[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

[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

[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

[Ethical issues of new communication and information technologies applied in medicine]

The fast development of New Communication and Information Technologies [NTIC] and their use in increasingly numerous fields in medicine; raised new ethical issues. The aim of this paper is to highlight ethical and deontological guidelines for health professionals and physicians which must guide their use of the NTIC. A research in the Anglophone and French medical literature and on the Internet, using various key words related to ethics and medical computing. Ethical issues are mainly related to the property, the access and the use of the broad data bases of medical records, the legal obligations and ethics which must govern the course of a teleconsultation or a therapeutic remote intervention and the rules which must define the relationship between the teleconsultants and their patients. The use, increasingly frequent, of various expert systems of decision-making and/or of expertise in various clinical settings, also, poses ethical problems relating to the reliability of such systems, the qualifications necessary for their application and the responsibility for their development, maintenance and use. Medical information available on the Internet, of a very unequal and not controlled quality, raises many questions about the responsibility for the medical professionals in the education for the patients and their warning against sometimes erroneous information published on the Web. The ethical rules of research on the Internet must also be clearly formulated and diffused among the researchers. The general principles infront of an ethical problem related to the use of the NTIC remain based on the interest of the patient, the absence of a harmful effect, the respect of the professional secrecy and the safeguarding of the quality of the care and its conformity to the most recent scientific data

Les angiomes veertebraux compressifs: a propos d'un cas

The authors report the case of a 67 years old man with a sub acute thoracic myelopathy complicating a compressive vertebral hemoangioma, involving the fourth vertebral body and posterior arc of the dorsal column. The neurologic presentation was caused by an epidural extension of the vascular malformation. The rarity of such eventuality is emphasized. They describe, owing to a throughout review of the scientific literature, the main neurologic mainfestations of compressive vertebral angiomas and underline the usefulness of tomodensitometry and imaging magnetic resonance [IRM] in the diagnosis and the pre operating assessment of tumor extension. Therapeutic options and prognosis in the course of this pathology are briefly explained

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