[Pathophysiology of complex regional pain syndrome [CRPS] type 1]

If the pathophysiology of complex regional pain syndrome [CRPS] type 1 remains controversial, most authors agree on a combination in varying proportions, a sensitization of peripheral nerves. To describe the state of advances in the physiopathology of complex regional pain syndrome type 1. Bibliographic research and literature review performed by referring to databases [Medline, Science Direct]. The physiopathology of complex regional pain syndrometype 1 remains still poorly understood and controversial. Several arguments demonstrated both peripheral [inflammation, abnormal sympathetic ...] and central [neurological and cognitive] mechanisms. A better knowledge of the physiopathology of complex pain syndrome type 1 is necessary in order to adapt efficient curative therapy or to a better prevention of this syndrome

Childhood occipital epilepsy of gastaut: a case report

Idiopathic childhood occipital epilepsy of Gastaut is a rare but well defined syndrome within the group of idiopathic focal epilepsies in childhood. Clinical manifestations are characterized b simple partial seizures with mainly visual symptoms followed by secondary generalization. Report of a case of Childhood Occipital Epilepsy. We report a case of 10-year-old-girl, with no history. At the age of 9 years, the patient started experiencing repetitive events without fever. The first event consisted of several episodes of loss of consciousness with hypotonia and post ictal amnesia. The second type was three episodes of stereotyped, elaborated complex visual hallucinations, during 10 minutes. One month later, a third type n‚ tonico-clonic generalized seizures appeared. Neurological examination and routine laboratory investigation were normal. Bram neuroimaging was normal. Interictal EEG showed bilateral discharges of slow generalized waves activated by hyperventilation. She has been treated by Sodium Valproate. All seizures stopped and she remained free of seizures. This epileptic syndrome must be identified, and treated without delay. In fact, without appropriate treatment, the evolution may lead to a continuous spike-wave during the sleep with cognitive deterioration

[Neurovascular progress in the dawn of the 21st century]

Development on progress in cerebral vascular pathology. Research on PubMed concerning advances on Neurovascular diseases during the last twenty years. Stroke incidence and prevalence have shown an increase for a few years. High blood pressure [HBP] is well the main risk factor; the implication of tabagism, even passive, and of hormone substitutive therapy were also proven. Vascular and cellular mechanisms are implied in cerebral ischemia. The definition of transient ischemic attack [TIA] is currently based on a lesion criterion, conveying the emergency concept. The physiological rise in blood pressure on stroke early phase must be respected for the majority of patients. Progress of radiological explorations revolutionized stroke's care. Biological markers at the early stage of stroke are under development. New causes of stroke are reported. Stroke Units reduced the morbi-mortality by 50%. The treatment profited from solid clinical trials data and is now more effective. Physical rehabilitation benefitted from new movement and balance evaluation technologies and neuroplasticity concept, for better adapting the patient's rehabilitation. Neuro-vascular research knew a formidable renewed interest during two last decades. Stroke constitutes today a major public health's stake. It is important to organize the stroke channel's care in order to shorten hospitalization'delay, not to harm and carry out urgent clinical and paraclinic expertise for optimal therapeutic choice

[Epilepsy progress in the dawn of the 21st century]

Review of development on recent acquisitions in Epileptology. A research in the medical literature on PubMed and an exhaustive review of the Published summaries and reports of Epileptology International Meetings, in the last five years. We included cohort studies, reviews and randomized double blinded therapeutic trials publications related to the pathogenic, diagnostic and therapeutic advances. Case reports and pure research studies have been excluded. Defective genes and/or physiopathological mechanisms were identified for some clinical forms of epilepsy. New antiepileptics drugs [AED] with a more accurate pathogenic target were, therefore, developed. Modern technologies of cerebral explorations and in particular the MRI [magnetic resonance imagery] and the PET [Positons Emission Tomography] constitute a progress not only for research but also for the diagnostic and therapeutic evaluation in particular for patients candidates to surgery. Five new drugs are on sale, several others are being studied. Diets would be alternatives to the AED in case of intractable epilepsy. Surgery indication is currently extended to the elderly. The global care of epileptic patients implies also the fight against incomprehension and exclusion. The formidable development in epilepsy knowledge in fundamental and in clinical research, is not an exclusive matter of researchers and specialists in this discipline but also with the generalists, the pediatrists and all the professionals of health implicated on epileptic's care; thus allowing an improvement of the prognosis and the quality of life of these patients

[Particularities of epileptic women's care]

Development on the epileptic women's care. A research in the medical literature on PubMed and an exhaustive review of the published summaries and reports of Epileptology International Meetings, in the last five years. We included cohort studies, reviews and randomized double blinded therapeutic trials. Case reports and fundamental research studies have been excluded. Sensitizing of the epileptic women starts with adolescence with an education and a preparation to sexual life and Available contraceptive methods, in order to avoid undesired pregnancies and the serious consequences which they are likely to generate. Approximately 1/3 of the epileptic women have variations of their disease related to the menstrual cycle, probably because of a neurotoxic effect of estrogens [not counterbalanced by progestational hormones]. Antiepileptic teratogenicity issue is not, yet, solved, in spite of new molecules commercialisation. The upkeep of a register concerning the use of AED during pregnancy makes it possible to better identify the problems and to establish an optimal therapeutic control for the mother and the child. Epilepsy impact on women's life is very different compared to men, because it interferes with the fields of sexuality, reproduction, menstrual cycle and contraception, in addition of AED teratogenicity. A close cooperation between Obstetricians and Neurologist and a sensitizing of health professionals are essential for the global care of the epileptic pregnant women or in age of procreation

[Epilepsy surgery program in Tunisia, the Charles Nicolle hospital experience]

Epilepsy surgery is the best treatment in case of intractable epilepsy. However, it is underused in developing countries, creating an enormous treatment gap. On 2006, an epilepsy surgery program was set up in the Neurological Department of Charles Nicolle Hospital, Tunis, Tunisia. To describe its establishment and to emphasize on its originality that is an exchange and surgery decision taken by two Neurological teams via the internet. Patients underwent a phase 1 presurgical evaluation at the Neurological Department of Charles Nicolle Hospital of Tunis. It included a detailed clinical history, a neurological evaluation, brain MRI, a continuous video EEG scalp monitoring and a neuropsychological evaluation. According to the different electro clinical and radiological findings, the surgery indication was taken between the Neurological department of Charles Nicolle Hospital of Tunis and the Neurophysiological Department of Charles Nicolle Hospital in Rouen through the EUMEDCONNECT network project. ATL was performed and the four patients are actually seizure free. Epilepsy surgery is actually a possible treatment option in Tunisia and should be indicated in patients with intractable partial seizures

[Progress in child epilepsy]

Child epilepsy continues to impassion the researchers and the clinicians and carried out these last years of important progress as well in the genetic field, as in physiopathology, clinic and therapeutic one. The identification of new genes of epilepsy, epilepsies related to channelopathy and new phenotypes related to precise genetic mutations, constitutes a major progress of pediatric epilepsy. The debate around the role of febrile convulsions in the development of hippocampal sclerosis is started again thanks to Diffusion MRI techniques. In utero exposure to antiepileptic drugs [AED], and its effects on neurodevelopment, is a very active field of research. An exposure to a polytherapy or to valproate would increase the risk of development delay. The ketogenic diet could be an alternative therapeutic during refractory epilepsies but can have serious consequences on the growth. Temporal lobe surgery is a good therapeutic option for refractory epilepsies of the child and offers, to him, better chances of social integration

[Xeroderma pigmentosum: Cutaneous, ocular, and neurologic abnormalities in 49 Tunisian cases]

This is a retrospective study about 49 cases of xeroderma pigmentosum [XP]. The goal was to determine the clinicalfeatures of XP in Tunisia. Our study revealed the predominance of a moderate form. Malignant skin tumors showed early. Squamous cell carcinoma [SCC] remained the most frequent skin malignancy in all clinical forms. Neurological abnormalities were more frequent in the moderate form. Mental retardation and peripheral neuropathy were the most common signs

Aspect pseudo-polymyositoque d'une sclerose laterale amyotrophique

We present three cases of short-coupled variant of torsade de pointes with review of the literature. These women presented with syncope or presyncope due to torsade de pointes initiated by a short-coupled premature ventricular beat and without evidence of prolonged QT. There were no electrolyte disturbances in all cases, no apparent structural heart disease in two cases and a mild interventricular septum hypertrophy in the other case. One patient took spiramycin and metro nidazole and another was taking pheniramin and lincomycin without any evidence of cause to effect relationship. One patient responded to verapamil but died suddendly after 44 months of follow-up. The two others. Received implantable cardioverter-defibrillators and verapamil per os. They still alive 46 and 54 months later. Short-coupled variant of torsade de pointes have a high incidence of sudden death, so it is very important for physicians to identify and treat it promptly, long-term verapamil treatement is effective but still insufficient and patients should be considered for implantable cardioverter-defibrillator therapy

Arabic melodic and rhythmic therapy

The necessity of a therapy allowing aphasics to be rehabilitated quickly in social life urged us to adapt a therapeutic strategy developed in the USA and implemented in France under 'therapie melodique et rythmee'. This model of language therapy has been destined to aphasics with good auditory comprehension and emotional stability despite severe language impairment. A careful evaluation of the patient is necessary to select the candidates for exposure to this therapy. Our evaluation is based on an examination battery [made of repetition, naming, auditory comprehension], items inspired by the Boston Diagnostic Aphasia Examination and adapted to Tunisian context. This method relies on the prosodic features of Tunisian Arabic [melody patterns, rhythm, pitch, stress '.] and proceeds from non verbal exercises. The latter are realised by a corpus of texts of various length and structure. Applying Arabic melodic and rhythmic therapy allowed patients to recover the capacity to communicate to different degrees with others

Syndrome de Sneddon: Etude d'un cas

The case of a 33 years old woman with recurrent cerebral infarcts leading to demential syndrome and skin abnormalities with livedo racemosa is reported. Acrocyanosis and Raynaud syndrome are eliminated since the livedo is extended to the whole skin. Takayashu disease is eliminated in the absence of arterial murmur or hypertension. Antiphospholipid syndrome is eliminated. Sneddon's syndrome is diagnosed in presence of vascular dementia, livedo, peripheral circulatory troubles, repetitive abortions and valvular cardiopathy