Cyclosporine A plus low-dose steroid treatment in COVID-19 improves clinical outcomes in patients with moderate to severe disease: A pilot study.

BACKGROUND: COVID-19 pandemic causes high global morbidity and mortality and better medical treatments to reduce mortality are needed. OBJECTIVE: To determine the added benefit of cyclosporine A (CsA), to low-dose steroid treatment, in patients with COVID-19. METHODS: Open-label, non randomized pilot study of patients with confirmed infection of SARS-CoV-2 hospitalized from April to May 2020 at a single centre in Puebla, Mexico. Patients were assigned to receive either steroids or CsA plus steroids. Pneumonia severity was assessed by clinical, laboratory, and lung tomography. The death rate was evaluated at 28 days. RESULTS: A total of 209 adult patients were studied, 105 received CsA plus steroids (age 55.3 ± 13.3; 69% men), and 104 steroids alone (age 54.06 ± 13.8; 61% men). All patients received clarithromycin, enoxaparin and methylprednisolone or prednisone up to 10 days. Patient's death was associated with hypertension (RR = 3.5) and diabetes (RR = 2.3). Mortality was 22 and 35% for CsA and control groups (P = 0.02), respectively, for all patients, and 24 and 48.5% for patients with moderate to severe disease (P = 0.001). Higher cumulative clinical improvement was seen for the CsA group (Nelson Aalen curve, P = 0.001, log-rank test) in moderate to severe patients. The Cox proportional hazard analysis showed the highest HR improvement value of 2.15 (1.39-3.34, 95%CI, P = 0.0005) for CsA treatment in moderate to severe patients, and HR = 1.95 (1.35-2.83, 95%CI, P = 0.0003) for all patients. CONCLUSION: CsA used as an adjuvant to steroid treatment for COVID-19 patients showed to improve outcomes and reduce mortality, mainly in those with moderate to severe disease. Further investigation through controlled clinical trials is warranted.

Resultados sobre la aplicación cráneo-facial del parche de capsaicina 8 % en una serie de 5 casos / Results of the capsaicin 8% patch in craniofacial application in five clinical cases

Los parches de capsaicina al 8 % son una alternativa de segunda línea para el tratamiento del dolor neuropático periférico. Aunque tiene pocos efectos secundarios, no tiene indicación para el tratamiento cráneo-facial debido a la posible irritación de mucosas por la capsaicina. Sólo hemos encontrado tres publicaciones que refieren la aplicación del parche en estas localizaciones, describiendo 7 casos clínicos. Hemos recogido 4 casos en los que se realizan 5 aplicaciones en total, 3 mujeres (repitiendo aplicación en una de ellas) y 1 hombre, entre 58 y 84 años, con los siguientes diagnósticos: necrosis cáustica en labio inferior tras limpieza dental, neuralgia del trigémino y neuropatía postherpética. Tras comprobar ineficacia de otros tratamientos, se propuso el parche de capsaicina al 8 %, con firma previa de los consentimientos informados de la aplicación de parche en régimen de hospital de día y de tratamiento fuera de ficha técnica. Previamente a la aplicación del parche en la zona cutánea dolorosa, se procedió a realizar protección ocular de ambos ojos con parche oftálmico quirúrgico, y de mucosas oral y nasal con mascarilla facial quirúrgica sellada. La protección se mantuvo durante toda la aplicación del parche y se quitó una vez retirado éste y limpiada la zona de aplicación. Únicamente se reportaron 3 efectos secundarios leves del total de las 5 aplicaciones: un paciente presentó piel eritematosa que cedió espontáneamente, otra paciente refirió sensación de quemazón y dolor que cedió con analgesia endovenosa, y otra paciente explicó dolor leve bien tolerado, que cedió de manera espontánea. En ninguno de los casos se apreciaron efectos secundarios a nivel de mucosas. En cuanto a resultados, dos pacientes notaron mejoría durante uno y dos meses, colocando nuevamente el parche en una de ellas, sin lograr esta segunda vez alivio. Las otras dos pacientes no notaron ningún cambio. El tratamiento con parches de capsaicina 8 % en superficies cráneo-faciales parece tener similar eficacia a su aplicación en otras áreas de la piel. Los efectos secundarios en su aplicación en estas superficies son escasos, al igual que en otras aplicaciones corporales. Creemos que con las medidas de precaución adecuadas en las regiones cráneo-faciales, la utilidad clínica observada del parche de capsaicina 8 % lo sitúa como otra opción de tratamiento para dolor neuropático, sin complicaciones añadidas. No obstante, estudios clínicos con mayor número de pacientes deberían llevarse a cabo para confirmar estos hallazgos (AU)

The capsaicin 8 % patch is a secondary line alternative to neuropathic peripheral pain treatment. Although it has few secondary effects, is not indicated in head and facial treatment due to the possibility of the irritation of mucosa. We have only found three publications related with the patch application in those locations, describing 7 clinical cases. We have analyzed 4 cases in which we have applied 5 patches in total. There were 3 women (repeating the application in one of them) and 1 man, between 58 and 84 years old, with the following diagnosis: caustic necrosis in the inferior lip after dental cleaning, trigeminal neuralgia and post-herpetic neuropathy. Inefficacy of other treatments was confirmed, and after that, the capsaicin 8 % patch was proposed. Informed consent of the application of the patch at day clinic and treatment out of technical data sheet were previously signed. Before the patch was applied to the painful cutaneous area, we proceed with ocular protection of both eyes with surgical ophthalmic patch and oral and nasal mucosa protection with surgical mask hermetically seal. That protection was maintained during the whole application of the patch, and was removed once the capsaicin patch was taken off and the application area was cleaned. There were only 3 mild secondary effects of the total 5 applications: one patient showed erythematic skin that was resolved spontaneously, another patient related burn and pain sensation which was solved with endovenous analgesia. Finally, another patient explained mild pain well tolerated, that was resolved also spontaneously. In no cases there were secondary effects in mucosa. Related with the results, 2 patients felt improvement between one and two months, applying again the patch in one of them, not reaching this time relief in the pain. The other 2 patients did not notice any change. The capsaicin 8 % patch treatment in head and facial areas seems to have similar efficacy as the application in other skin areas. Secondary effects in these surfaces are very low, the same as in other corporal locations. We believe that with the adequate preventive measures in head and facial areas, clinical utility observed with capsaicin 8 % patch places it as another treatment option for neuropathic pain, with no complications added. However, clinical studies with a higher number of patients should carry on to confirm these findings (AU)

Neuroplasticity of ascending and descending pathways after somatosensory system injury: reviewing knowledge to identify neuropathic pain therapeutic targets.

STUDY DESIGN: This is a narrative review of the literature. OBJECTIVES: This review aims to be useful in identifying therapeutic targets. It focuses on the molecular and biochemical neuroplasticity changes that occur in the somatosensory system, including ascending and descending pathways, during the development of neuropathic pain. Furthermore, it highlights the latest experimental strategies, based on the changes reported in the damaged nociceptive neurons during neuropathic pain states. SETTING: This study was conducted in Girona, Catalonia, Spain. METHODS: A MEDLINE search was performed using the following terms: descending pain pathways; ascending pain pathways; central sensitization; molecular pain; and neuropathic pain pharmacological treatment. RESULTS AND CONCLUSION: Neuropathic pain triggered by traumatic lesions leads to sensitization and hyperexcitability of nociceptors and projection neurons of the dorsal horn, a strengthening in the descendent excitatory pathway and an inhibition of the descending inhibitory pathway of pain. These functional events are associated with molecular plastic changes such as overexpression of voltage-gated ion channels, algogen-sensitive receptors and synthesis of several neurotransmitters. Molecular studies on the plastic changes in the nociceptive somatosensory system enable the development of new pharmacological treatments against neuropathic pain, with higher specificity and effectiveness than classical drug treatments. Although research efforts have already focused on these aspects, additional research may be necessary to further explore the potential therapeutic targets in neuropathic pain involved in the neuroplasticity changes of neuropathological pathways from the injured somatosensory system.

Epigallocatechin-3-gallate treatment reduces thermal hyperalgesia after spinal cord injury by down-regulating RhoA expression in mice.

BACKGROUND: (-)-Epigallocatechin-3-gallate (EGCG) is the major polyphenolic constituent found in green tea. It has been reported that may be a natural agent for reducing thermal and mechanical pain after nervous system injuries. However, the molecular pathways implicated in these beneficial effects have not been completely elucidated. This study aimed to assess the EGCG treatment effects on thermal hyperalgesia, spinal cord gliosis and modulation of Ras homologue gene family member A (RhoA), fatty acid synthase (FASN) and tumour necrosis factor alpha (TNF-α) expression after spinal cord contusion in mice. METHODS: Animals were subjected to a spinal cord contusion. Thirty minutes after contusion and daily during the first week post-surgery, animals were treated with EGCG or dimethyl sulfoxide-saline (DMSO-saline). At 7 and 14 days post-operation, motor recovery was evaluated using the Basso Mouse Scale, and nociceptive response was evaluated using the Hargreaves test. Furthermore, at 14 days, the expression of RhoA, FASN and TNF-α proteins was quantified in the lesion site of spinal cord by Western blot technique. Finally, spinal cord samples were processed by immunohistochemical techniques for observing astrocytes, microglia and afferent nerve fibres. RESULTS: At short time, EGCG treatment reduced significantly thermal hyperalgesia but had no effect on locomotor recovery in spinal cord injured mice. Furthermore, EGCG treatment down-regulated the RhoA, FASN and TNF-α proteins expression, and decreased astro- and microglia reactivity in spinal cord. CONCLUSION: These findings suggest that at short time EGCG treatment reduces thermal hyperalgesia and gliosis via FASN and RhoA pathway, causing a decrease in cytokines in spinal cord.

Schwann cell targeting via intrasciatic injection of AAV8 as gene therapy strategy for peripheral nerve regeneration.

Efficient transduction of the peripheral nervous system (PNS) is required for gene therapy of acquired and inherited neuropathies, neuromuscular diseases and for pain treatment. We have characterized the tropism and transduction efficiency of different adeno-associated vectors (AAV) pseudotypes after sciatic nerve injection in the mouse. Among the pseudotypes tested, AAV2/1 transduced both Schwann cells and neurons, AAV2/2 infected only sensory neurons and AAV2/8 preferentially transduced Schwann cells. AAV2/8 expression in the sciatic nerve was detected up to 10 weeks after administration, the latest time point analyzed. The injected mice developed neutralizing antibodies against all AAVs tested; the titers were higher against AAV2/1 than AAV2/2 and were the lowest for AAV2/8, correlating with a higher transgene expression overtime. AAV2/8 coding for ciliary neurotrophic factor (CNTF) led to an upregulation of P0 and PMP22 myelin proteins, four weeks after transduction of injured sciatic nerves. Importantly, CNTF-transduced mice showed a significant increase in both GAP43 expression in sensory neurons, a marker of axonal regeneration, and the compound muscle action potential. These results prove the utility of AAV8 as a gene therapy vector for Schwann cells to treat myelin disorders or to improve nerve regeneration.

Dolor nocioceptivo, dolor neuropático y memoria de dolor / Nocioceptive pain, neuropathic pain and pain memory

Introducción. El dolor es una evaluación cognitiva y su traducción en las nuevas técnicas de imagen funcional ha despertado un gran interés. El dolor nocioceptivo, habitualmente agudo o persistente, tiene como función alejar al animal del daño. Desarrollo. El dolor crónico constituye una enfermedad por sí mismo y es debido a fenómenos de sensibilización y de memoria de dolor con una marcada relación en los aspectos emocionales. El dolor neuropático es un síntoma neurológico debido a una disfunción en el sistema somatosensorial en el que intervienen fenómenos de generación ectópica de impulsos, hiperexcitabilidad axonal y sináptica y secundariamente instauración de fenómenos de sensibilización central y memoria. Conclusión. El tratamiento del dolor debe ser orientado a partir de su fisiopatología. Las unidades de dolor, entrenadas en el tratamiento analgésico y en técnicas relativamente invasivas, son habitualmente muy eficaces en el tratamiento del dolor agudo nocioceptivo. El dolor neuropático debe tener un enfoque principalmente neurológico, tanto en el diagnóstico como en el tratamiento. El dolor crónico por memoria de dolor debe interesar a los neurólogos cada vez más a medida que se conozcan mejor los mecanismos cerebrales de la cognición. de los ensayos terapéuticos (AU)

Introduction. Pain is a cognitive evaluation. Its appearance in the new functional image systems is promising. Nocioceptive pain, usually acute or persistent, is useful to prevent animals from getting injured. Discussion. Chronic pain is disease per se: It is due to a sensitisation phenomena and pain memory with an important relationship with emotions. Neuropathic pain is a neurological symptom due to a somatosensorial system dysfunction. In this case, axonal ectopic generation of impulses and synaptic hyperexcitability occurs. In persistent cases, sensitisation phenomenon and memory of pain appear together with neuropathic pain. Conclusions. Pain treatment should be physiopathologicaly orientated. Pain units, specialized in analgesic treatment and some invasive techniques, are usually competent in the treatment of nocioceptive pain. Neuropathic pain should have a neurologic diagnosis and treatment. But neurologist need to be more and more interested in the chronic pain related with memory and sensitisation: better knowledge of the cerebral mechanisms in this phenomenon can add to this pathology in our field (AU)

Linfangioma quístico sin otras anomalías asociadas / Cystic lymphangioma without associated anomalies

El higroma, o linfangioma quístico, se debe a una anomalía del sistema linfático producida por la obstrucción del drenaje de los sacos linfáticos cervicales al sistema venoso yugular. Habitualmente se localiza en la región cervical posterior o posterolateral y contiene múltiples tabiques. Entre el 20 y el 40% de los casos se asocia a normalidad cromosómica; el resto de los casos se asocia a diversas aneuplodías o malformaciones. El diagnóstico diferencial incluye edema nucal, meningocele, encefalocele, teratoma cervical, seudomembranas, hemangioma y quiste placentario subcorial.Su incidencia es de uno cada 1.775 a 6.000 nacidos vivos. La tasa de aneuploidía asociada al linfangioma quístico diagnosticado prenatalmente es del 45 al 60% (principalmente síndrome de Turner y síndrome de Down). También se ha observado asociación a otros síndromes polimalformativos. El resultado fetal es incierto y varía según los estudios revisados.A continuación se presenta el caso de un linfangioma quístico inusual por varios motivos: su gran tamaño, la ausencia de otras anomalías morfológicas y de aneuploidías, la joven edad de la madre y el desarrollo morfológico posnatal normal (AU)

Hygroma or cystic lymphangioma is due to an obstruction of jugular lymph sac drainage to the jugular venous system. The most common localization is the posterolateral neck region. These lesions are usually multiseptated. Between 20% and 40% of affected individuals have a normal karyotype and the remainder show diverse aneuploidies and/or malformations. The differential diagnosis includes nuchal edema, meningocele, encephalocele, cervical teratoma, pseudomembranes, hemangioma and subchorial placental cyst.The incidence of cystic lymphangioma has been reported to be 1/6,000–1,775 live-newborns. The rate of aneuploidy associated with prenatally diagnosed cases are between 45% and 60% (mainly Turner and Down syndromes). Some cases are associated with other polymalformation syndromes. Fetal outcome is uncertain and differs among studies.We present the case of a fetal cystic lymphangioma that is unusual for several reasons: its huge size, the absence of any other morphological abnormalities and aneuploidies, the young age of the mother, and the normal morphological postnatal growth (AU)

[Treatment of neuropathic pain in neurology units. The PREVADOL study]. / Tratamiento del dolor neuropático en las consultas de neurología. Estudio PREVADOL.

INTRODUCTION: Neuropathic pain (NPP) is defined as a pain started or caused by an injury to or dysfunction of the nervous system. Its treatment is different to that of nociceptive pain since it does not respond to conventional analgesics or non-steroidal antiinflammatory drugs. AIM: To describe the treatment being received by patients with NPP in the daily clinical practice of the specialist in neurology. PATIENTS AND METHODS: An observational, epidemiological, cross-sectional study was conducted in 36 neurology units (24 extra-hospital and 12 belonging to hospitals). We collected the clinical data and the treatment administered to the first 20 patients with NPP to visit the neurology units over a period of 20 consecutive working days. RESULTS: Data were collected for a total of 451 patients with NPP. The pharmacological groups most frequently used in patients with NPP attended in neurology units are antiepileptics (71%) and antidepressants (15%). Of these patients, 60% were being treated with a single drug (an antiepileptic agent in 84.5% of cases; antidepressants in 10.3%). Two pharmacological treatments were being received by 23.7%, and 2.3% of patients were given treatment involving three or more pharmacological agents. A total of 30% received non-pharmacological treatments, especially physiotherapy (50.4%). CONCLUSIONS: Most patients with NPP attended in neurology units follow first-order pharmacological treatments (antiepileptics or antidepressants). Over half the patients are controlled with monotherapy, usually with an antiepileptic agent. Non-pharmacological treatments (especially physiotherapy) are used in a third of the patients.

[Epidemiological study of prevalence, incidence and neuropathic pain characterization in neurology units. PREVADOL study]. / Estudio de prevalencia, incidencia y caracterización del dolor neuropático en consultas de neurología. Estudio PREVADOL.

INTRODUCTION: Neuropathic pain is defined as a pain initiated or caused by a lesion or dysfunction in the nervous system. The objectives of the study were to estimate the prevalence and incidence of neuropathic pain in hospital neurology units and primary care centres, to characterize the clinical profile of the patient with neuropathic pain and to know the most frequent treatments in the pharmacological management of this type of pain. METHODS: Observational, cross-sectional epidemiological survey carried out in 36 Neurology Units of the national territory (24 primary care centres and 12 hospitals). During 20 consecutive days neurologists collected the diagnoses of all the attended patients by any reason, up to 30 patients/day. In parallel the 20 first consecutive patients with neuropathic pain were chosen for their characterization in depth by means of a specific questionnaire. RESULTS: A total of 12,688 patients were attended and a total of 13,555 diagnoses were collected through 713 consultation days. The most frequent diagnosis was migraine/cephalea, with a prevalence of 23.40% (95% CI: 22.66%-24.14%). Neuropathic pain represented the eighth more frequent diagnosis, with a prevalence in neurology units of 3.88% (95% CI: 3.54%- 4.22%). The prevalence of neuropathic pain was 2.92% in primary care centres and 6.09% in hospital units (p < 0.01). The daily incidence of new neuropathic pain cases was 1.24% (95% CI: 1.05%-1.53%); 1.14% in primary care neurology centres and 1.45% in hospital units. CONCLUSIONS: The data obtained indicate that neuropathic pain is the eighth more frequent diagnosis in the neurology units. Medical assistance request by neuropathic pain is higher in the hospital units.

Estudio de prevalencia, incidencia y caracterización del dolor neuropático en consultas de neurología. Estudio PREVADOL / Epidemiological study of prevalence, incidence and neuropathic pain characterization in neurology units. PREVADOL study

Introducción. El dolor neuropático (DNP) se define como un dolor iniciado o causado por una lesión o disfunción del sistema nervioso. Los objetivos del estudio fueron estimar la prevalencia e incidencia de DNP en consultas de neurología hospitalarias y extrahospitalarias, caracterizar el perfil del paciente con DNP y conocer los tratamientos más utilizados en el manejo farmacológico de este tipo de dolor. Métodos. Se realizó un estudio observacional, epidemiológico y transversal, en 36 consultas de neurología del territorio nacional (24 extrahospitalarias y 12 hospitalarias). Durante 20 días consecutivos se recogieron los diagnósticos de los pacientes que acudieron a consulta por cualquier motivo, hasta un máximo de 30 pacientes/día. Paralelamente se eligieron los primeros 20 pacientes consecutivos que presentaban DNP, para su caracterización en profundidad mediante un cuestionario específico. Resultados. Se recogieron 13.555 diagnósticos de un total de 12.688 pacientes atendidos en 713 días de consulta. El diagnóstico más frecuente fue migrañas/cefaleas, con una prevalencia del 23,40% (IC 95%: 22,66-24,14%). El DNP representó el octavo diagnóstico más frecuente, con una prevalencia en consultas de neurología del 3,88 % (lC 95 %: 3,544,22%). La prevalencia de DNP fue del 2,92 % en consultas extrahospitalarias y del 6,09 % en consultas hospitalarias (p < 0,01). La incidencia diaria de casos nuevos de DNP se situó en el 1,24% (lC 95%: 1,05-1,53 %); 1,14% en consultas de neurología extrahospitalarias y 1,45% en consultas hospitalarias. Conclusiones. Los datos obtenidos indican que el DNP es el octavo diagnóstico más frecuente en las consultas de neurología. La demanda asistencial por DNP es más elevada en las consultas hospitalarias

Introduction. Neuropathic pain is defined as a pain initiated or caused by a lesion or dysfunction in the nervous system. The objectives of the study were to estimate the prevalence and incidence of neuropathic pain in hospital neurology units and primary care centres, to characterize the clinical profile of the patient with neuropathic pain and to know the most frequent treatments in the pharmacological management of this type of pain. Methods. Observational, cross-sectional epidemiological survey carried out in 36 Neurology Units of the national territory (24 primary care centres and 12 hospitals). During 20 consecutive days neurologists collected the diagnoses of all the attended patients by any reason, up to 30 patients/day. In parallel the 20 first consecutive patients with neuropathic pain were chosen for their characterization in depth by means of a specific questionnaire. Results. A total of 12,688 patients were attended and a total of 13,555 diagnoses were collected through 713 consultation days. The most frequent diagnosis was migraine/cephalea, with a prevalence of 23.40 % (95 % Cl: 22.66 %-24.14 %). Neuropathic pain represented the eighth more frequent diagnosis, with a prevalence in neurology units of 3.88 O/o (95 % CI: 3.540/04.22 %). The prevalence of neuropathic pain was 2.92 % in primary care centres and 6.09 % in hospital units (p < 0.01). The daily incidence of new neuropathic pain cases was 1.24 % (95 % CI: 1.05 %-1.53 %); 1.14 % in primary care neurology centres and 1.45 % in hospital units. Conclusions. The data obtained indicate that neuropathic pain is the eighth more frequent diagnosis in the neurology units. Medical assistance request by neuropathic pain is higher in the hospital units

[Clinical analysis of musicians' focal hand dystonia. Review of 86 cases]. / Análisis clínico de la distonía focal en los músicos. Revisión de 86 casos.

INTRODUCTION: Focal hand dystonia in musicians due to its rareness and specificity. It has been insufficiently described thus remaining a largely unknown condition. OBJECTIVE: To describe the clinical characteristics of musician's focal dystonia. METHODS AND RESULTS: We analyzed 658 musicians' cases seen during the past 4 years in a medical center for performing artists. Of the musicians treated, 86 (13 %) suffered from focal dystonia, 42 % were guitarists, 21% pianists and 6% violinists. Men were more affected than women (7:1). Sufferers reported longer practice times (4.8 hours per day) and were older (33.6 years). In comparison, other pathologies were seen when musicians were younger (26.5 years) and played no more than 3.5 hours per day. CONCLUSIONS: Focal dystonia in musicians appear to be the consequence of a long history of intense and repetitive manual work while playing music added to other factors, as for example, gender.

Análisis clínico de la distonía focal en los músicos. Revisión de 86 casos / Clinical analysis of musicians' focal hand dystonia. Review of 86 cases

Introducción. La distonía focal en el músico, por su ra¬reza y especificidad, ha sido descrita insuficientemente y, por tanto, es poco conocida.Objetivo. Describir las características clínicas de la distonía focal en los músicos.Métodos y resultados. Se analizan los 658 músicos atendidos en un centro especializado en la atención de artistas escénicos durante 4 años. De éstos, 86 fueron diagnosticados de distonía focal (13 %). Como factores de riesgo para la distonía se identifican el hecho de tocar la guitarra (representa el 42 % de los casos, seguido del piano con 21 % y el violín 6 %), ser varón (proporción: 7:1) y haber acumulado una cantidad de horas de ensayo superior a la mediana (la distonía aparece en músicos de 33,6 años de edad media que tocan 4,8 h diarias, mientras que otras patologías se presentan a los 26,5 años en músicos que tocan 3,5 h al día en nuestra muestra).Conclusiones. La distonía focal en el músico parece la consecuencia de un trabajo manual repetitivo, intenso y refinado realizado durante muchos años sobre el instrumento musical a lo que se añadirían otros factores como, por ejemplo, el sexo

Introduction. Focal hand dystonia in musicians due to its rareness and specificity. It has been insufficiently described thus remaining a largely unknown condition.Objective. Io describe the clinical characteristics of musician's focal dystonia.Methods and results. We analyzed 658 musicians' cases seen during the past 4 years in a medical center for performing artists. Of the musicians treated, 86 (13 %) suffered from focal dystonia, 42 % were guitarist, 210/0 pianists and 6 % violinists. Men were more affected than women (7:1). Sufferers reported longer practice times (4.8 hours per day) and were older (33.6 years). In comparison, other pathologies were seen when musicians were younger (26.5 years) and played no more than 3.5 hours per day.Conclusions. Focal dystonia in musicians appear to be the consequence of a long history of intense and repe¬titive manual work while playing music added to other factors, as for example, gender

[Sphincter function disorders. physiopathology and neurophysiological study]. / Trastornos de la funcion esfinteriana. Fisiopatología y estudio neurofisiológico.

Miction and defecation disturbances are very frequent in the general population and far more so among neurological patients. It is essential to know the physiopathology of these disorders in clinical practice. The neurological control of these functions is carried out by automatisms that are regulated in the nuclei of the brain stem through somatic and vegetative peripheral structures that act simultaneously. The cortical, hypothalamic and reticular levels play a part in the activation or inhibition of the pontine nuclei. Continence depends on the integrity of the anatomical structures and the sensory, pressure and mechanical systems that enable the automatisms to develop. Neurological examination must be combined with studies conducted by other specialists on patients in which no neurological illness is known, but who have this kind of dysfunction. Adding a neurophysiological examination allows us to complete the clinical study and to check objectively for the existence of external anal sphincter denervation or disorders involving the exteroceptive reflexes of the sacrum. The recent appearance of techniques for treating incontinence that make use of the repeated and continuous stimulation of the sacral roots has revolutionised the way these patients are treated and calls for greater involvement of neurologists in dealing with these problems.

[Congenital neuromyotonia. Retrospective study of 4 cases]. / Neuromiotonía congénita. Estudio retrospectivo de cuatro casos.

BACKGROUND: Fasciculation, double discharge, myokymia and neuromyotonia are different kinds of involuntary muscular activity that originate in ectopic discharges of the motor axons. Electrophysiological studies are needed in all cases for the diagnosis. Non rigorous electrophysiological studies in some cases is the cause of the historically unclear nosological delimitation of the neuromyotonic syndromes. OBJECTIVE: To report the clinical picture and electrophysiological findings in patients with congenital neuromyotonia. PATIENTS AND METHODS: Four patients with congenital neuromyotonia were studied. Electrophysiological exam included nerve conduction measurements, study of the after-discharges and conventional EMG. Spontaneous discharges were displayed after applying a low pass filter, signal trigger and delay line. RESULTS: In one case positive motor features predominate (continuous muscle fiber activity). On the contrary, two cases, showed neuropathic deficitary signs with a Charcot-Marie-Tooth type II disease phenotype; neuromyotonia was, in both cases, an electrophysiological feature. In the last patient, motor signs were limited to the facial muscles but electrophysiological study discovered generalized neuromyotonia. Treatment with carbamazepine or oxcarbazepine was useful in the four cases. CONCLUSION: Congenital neuromyotonia is a clinically heterogeneous syndrome with uniform electrophysiological features that permit its qualification.

[Treatment of Guillain-barre syndrome: immunoglobulins or plasmapheresis?]. / Tratamiento del síndrome de Guillain-Barré: inmunoglobulinas o plasmaféresis?

The aim of this study was to compare the efficacy of IgIV versus plasmapheresis in the treatment of Guillain-Barré syndrome. Twenty-four Guillain-Barré patients were treated either with IgIV (n = 17), or plasmapheresis (n = 7). Evolution during the first year after onset were assessed using the motor functional scale of Hughes and nerve conduction studies. IgIV treated patients had better functional recovery than the plasmapheresis group (p < 0.05) and shorter hospital stays (p < 0.05). These differences were significant from day 30 after treatment. Complications occurred in 14 patients: 9 (58%) in the IgIV group, and 5 (71%) in the patients treated with plasmapheresis. IgIV treated patients had better functional recovery scores and shorter hospital stays. There were no differences in the complication rates. Therefore we believe that IgIV is the treatment of choice for Guillain-Barré syndrome in our clinical setting.

[A program of quality improvement in transfusion safety. Experience at Saint-Camille Hospital]. / Programme d'amélioration de la qualité en sécurité transfusionnelle. L'expérience de l'hôpital Saint-Camille.

A program of quality improvement of blood transfusion safety was carried out in St Camille Hospital after a call for tenders had been jointly issued by the French Ministry of Health and the French Agency for Medical Evaluation (ANDEM). The blood transfusion process was analysed and a diagnosis of the situation was performed. Improvement actions were then undertaken to control the blood transfusion process. They consisted in education programs, elaboration of procedures and documents such as a transfusion record and a transfusion manual. The effectiveness of the actions was measured using indicators. Such a quality improvement approach revealed to be a good method to manage the blood transfusion process and to improve safety. However, it requires people's involvement in the project, and rigorous project management.

[Electroneurographic parameters in cubital neuropathy of the elbow]. / Diferentes parámetros electroneurográficos en la neuropatía cubital en el codo. Interés de la conducción sensitiva antidrómica.

Using conventional techniques with cutaneous electrodes, 14 parameters of antidromic, motor and mixed segmentary sensory conduction of the cubital nerve were assessed in the first 45 patients presenting to us with some form of electroneurographic abnormality. Changes suggestive of axonal degeneration due to a decrease in amplitude or conduction velocity of the distal segment were found in 17. The remaining 28 patients showed only signs of change in conduction velocity at the elbow and could be classified according to electroneurographic degrees of progressive abnormality. Changes in antidromic sensory conduction are early and constant, constituting the parameter of choice for detection of slight compressive neuropathy.