Biomedical subjects

B Bussel

Publications and source records attributed to B Bussel.

At least 19 recordsLinked to original sources

PubMed2003

[Botulinum toxin and spinal cord injury].

OBJECTIVE: To realize a clarification about the interest of the use of botulinum toxin in spinal cord injured patients. METHOD: Interrogation of Medline database (crossing of botulinum toxin and spinal cord injury). We have also analyzed data from R. Poincaré Hospital in 2001. RESULTS: Three articles of the twenty-five selected, treated effectively of botulinum toxin effect in the limbs muscles of spinal cord injured patients. DISCUSSION: There are some indications of botulinum toxin in spinal cord injured patients ASIA C and D when spasticity induce focal functional discomfort. Indications are exceptional for ASIA A and B patients. No study showed improvement of functional abilities after botulinum toxin injection in spinal cord injured patients. Published studies only covered small number of patients.

Anti-Dyskinesia Agents↗

PubMed2003

Motor compensation and recovery for reaching in stroke patients.

OBJECTIVES: To examine the mechanisms of alternative strategies developed by stroke patients to compensate their motor impairment and their role in recovery. MATERIAL AND METHODS: The three-dimensional kinematics of the upper limb were quantified during unconstrained reaching movements in seven healthy individuals and in 15 stroke patients. Nine patients were followed-up. Individual observations were correlated with anatomical and functional brain imaging described elsewhere (Feydy et al. Stroke 2002;33:1610). RESULTS: Healthy subjects used mainly elbow extension and shoulder flexion, scaled to movement distance. Patients with hemiparesis because of stroke used different patterns of joint recruitment with different scaling rules. Patients with the greatest impairment compensated by recruiting extra degrees of freedom, particularly trunk bending. Improvement was because of a restoration towards a normal movement pattern (recovery) and/or to a reinforcement of compensation, which led to a poorer outcome. CONCLUSION: Individual behavioural data are necessary to discuss the mechanisms of functional improvement following stroke with respect to recovery and/or compensation.

Adult↗

PubMed2003

[Clinical evaluation of spasticity].

Spasticity is one component of the upper motor neurone syndrome. Unlike motor deficit and co-contraction, spasticity is responsive to treatment. Thus it receives more attention than the other features of the upper motor neuron syndrome. In order to treat correctly the patients, we need to know expectations of the patient and family. Detailed clinical evaluation including functional analysis is necessary to determine whether the objectives are reasonable. This evaluation is not always very easy because of complex clinical features. Simply aiming to reduce spasticity is not a final treatment goal. There must be a purpose behind it. It is actually very difficult to evaluate functional effect of spasticity treatments. Few studies show a real functional improvement. Yet patients are satisfied with the results and the goals are often achieved. One explanation is that functional scales usually used do not fit to the spasticity problem.

Humans↗

PubMed2003

[Spastic gait analysis. Contribution of the motion lab].

Etienne-Jules Marey introduced gait motion analysis at the end of the XIXth century. It was rapidly adopted by clinicians and Charcot used it at the beginning of the XXth century in La Salpêtrière. Motion analysis was widely used after the first optoelectronic system was built by Furné in 1968. The optoelectronic system calculates the orientation of each body segment in the space after the determination of the space co-ordinates of cutaneous markers placed over them. It is particularly useful for spastic gait. Many disturbances of kinematics and kinetics have been described during spastic gait. They are the consequences of spasticity and other motor and sensory deficits of central nervous system lesions. Motion analysis must be coupled with electromyographic recording of spastic muscles activity which, with kinetic analysis, enables distinguishing the mechanisms underlying gait disturbances. Motion analysis provides clinicians with an indispensable tool for understanding spasticity and evaluating therapeutic efficacy.

Biomechanical Phenomena↗

PubMed2003

[Intrathecal therapy for bladder hyperreflexia].

Intrathecal clonidine was tested for the control of bladder hyperreflexia resistant to pararsympathicolytic drugs in spinal cord injured patients. Urodynamic parameters were significantly improved after acute bolus of intrathecal low doses of clonidine. Unfortunately, the chronic intrathecal infusion of clonidine induced cardiovascular side-effects. Intrathecal baclofen did not modified significantly neurogenic bladder dysfunction from spinal lesion. But intrathecal baclofen modified penile erection quality and impaired the ejaculation reflex induced by penile vibratory stimulation in the same population.

Adrenergic alpha-Agonists↗

PubMed2003

[Spasticity: today and tomorrow].

History of the spasticity is evoked including its physiological and medical aspects. The reduction of functional capacity of the patient experiencing spasticity is, for the author, one of the major duties of the medical staff involved in the treatment of this symptom. Some aspects of the measure of the reduction of functional capacity due to this symptom are described. Its seems to the author that the new treatments (neuronal graft.) should increase the number of patients to be treated for spasticity.

History, 20th Century↗

PubMed2002

Effect of intrathecal clonidine on group I and group II oligosynaptic excitation in paraplegics.

We investigated the possibility that a change in transmission in group II pathways contributes to the spasticity of patients with spinal lesions. Thirteen patients were tested by measuring the quadriceps stretch reflex (Ashworth scale), the threshold of the quadriceps H reflex, and the oligosynaptic facilitation of the quadriceps H reflex elicited by volleys to groups I and II afferents in the common peroneal nerve (CPN). All these tests were performed before and after intrathecal injection of clonidine (60 microg). Early group I CPN-induced excitations occurred in 13 patients, and late group II CPN-induced excitations in 12. Both facilitations were, on average, significantly greater than those reported for normal subjects, but these increases were not correlated with the clinically assessed spasticity. Clonidine caused a constant, prolonged and dramatic decrease in spasticity, but did not alter the threshold of the quadriceps H reflex. CPN-induced group I and group II non-monosynaptic excitations of quadriceps motoneurones were significantly decreased, although they did not return to normal values. These results provide a further indication that group II pathways gives rise to the heteronymous late CPN-induced excitation. The pathophysiological role of a change in transmission in group II pathways in spasticity is discussed.

Adrenergic alpha-Agonists↗

PubMed2002

Longitudinal study of motor recovery after stroke: recruitment and focusing of brain activation.

BACKGROUND AND PURPOSE: The goal of this study was to characterize cortical reorganization after stroke and its relation with the site of the stroke-induced lesion and degree of motor recovery using functional MRI (fMRI). METHODS: Fourteen stroke patients with an affected upper limb were studied longitudinally. Three fMRI sessions were performed over a period of 1 to 6 months after stroke. Upper limb recovery, Wallerian degeneration of the pyramidal tract, and responses to transcranial magnetic stimulation were assessed. RESULTS: Two main patterns of cortical reorganization were found. Pattern 1 was focusing, in which, after initial recruitment of additional ipsilateral and contralateral areas, activation gradually developed toward a pattern of activation restricted to the contralateral sensorimotor cortex in 9 patients. Five patients were found to have pattern 2, persistent recruitment, in which there was an initial and sustained recruitment of ipsilateral activity. Occurrence of recruitment or focusing seemed to depend mainly on whether the primary motor cortex (M1) was lesioned; persistent recruitment was observed in 3 of 4 patients with M1 injury, and focusing was seen in 8 of 10 patients with spared M1. These patterns had no relation to the degree of recovery; in particular, focusing did not imply recovery. However, there was a clear relation between the degree of recovery and the degree of Wallerian degeneration. CONCLUSIONS: These results suggest that ipsilateral recruitment after stroke corresponds to a compensatory corticocortical process related to the lesion of the contralateral M1 and that the process of compensatory recruitment will persist if M1 is lesioned; otherwise, it will be transient.

Adaptation, Physiological↗

PubMed2002

[Double dissociation between unilateral neglect and anosognosia].

We report two patients presenting with a subacute right hemisphere stroke. These cases demonstrate a double dissociation between unilateral neglect and anosognosia for hemiplegia. The first patient suffered from a severe left hemiplegia associated with severe and persisting unilateral neglect. He appeared fully aware of his motor impairment. The second patient had a severe left hemiplegia, without any major sign of unilateral neglect on clinical tests nor on behavioural assessment. Nevertheless, he presented a severe and sustained anosognosia for hemiplegia. These case reports support the assumption that anosognosia and unilateral neglect, although they are frequently associated, may rely on independent mechanisms.

Aged↗

PubMed2001

Urodynamic monitoring during percutaneous sacral nerve neurostimulation in patients with neurogenic detrusor hyperreflexia.

The purpose of this study was to assess urodynamics parameter changes induced by acute sacral neurostimulation (SNS) in spinal cord injury (SCI) patients with neurogenic detrusor hyperreflexia. Fourteen SCI patients with urge incontinence owing to a hyperreflexive bladder were prospectively evaluated. Neurostimulation was performed on the root that obtained the best motor response (10 Hz, 210 microseconds) and amplitude ranges of >0 to 10 V. The urodynamics study was done in the prone position. Four cystometries were recorded before (two), during (one), and 10 minutes after stimulation (one). Maximal bladder capacity (MBC) (volume to first leakage), bladder volume at first uninhibited contraction (BV(1stC)), and maximal detrusor pressure during uninhibited contractions (P(det)max) were compared. Left S3 foramen was the most commonly used (9/14). Mean amplitude of stimulation was 4.5 V (range, 0.5-8.5 V). Statistically significant differences (Mann-Whitney U-test) were found for MBC, BV(1stC), and P(det)max with mean variations of +206.8 mL (+107%, P < 0.001), +151.5 mL (+98%, P < 0.01), and -23.4 cm H2O (-27%, P < 0.05), respectively. Patient gender and SCI level did not reveal any difference. Patients who reached a MBC of up to 400 mL (+278.2 mL, +129%, n = 10) with SNS had statistically significant improvement of BV(1stC) (+210.2 mL, +125%, P < 0.01) and P(det)max (-33.3 cm H2O, -38%, P < 0.01). Acute temporary SNS in SCI patients has a profound effect on key urodynamics parameters. These neurologically impaired patients with detrusor hyperreflexia may be appropriate candidates for implantable SNS.

Adult↗

PubMed2001

Feasibility of a temporary urethral stent through the striated sphincter in patients in the early phase (6 months) of spinal cord injury.

OBJECTIVE: To assess the feasibility of a temporary urethral stent through the striated sphincter in patients in the early phase (before 6 months) of spinal cord injury (SCI) in a department of neurological rehabilitation. METHODS: Fourteen consecutive men with SCI with urinary retention within 6 months after SCI were prospectively treated. Thirteen patients were tetraplegic (C2 to C7) and 1 was paraplegic. All patients were managed with indwelling catheters (10) or intermittent catheterization (4). The Nissenkorn polyurethane urethral stent was inserted across the external sphincter under local anesthesia for an anticipated 4-month duration. RESULTS: No perioperative complications were encountered. Hospital mean stay at the urological department was 1.9 days (range 1-4 days). All patients had good emptying of the bladder (residual urine less than 100 ml) and were free of all types of catheterization. Five stents had to be repositioned in the first 2 weeks, 1 was removed for obstruction at 2.5 months. There was no lithiasis, no upper urinary tract alteration, no symptomatic infection nor local discomfort during follow-up. At a mean of 3.7 months after implantation, 10/14 (71.5%) patients chose sphincterotomy by permanent urethral stent and 4 had stent removal for learning of self-intermittent catheterization (3) and indwelling catheter (1). CONCLUSIONS: The temporary sphincter stent is a new, feasible and reversible technique to manage neuropathic bladder dysfunction in the early phase after SCI. A randomized study on intermittent catheterization should be conducted. It should consider patients' and nursing caregivers' evaluations.

Adult↗

PubMed2001

Intrathecal clonidine for controlling spastic hypertonia.

Intrathecal clonidine is a powerful antispastic drug. Its mechanism of action is more selective than baclofen. The acute effects are reviewed. An assessment of side effects of clonidine during chronic infusion is needed.

Adrenergic alpha-Agonists↗

PubMed2001

[Spasticity and multiple sclerosis].

Spasticity is a common symptom in MS patients. It is easy to recognize and evaluate spasticity at rest. The efficacy of numerous treatments has been well documented. Nevertheless, it is difficult, particularly in MS patients, to assess the functional disability due to spasticity and the functional benefit due to treatment. This is why it is appears more appropriate to use therapeutic tests with transitory effects such as anesthetic blocks in case of focal spasticity or intrathetical baclofen in case of diffuse spasticity. It is also possible to use reversible treatments such as botulinum toxin injections before proposing section of a peripheral nerve.

Disability Evaluation↗

PubMed2000

Foraminal epidural extra osseous cavernous hemangioma of the cervical spine: a case report.

STUDY DESIGN: A case report of purely epidural foraminal cervical cavernous angioma assessed by magnetic resonance imaging and diagnosed at pathologic study. OBJECTIVE: To illustrate a rare cause of cervical foraminal mass mimicking a schwannoma. SUMMARY OF BACKGROUND DATA: Several cases of epidural cavernous angioma have been reported. A purely epidural cavernous angioma in a cervical foramen has never been reported in the literature. METHOD: A 36-year-old man sought treatment for acute weakness in his right upper limb with radicular distribution. On magnetic resonance images, the lesion appeared as a foraminal mass with no bone invasion or hematic components. It enhanced after intravenous administration of Gadolinium. Pathologic study after surgery showed a typical cavernous angioma. RESULTS: The patient improved slightly after surgery. CONCLUSION: Clinical and radiologic presentation could be confusing in a purely foraminal epidural cervical cavernous hemangioma. Cavernous hemangioma must be known as a differential diagnosis of a foraminal schwannoma. Diagnosis of cavernous angioma is made easily on pathologic examination.

Adult↗

PubMed2000

Kinematics of prehension and pointing movements in C6 quadriplegic patients.

AIMS: C6 quadriplegic patients lack voluntary control of their triceps muscle but can still perform reaching movements to grasp objects or point to targets. The present study documents the kinematic properties of reaching in these patients. MATERIALS AND METHODS: We investigated the kinematics of prehension and pointing movements in four quadriplegic patients and five control subjects. Prehension and pointing movements were recorded for each subject using various object positions (ie different directions and distances from the subject). The 3D motion was analyzed with Fastrack Polhemus sensors. RESULTS: During prehension tasks the velocity profile of control subjects showed two peaks (go and return); the first velocity peak was scaled to the distance of the object. In quadriplegic patients there was a third intermediary peak corresponding to the grasping of the object. The amplitude of the first peak was slightly smaller than in control subjects. Velocity was scaled to the distance of the object, but with a greater dispersion than in control subjects. Total movement time was longer in quadriplegics because of the prolonged grasping phase. There were few differences in the pointing movements of normal and quadriplegic subjects. The scapula contributed more to the reaching phase of both movements in quadriplegic patients. CONCLUSION: In spite of some quantitative differences, the kinematics of the hand during reaching and pointing in quadriplegic patients are surprisingly similar to those of control subjects. Spinal Cord (2000) 38, 354 - 362.

Adult↗

PubMed2000

A urethral stent for the treatment of detrusor-striated sphincter dyssynergia.

OBJECTIVE: To assess the technique, efficacy and complications of the Ultraflex urethral stent (Boston Scientific Corp., Boston, MA) for the treatment of detrusor-striated sphincter dyssynergia (DSD). PATIENTS AND METHODS: Forty consecutive patients with DSD who had a Ultraflex stent placed in the membranous urethra were evaluated prospectively. DSD was caused by spinal cord injury in 30, multiple sclerosis in six and other neurological diseases in four. All patients were either tetraplegic or paraplegic and unable to use intermittent self-catheterization. Previous bladder management consisted of an indwelling catheter in 15 patients, chronic suprapubic catheters in two, intermittent catheterization in nine, and trigger reflex micturition in 14. The Ultraflex stent was placed under local anaesthesia. The stents were 50 mm long in 36 patients, 45 mm in two and 40 mm in two. The mean (SD) follow-up was 16.9 (13. 8) months. RESULTS: The mean (SD) residual urine decreased from 245. 9 (117) mL before stenting to 65.2 (19.3) mL at 12 months afterward (n = 19). One stent was removed at 13 months for chronic prostatic and urinary tract infection leading to autonomic dysreflexia. There was no stent stenosis and 17 of 18 stents had > 75% epithelial coverage at one year. None of the stents migrated. Seven patients underwent secondary bladder neck incision through the stent. The stent length was increased in four patients using a second overlapping distal stent, twice during the first procedure and twice within 6 months because the sphincter was inadequately covered. CONCLUSIONS: The Ultraflex stent achieved the expected results for a prosthetic sphincterotomy and appears to be an appropriate but less invasive treatment for DSD.

Adult↗

PubMed2000

MRI analysis of brain atrophy after severe closed-head injury: relation to clinical status.

The purpose of this study was to determine the clinical correlates of supratentorial ventricular dilations and of corpus callosal atrophy at the subacute stage after a severe closed-head injury (CHI). Thirty-three CHI patients underwent MRI 2 months or more after injury. Morphometric measures were compared to clinical data (coma score, coma duration and Glasgow Outcome Scale). There were numerous significant correlations between clinical data and mid-third ventricle and frontal horns measurements. Fewer significant correlations were found with the lateral ventricle bodies and the corpus callosal body. There was no significant correlation with the posterior part of the corpus callosum and of the ventricles. Corpus callosum atrophy correlated significantly with anterior and deep ventricular dilatation. In conclusion, the best indicator of clinical status was ventriculomegaly, and particularly third ventricle enlargement, which probably reflects the extent of both anterior and deep white matter lesions.

Adult↗

PubMed2000

Intrathecal catheter with subcutaneous port for clonidine test bolus injection. A new route and type of treatment for detrusor hyperreflexia in spinal cord-injured patients.

INTRODUCTION AND OBJECTIVES: The objective of this study was to assess the feasibitity, technical data and use of intrathecal catheter implantation with subcutaneous port for clonidine test injections and individual evaluation. METHODS: According to approval of the local ethics committee, 9 consecutive SCI patients (6 men, 3 women) had catheter and port implantation between January 1998 and May 1999. All did not respond to systemic drug therapy in combination to self-clean intermittent catheterisation (SCIC). Implantation was done under general anesthesia. Needle and catheter were Medtronic Infusion Synchromed Intraspinal catheter (Induratrade mark, 8703W). Clonidine test injections were allowed at D5. RESULTS: There were no complications during operation. Follow-up was 8.2 months (0.5-17). After clonidine bolus injection test and validation, 6 patients decided to have permanent pump implantation, 2 chose other therapies and one did not tolerate clonidine intrathecal injections for blood arterial pressure side effects. CONCLUSIONS: Intrathecal clonidine may represent a useful conservative treatment of both severe bladder hyperreflexia and spinal spasticity. Its short-term effects can be individually evaluated through bolus injection in subcutaneous port before definitive pump implantation.

Adult↗