[Anatomophysiological consideration on the sacral reflex]. / Considérations anatomo- physiologiques à propos du réftexe sacré.

Sacral reflex testing is a very specific one. Coming from sensory receptors afferent neuronal pudendal passway enters the spinal cord S2 to S4 via spinal dorsal roots and transmits the bioelectrical activity to a complex interneuronal circuitry. Information is processed at this level and dispached into spinal motoneurones for innervating the pelviperineal muscles according to their specific radicular origins. Selective staged sacral reflexes contribute to locate the site of compression. Sacral reflex configuration was based on clinical and electrophysiological findings which is actually confirmed and valided by anatomical studies. This testing is the most efficacious and useful procedure of assessing the pudendal neuralgia, the S2 to S4 reflexes and the pelvic floor dysfunctions.

[Selection of electrophysiological investigations for diagnosis in idiopathic facial palsy. Twenty years experience in an ENT department]. / Les explorations électrophysiologiques des paralysies faciales idiopathiques. Standardisation après vingt années de pratique dans un service ORL.

Electrophysiological exploration of the facial nerve requires different tests to differetciate the importance of the block, denervation and canal conduction. We must answer five questions: 1) Assessing the degree and the phase of the nerve lesion, 2) Deciding on the advisability of a facial decompression in the early stage of the palsy, 3) Evaluating the prognosis, 4) Choosing the best therapeutic approach, 5) Detecting facial hyperkinesis in an infraclinic period. In order to answer these questions, we select the following methods: 1) Quantified Electroneuronography should be applied as early as the 2nd day after onset, repeated on the 7th and 10th days. Unfortunately this is not always possible for practical reasons. In any case a minimum of two investigations should be performed during the 12 first days. 2) We add Computer EMG in order to control the evolution of the blocked fibers with regard to denervated fibers. 3) Blink reflex and Stapedius reflex are investigated from the 3rd day. After the acute phase of the palsy, recovery is detected by the reappearance of the blink and stapedius reflexes and the evolution of the computed EMG. These tests are sufficient for answering the five questions mentioned above without discomfort for the patient.

[Prognostic value of early somatosensory evoked potentials in the presence of traumatic lesions of the spinal cord]. / Valeur pronostique des potentiels évoqués somesthésiques précoces au cours des lésions médullaires traumatiques.

Cortical and cervical early somatosensory evoked potentials (SEPs) were recorded after stimulation of median, ulnar, tibial or common peroneus nerves in 23 patients with traumatic paraplegia or quadriplegia. The clinical progress of these patients was followed for more than 18 months. The gradual clinical recovery or its absence was compared with neurophysiological data. In complete spinal injury, the absence of SEPs in response to stimulation of a nerve entering the cord below the level of injury demonstrates the high degree of spinal cord damage. There was a good correlation between the presence of SEP, even of low amplitude or long latency, and a favorable prognosis. The return of the SEP could herald clinical recovery of posterior column function. From a practical point of view, these preliminary data suggest that the investigation of early SEPs must begin with a very short delay after injury and be continued for approximately 6 months so that the irreversibility of the lesion can be clearly established.

[Strategy for the prevention and treatment of post-paralytic facial syncinesis]. / Stratégie de la prévention et du traitement des syncinésies faciales post-paralytiques.

The existence of facial heimspasm and post-paralytic syncinesia is in general interpreted as the result of aberrant reinnervation following a Bell's palsy. In a certain number of cases, electrophysiological tests reveal synaptic abnormalities in the facial nucleus. These findings must be taken into consideration, together with the possibility of ephapsic stimulation of the proximal part of the facial nerve, when explaining the regression of syncinesia which is found in certain patients during the reinnervation phase. Prevension is based principally upon the quality of treatment and the rapidity with which both electrophysiological testing is undertaken and treatment started. It is important to avoid treatment aimed at accelerating reinnervation (neuronotrophic factors, dielectrolysis, etc . . . The process should take place naturally. Electrical stimulation, administered under conditions of choice of current on the basis of the lesion, experimentally prevents dissemination of reinnervation. Repeated evaluation of possible diffusion of the blink reflex can be used to detect sub-clinical stages of progression to syncinesia. It would seem necessary to review from a particular standpoint the organised programming of physiotherapy and its association with biofeedback-EMG techniques. If signs of syncinesia develop, appropriate physiotherapy, biofeedback-EMG techniques and contralateral strio-motor electrotherapy combined with sedative and anti-paroxysmal therapy should be started.

[Epicondylalgia]. / Les épicondylagies.

The authors review several aspects of epicondylalgiae, considering this condition under the angle of pathology, etiology, semiology and clinical examination. Using electrophysiological methods, they attempt better to define the data allowing a precise electrological and topographical diagnosis. A classification of the electromyographical syndromes associated with epicondylalgiae is provided. Finally, the various types of treatments which have been proposed according to the etiology of this condition are discussed.