dopaminergic transmission and to induce KET-like discriminative and rewarding effects. In light of the renewed interest in KET and PCP analogs, we decided to deepen the investigation of MXE-induced effects by a battery of behavioral tests widely used in studies of "safety-pharmacology" for the preclinical characterization of new molecules. To this purpose, the acute effects of MXE on neurological and sensorimotor functions in mice, including visual, acoustic and tactile responses, thermal and mechanical pain, motor activity and acoustic startle reactivity were evaluated in comparisons with KET and PCP to better appreciate its specificity of action. Cardiorespiratory parameters and blood pressure were also monitored in awake and freely moving animals. Acute systemic administrations of MXE, KET and PCP (0.01-30 mg/kg i.p.) differentially alter neurological and sensorimotor functions in mice depending in a dose-dependent manner specific for each parameter examined. MXE and KET (1 and 30 mg/kg i.p.) and PCP (1 and 10 mg/kg i.p.) also affect significantly cardiorespiratory parameters, systolic and diastolic blood pressure in mice.

关键词： pQCT   image acquisition   neurological impairment   spinal cord injuries   Systematic review  

摘要： In 2015, the International Society for Clinical Densitometry (ISCD) position statement regarding peripheral quantitative computed tomography (pQCT) did not recommend routine use of pQCT, in clinical settings until consistency in image acquisition and analysis protocols are reached, normative studies conducted, and treatment thresholds identified. To date, the lack of consensus-derived recommendations regarding pQCT implementation remains a barrier to implementation of pQCT technology. Thus, based on description of available evidence and literature synthesis, this review recommends the most appropriate pQCT acquisition and analysis protocols for clinical care and research purposes, and recommends specific measures for diagnosis of osteoporosis, assigning fracture risk, and monitoring osteoporosis treatment effectiveness, among patients with neurological impairment. A systematic literature search of MEDLINE, EMBASE, CINAHL, and PubMed for available pQCT studies assessing bone health was carried out from inception to August 8th, 2017. The search was limited to individuals with neurological impairment (spinal cord injury, stroke, and multiple sclerosis) as these groups have rapid and severe regional declines in bone mass. Of 923 references, we identified 69 that met review inclusion criteria. The majority of studies (n = 60) used the Stratec XCT 2000/3000 pQCT scanners as reflected in our evaluation of acquisition and analysis protocols. Overall congruence with the ISCD Official Positions was poor. Only 11% (n = 6) studies met quality reporting criteria for image acquisition and 32% (n = 19) reported their data analysis in a format suitable for reproduction. Therefore, based on current literature synthesis, ISCD position statement standards and the authors' expertise, we propose acquisition and analysis protocols at the radius, tibia, and femur sites using Stratec XCT 2000/3000 pQCT scanners among patients with neurological impairment for clinical and research purposes

关键词： Lupus   Microglia   Neurological degeneration   Synapses  

关键词： Cardiac arrest   Hypothermia induced   Neutrophil-to-lymphocyte ratio   Prognosis  

摘要： Purpose: This study aimed to elucidate the association between the neutrophil-to-lymphocyte ratio (NLR) and neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM). Materials and methods: A retrospective study was performed on patients treated with TTM after OHCA. Patients were divided into two groups according to their calculated NLRs (NCR < 6 and NCR >= 6). The primary outcome was poor neurological outcome at 6 months as defined by a Cerebral Performance Category between 3 and 5. Results: A total of 216 were included and 131 subjects had poor neurological outcomes at 6 months. In the univariate model, NLRs >= 6 at 48 and 72 h after ROSC were associated with poor neurological outcomes (OR: 3.716, 95% CI: 1.243-11.114;OR: 7.429, 95% CI: 3.693-14.945, respectively). In the multivariate logistic regression analysis, an NLR >= 6 at 72 h was associated with poor neurological outcomes after adjusting for history of HIM shockable rhythm, cardiac cause of arrest and time from collapse to ROSC and highest WBC, hs-CRP, lactate and pneumonia (OR = 3299, 95% CI = 1.080-10.081). Conclusions: An NLR >= 6 at 72 h after the ROSC is associated with poor neurological outcomes at 6 months after CA. (C) 2018 Elsevier Inc. All rights reserved.

关键词： Electroencephalography   ictogenesis   pathogenesis   Sturge-Weber syndrome   transient neurological symptoms  

摘要： Although transient neurological deficits in Sturge-Weber syndrome (SWS) have been acknowledged for many years, the underlying pathogenesis still constitutes a major topic of discussion. Here, we present the case of a 10-year-old boy with SWS presenting with a progressive clinically mimicking right middle cerebral artery syndrome. Cranial magnetic resonance imaging showed unremarkable findings except extensive right hemisphere leptomeningeal angiomas. Antiepileptic drug (AED) treatments provided recovery of the patient, and concurrently recorded electroencephalography (EEG) revealed delta slowing of the lesional hemisphere in the acute period. However, slowing of the background activity extended to the contralateral hemisphere in subacute period, while ipsilateral background activity started to recover. In the 3rd week of follow-up on intensive AED treatments, the patient totally recovered as well as nearly the normalization of EEG was achieved. In this report, we focus on the dramatic revolution of EEG activity in both hemispheres during the recovery period. Based on this rare illustration and limited literature data, the author suggests some hypotheses regarding the pathophysiology of this mysterious manifestation (transient neurological deficit) in SWS. Future studies of large case series, including detailed paraclinical parameters and remarkably electrophysiological data, are warranted to clarify these arguments.