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Biomedical subjects

L Rumbach

Publications and source records attributed to L Rumbach.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Social and economic impact of multiple sclerosis].

The evolution of multiple sclerosis is unforeseeable; it can induce disability and fatigue; thus, it has a socio-economical impact. Married and family life, relationships and work are the most affected areas. Financial problems can also occur. Counselling and aid services must be provided. All these social impacts induce an indirect cost which is the major component of the total cost of multiple sclerosis. Data show that there are great differences between countries and that the cost increases when there is a disability. The economic impact of the "new" drugs is unknown and must be assessed.

Counseling↗
PubMed1999

[New therapeutic strategies in multiple sclerosis].

Until a few years ago, the focus of MS therapy was mainly on the symptomatic approach. Several rigorous clinical trials concerning mainly relapsing-remitting forms were conducted recently. As a result of these, therapeutical views have changed. Elevated doses of methylprednisolone, used during a short period have significantly improved the handicap; but impact over a longer time is unknown. It has now been demonstrated that beta interferons reduce the frequency of relapses, modify the handicap favourably and improvements are clearly shown on MRIs. Therefore MRI has become an invaluable tool for the evaluation of the efficacy of new drugs. Recently, there have been positive results made in progressive MS. Two other drugs, Copolymer and Immunoglobulins have also shown encouraging results but other studies are still necessary. The role of some immunosuppressive agents, but mainly the role of mitoxantrone are now better understood. These results are encouraging but they have also raised a lot of questions such as: how can these drugs be used in other forms of MS; what is their long-term impact on the disease; what is the mechanism of their action; what is the etiopathogeny of MS? Clinical trials are being conducted to answer these questions and to study the usefulness of combined therapies. Even though these results have been positive, other therapies which focus on spasticity, fatigue, sphincter, dysfunction and psychosocial problems must not be neglected.

Adjuvants, Immunologic↗
PubMed1999

Interferon gamma, IL2, IL4, IL10 and TNFalpha secretions in multiple sclerosis patients treated with an anti-CD4 monoclonal antibody.

In order to better understand the mechanisms of action of a monoclonal anti-CD4/BF5 antibody(mAb), cytokine secretions were studied in 14 multiple sclerosis (MS) patients treated in a phase 1 trial. Secretion patterns of IFNgamma, IL2, IL4, IL10 and TNFalpha by peripheral blood mononuclear cells were studied before (DO) and after (D30) the treatment. We decided to undertake this study because in a previous one we observed no variations in serum levels of TNFalpha, IFNgamma, IL1, IL6. Results showed significant reductions in IFNgamma, IL2 and TNFalpha secretions after treatment. The anti-CD4 mAb seemed to act on both Th1- and Th2-cells but with preferential action on Th1-cells. Results on Th2-cells were less obvious even though a significant decrease in IL10 was observed. There was no correlation between any of the immunological markers studied and disease activity. This study demonstrates that pharmacological modifications of the CD4 receptor can induce variations in several cytokine secretion levels. It also stresses the role played by Th1- and Th2-cells in the etiopathogenesis of MS.

Adult↗
PubMed1998

Intraindividual variability of paracetamol absorption kinetics after a semi-solid meal in healthy volunteers.

OBJECTIVE: The absorption kinetics of paracetamol is dependent on gastric emptying and its measurement was proposed as a non-invasive method to estimate gastric emptying rate. The objective of this study was to evaluate the intraindividual variability of paracetamol absorption kinetics after a semi-solid meal. METHODS: The pharmacokinetics of paracetamol was studied on two occasions in 15 healthy volunteers without Helicobacter pylori antibodies. A 1-g dose of paracetamol was given as a solution together with a standardised semi-solid meal and the subjects stayed in the supine position. RESULTS: For most of the subjects, the time course of paracetamol concentrations was similar on the two occasions. The intraindividual variability was low, with coefficients of variation of 38.3%, 8.0% and 3.8% for time to maximum plasma concentration, maximum concentration and area under the plasma concentration - time curve until 6 h, respectively. CONCLUSION: The assessment of paracetamol absorption kinetics is reproducible when the drug is given together with a semi-solid meal in Helicobacter pylori-negative healthy subjects.

Absorption↗
PubMed1997

[Isolated spastic paraparesis disclosing Krabbe disease in adult age].

A 25-year-old woman developed a slowly progressive spastic paraparesis a few weeks after delivering of her first child. A cerebral MRI showed bilateral areas of hyperintensity in T-2 weighted images in the centrum semi-ovale, internal capsule, midbrain and occipital white matter. A profound deficiency of galactosyl/ceramidase activity was demonstrated in leukocytes (< 5 p. 100 of controls) and in cultured fibroblasts. The diagnosis of the adult form of Krabbe's disease was thus retained. We summarize the clinical symptoms and neuroradiological signs of this disorder and discuss the causative factors of its clinical heterogeneity.

Adult↗
PubMed1996

Early CT signs in acute middle cerebral artery infarction: predictive value for subsequent infarct locations and outcome.

During the first hours after acute ischemic stroke, the CT usually shows no abnormalities. Therapeutic trials of ischemia in the middle cerebral artery (MCA) territory involves decision-making when the CT may not show obvious ischemic changes. We reviewed 100 consecutive patients, admitted within 14 hours after a first stroke. Selective criteria were clinical presentation with MCA ischemia and at least two CTs (1 initial and 1 control). All CTs were retrospectively analyzed by at least two physicians blinded to the patient's status. On the first CT, early signs were hyperdense MCA sign (HMCAS), early parenchymatous signs (attenuation of the lentiform nucleus [ALN], loss of the insular ribbon [LIR], and hemispheric sulcus effacement [HSE]), midline shift, and early infarction. Subsequent infarct locations were classified according to total, partial superficial (superior or inferior), deep, or multiple MCA territories. Clinical features, etiology, and Rankin scale were collected. There were 52 women (mean age 70.8). The CTs were performed at mean 6.4 hours (1 to 14 hours) and before the sixth hour in 62% of the patients. Early CT was abnormal in 94% of the cases, and the abnormalities found were an HMCAS in 22 patients, ALN in 48, LIR in 59, HSE in 69, midline shift in 5, and early infarct in 7. CT was normal in six patients where it was performed earliest (mean 4.5 hours) and in the oldest patients (mean age 80.1). Early parenchymatous CT signs were significantly associated with subsequent MCA infarct location and extension: ALN and deep infarct, HSE and superficial infarct, LIR and large infarct. HMCAS was never found in isolation and was always associated with the three other signs in extended MCA infarct. The presence of two or three signs (ALN, LIR, or HSE) was associated with extended MCA infarct (p < 0.001) and poor outcome (p < 0.001). Our findings suggest that CT frequently discloses parenchymal abnormalities during the first hours of ischemic stroke. Early signs allow the prediction of subsequent infarct locations; CT may provide a simple tool in evaluating the early prognosis of MCA infarction and thus may be useful in selecting better treatments.

Adult↗
PubMed1996

[Unilateral asterixis and focal brain lesions. 12 cases].

Asterixis is a involuntary movement with spontaneous interruptions and intermittent muscle tone. It occurs during posture maintenance. It is usually bilateral and, in this case, is observed in metabolic encephalopathy. Unilateral asterixis is more uncommon. We report 12 cases which occurred in patients with focal brain lesions. In all cases asterixis involved the upper limb and the lower limb in only 2 cases. Asterixis was transient, discrete and always associated with other neurological signs. The causal lesions (7 infracts, 2 haematomas, 2 abscesses, 1 meningioma) were unique in 7 cases and multiple in 5. Asterixis was always contralateral to the unilateral lesions. Lesions mainly involved the thalamus (7 cases) and other structures (lenticular nucleus, frontal lobe, internal capsule, precentral regions and cerebellum). The frequency of thalamic involvement suggested dysfunction of the thalamo-cortical loop.

Aged↗
PubMed1996

[Pasteur's neurologic disease].

Based on Pasteur's own documents and studies devoted to him, we reconstruct the clinical presentation of his disease. At the age of 46, Pasteur suffered a left hemiplegia, probably with definitive dequellae related to a cavernoma. Ten years later, he developed signs of disturbed expression then a pseudo-bulbar syndrome. Possible causes are discussed.

Aged↗
PubMed1996

Biological assessment and MRI monitoring of the therapeutic efficacy of a monoclonal anti-T CD4 antibody in multiple sclerosis patients.

An initial group of 21 patients plus a second group of 14 patients with active multiple sclerosis (MS) (18 progressive and 17 relapsing-remitting forms) were treated with a murine monoclonal anti-T CD4/BF5 antibody as part of a phase I open trial. Tolerance was relatively good: minor general side-effects occurred in 22 patients only upon the first mAb infusion. One year later, functional disability was stabilised in only six of the 35 patients and after 2 years in two patients only (among 21). One year after treatment, nine of the 17 relapsing-remitting patients were relapse-free. CD4 counts decreased dramatically 2 h after treatment. These counts were back to baseline counts at 3 months. A transient increase was found in IL-6 and TNF alpha levels 2 h after treatment, which probably accounts for the observed side effects. Cell adhesion molecule levels were not modified. Serial MRI scans were performed in the second group of 14 patients. In all of these patients, lesion modifications were observed in the three scans performed prior to treatment. Yet, no changes in the lesions were noted on the MRI scans performed over the following 3 months. These findings demonstrate the feasibility of this treatment insofar as it induced a marked CD4 lymphocyte depletion. However, it did not seem to stabilise the evolution of the disease--although one must be careful in drawing such conclusions in a phase I trial--or to curb the evolution of MRI-documented lesions.

Antibodies, Monoclonal↗
PubMed1995

Double blind placebo controlled multicentre study of ginkgolide B in treatment of acute exacerbations of multiple sclerosis. The Ginkgolide Study Group in multiple sclerosis.

After an open labelled pilot study of ginkgolide B, a potent inhibitor of platelet activating factor, in the treatment of acute exacerbations of multiple sclerosis, a randomised double blind placebo controlled study was undertaken. One hundred and four patients were enrolled in the study: for seven days 43 received placebo, 29 received 240 mg/day ginkgolide B and 32 received 360 mg/day ginkgolide B. There was no statistical difference between the three groups for changes in Rankin, Kurtzke expanded disability status scale (EDSS), and Hauser ambulation index (AI) scores. Although there was a trend in favour of groups treated with ginkgolide for a change of Rankin and AI scores, it is concluded that ginkgolide B is not an effective treatment of exacerbations of multiple sclerosis.

Activities of Daily Living↗
PubMed1994

Nocturnal paroxysmal dystonia: a clinical form of focal epilepsy.

Different paroxysmal movements occur during sleep. They correspond either to epileptic seizures of sleep, or to parasomnia. Recently, other nocturnal motor phenomena have been described in the literature as nocturnal or hypnogenic paroxysmal dystonia (NPD), paroxysmal arousal, episodic nocturnal wanderings, etc. The NPD are involuntary nocturnal movements characterized by the association of dystonic postures, tonic movements of the four limbs and the body axis, automatisms, affective mimicry, and vocalization. In certain patients, the EEG records show abnormalities characteristic of epilepsy; in others, the EEG appears normal. A large proportion of the patients present epileptic seizures as antecedents. Typical generalized tonic-clonic seizures can follow an NPD. The NPD are improved with anti-epileptics. The considerable similarity of the clinical and paraclinical signs and of the effects of anti-epileptic treatments do not seem to justify the individualization of different subgroups as a function of the EEG patterns: the NPD are always the result of focal epilepsy, and never of a pathology of movement or of parasomnia. Numerous arguments based on the symptoms and the EEG suggest that these seizures involve the mesial frontal regions.

Adult↗
PubMed1994

[Event-related potentials and language processing].

The contribution of cognitive event-related potentials (ERPs) and particularly of the N400 component to the study of language processing is considered. After a general presentation of the various components of cognitive evoked potentials which are differentiated from early potentials (sensitive to perceptive parameters), the neurophysiological and psychological correlates of ERPs are discussed. Before the presentation of the main studies concerned with the correlation between specific late components and linguistic processes, it is proposed an introduction to some theoretical models of language processing which serve as conceptual framework supporting most of the experimental approaches in this field. The results of EPs studies devoted to functional asymetries in language processing are briefly mentioned. Then a number of studies are analysed, these demonstrate the sensitivity of event-related potential measures to linguistic manipulations. Finally, the studies concerned with the N400 are reviewed, this potential appears to be the more specifically language-related ERP component, even if its connection with specific linguistic processes or its differentiation from N200 are still under debate. Nevertheless language-related electrophysiological investigations may become in the near future a useful complementary approach to our understanding of language processing and language disorders.

Brain↗