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Biomedical subjects

P Azouvi

Publications and source records attributed to P Azouvi.

At least 19 recordsLinked to original sources
PubMed2003

[The psychopathology of the unawareness of cognitive impairments and behavioral limitations in traumatic brain-injured patients].

OBJECTIVE: To explore the unawareness of cognitive impairments and behavioral limitations using a psychopathological approach. PATIENTS AND SETTING: Fifteen patients with chronic severe TBI. Outpatient TBI rehabilitation programs in three different centers. MAIN OUTCOME MEASURES: Case reports. The data from semi-structured interviews with the patients and their families, at least six months after the accident, were compared with data supplied by the Patient Competency Rating Scale (PCRS) and the Neurobehavioral Rating Scale-Revised (NRS-R). RESULTS: Nine patients demonstrated unawareness of their limitations according to the PCRS (Group I), whereas six did not (Group II). Psychic phenomena specific to patients of group I were found. Some of these were specific to brain injury, such as the lack of representation of cognitive impairments and behavioral limitations or the difficulty to integrate the brain-injury into one's psychic space. Others were not specific to brain injury such as mourning process difficulties, personality characteristics, defense mechanisms. Several psychic phenomena coexisted in the same patient. CONCLUSION: This study shows the complexity of unawareness of cognitive impairments and behavioral limitations and makes future clinical and theoretical definition indispensable.

Adolescent↗
PubMed2002

Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke.

OBJECTIVES: The lack of agreement regarding assessment methods is responsible for the variability in the reported rate of occurrence of spatial neglect after stroke. The aim of this study was to assess the sensitivity of different tests of neglect after right hemisphere stroke. METHODS: Two hundred and six subacute right hemisphere stroke patients were given a test battery including a preliminary assessment of anosognosia and of visual extinction, a clinical assessment of gaze orientation and of personal neglect, and paper and pencil tests of spatial neglect in the peripersonal space. Patients were compared with a previously reported control group. A subgroup of patients (n=69) received a behavioural assessment of neglect in daily life situations. RESULTS: The most sensitive paper and pencil measure was the starting point in the cancellation task. The whole battery was more sensitive than any single test alone. About 85% of patients presented some degree of neglect on at least one measure. An important finding was that behavioural assessment of neglect in daily life was more sensitive than any other single measure of neglect. Behavioural neglect was considered as moderate to severe in 36% of cases. A factorial analysis revealed that paper and pencil tests were related to two underlying factors. Dissociations were found between extrapersonal neglect, personal neglect, anosognosia, and extinction. Anatomical analyses showed that neglect was more common and severe when the posterior association cortex was damaged. CONCLUSIONS: The automatic rightward orientation bias is the most sensitive clinical measure of neglect. Behavioural assessment is more sensitive than any single paper and pencil test. The results also support the assumption that neglect is a heterogeneous disorder.

Activities of Daily Living↗
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↗
PubMed2002

Quality of life in patients with traumatic brain injury-basic issues, assessment and recommendations.

INTRODUCTION: Traumatic brain injuries (TBI) are one of the most common consequences of traffic accidents. Patients with mild, moderate or severe brain injuries suffer from physical, cognitive, behavioral, emotional and social problems. Most of these problems have been a long standing focus amongst practitioners and researchers. Only recently a development has started that took interest in the quality of life outcome of TBI patients. The international members of this consensus meeting reviewed the literature on Quality of Life assessment after TBI and discussed the applicability of different measurements to this specific patient group. TIME POINTS: During the acute phase (T1; < 3 month after trauma) QoL it is difficult to assess due to the reduced consciousness of TBI patients. In the phase of rehabilitation (T2; < one year after trauma) and in the post-rehabilitation phase (T3) repeated assessment of QoL is recommended. INSTRUMENTS: Several generic and disease-specific instruments possibly relevant to TBI patients or specifically developed for this group were assessed according to the existing evidence in the literature. Criteria for the evaluation of these instruments were: feasibility, specificity, validity, comprehensiveness, international availability, existence of norms, and psychometric quality. The cognitive impairment and the existential dimension were not sufficiently considered in most of the reviewed instruments. GROUP CONSENSUS: The family's and relatives' view of the patient's QoL should not be used as a proxy but provides an additional source of information in the acute phase. At T2 and T3, assessment of the patient's quality of life should include a generic as well as a disease specific instrument. Among the generic instruments the SF-36, the EuroQol and the WHO-QoL should be considered. The literature about specific instruments for patients with TBI like the EBIC is scarce. Therefore, the group could hardly give an empirically based recommendation. The need for further investigation on QoL instruments in TBI patients is strongly emphasized.

Brain Injuries↗
PubMed2001

Script knowledge after severe traumatic brain injury.

Severe diffuse traumatic brain injury (TBI) may impair the performance of daily-life complex activities. The aim of the present study was to assess whether these difficulties are related to a representational impairment of action knowledge. Two tasks requiring the manipulation of scripts were used. The first (script reconstitution) required subjects to sort cards describing actions belonging to 4 different scripts, presented in a random order. The second (script generation) required subjects to generate actions belonging to a given script. The results showed that TBI patients had preserved access to goal representation and action knowledge. However, they demonstrated (1) significant impairments when they had to deal with simultaneous competing sources of information and (2) a lack of inhibitory control on routine overlearned skills. Patients' performance was significantly correlated with behavioral modifications in everyday life. These data suggest that action impairment in severe TBI patients cannot be attributed to an impairment of action knowledge per se. As previously suggested by Schwartz et al., a restriction of limited-capacity processing resources may account for the observed deficits.

Activities of Daily Living↗
PubMed2001

[Presenting a battery for assessing spatial neglect. Norms and effects of age, educational level, sex, hand and laterality].

The aim of this study was to build up a battery for assessing spatial neglect, then to analyse the norms and potential effects of age, education level, sex, hand used, and laterality. It was also to contribute evaluating the pseudoneglect phenomenon described by Heilman, which consists in a tendency of normal subjects to neglect the right peripersonal space. Tasks selected were presented to important groups of normal subjects, most often larger than 450. The battery comprised of a bell cancellation test, scene copy, clock drawing, two line bisection tasks, identification of overlapping figures, text reading, writing task, and the representational task of the France map. For each of them, different variables were selected, especially investigating the difference between performance in the right and the left hemispaces. This study allowed defining the threshold values (percentiles 5 and 95) for deciding of the pathological character of a patient performance. It also showed that the pseudoneglect phenomenon is more obvious in some tasks such as line bisection, and probably also in the representational task of the France map and writing. His importance and at times his side were influenced by the factors we studied, with between tasks differences, but also by the nature of the task to be performed, and especially his verbal component.

Adult↗
PubMed2000

Dual task performance after severe diffuse traumatic brain injury or vascular prefrontal damage.

The ability to perform two tasks simultaneously is a key function of the central executive of working memory (Baddeley, 1986). This study addressed dual-task performance after diffuse very severe traumatic brain injury (TBI) (mean coma duration = 21 days, mean post-traumatic amnesia = 70 days) or prefrontal damage due to a ruptured aneurysm of the anterior communicating artery (AACA). Mean time since injury was 8 and 16 months in the TBI and the AACA group respectively. A simple visual reaction time and random number generation were used as single and dual tasks. Randomization was self-paced, to control for individual differences in speed. Both patient groups had greater reaction time decrements than controls under the dual-task condition, suggesting a divided attention deficit. In addition, patients with AACA performed significantly poorer in random generation. These results suggest that patients with AACA and with severe TBI suffer from an impairment of the central executive system.

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

Neuroimaging correlates of cognitive and functional outcome after traumatic brain injury.

Magnetic resonance imaging (MRI) may provide an estimate of the severity of diffuse axonal injury by quantitative measurements of atrophy of white matter tracts (such as corpus callosum) and of ventricular enlargement (particularly the third ventricle). However, most MRI studies failed to reveal consistent relationships between the pattern of neuropsychological impairments and the site and extent of focal structural lesions after traumatic brain injury. Functional neuroimaging techniques, such as positron emission tomography or functional MRI, may reveal areas of cerebral dysfunction in regions that look structurally intact on MRI. Studies using these techniques have suggested that the cognitive and behavioural disturbances of traumatic brain injury could be related to a defective activation of a prefrontal-cingulate network.

Animals↗
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↗
PubMed1999

Functional anatomy of neuropsychological deficits after severe traumatic brain injury.

BACKGROUND: Neurobehavioral disorders after severe traumatic brain injury (TBI) are poorly correlated with focal lesions detected by structural neuroimaging techniques such as CT scan or MRI. OBJECTIVE: To explore the relationships between regional cerebral glucose metabolism at rest, as measured by PET, and neurobehavioral status after severe TBI at the subacute stage. METHODS: Thirteen patients without focal structural lesion on MRI were studied. Neuropsychological assessment included tests of memory, attention and speed of information processing, and executive functions, and a global neurobehavioral assessment. Regional cerebral glucose metabolism at rest was measured with (18F)-fluorodeoxyglucose and PET. RESULTS: A close link was found between cognitive and behavioral disorders and decreased cortical metabolism in prefrontal and cingulate cortex. Tests of memory and executive functions significantly correlated with regional metabolism in the mesial and lateral prefrontal cortex and the cingulate gyrus. Behavioral disorders correlated significantly with mesial prefrontal and cingulate metabolisms. CONCLUSION: These results suggest a predominant role of prefrontal and cingulate dysfunction in cognitive and behavioral disorders of patients with severe traumatic brain injury, even in the absence of focal structural lesion of the brain. Further cognitive functional activation research using PET or functional MRI might help clarify the relative contributions of both areas to dysfunction.

Adolescent↗
PubMed1999

Carbamazepine in agitation and aggressive behaviour following severe closed-head injury: results of an open trial.

Ten patients presenting agitation and anger outbursts at various stages following a severe closed head injury, were treated in a prospective open trial with carbamazepine, with doses ranging from 400 to 800 mg per day, during 8 weeks. Group analysis demonstrated a statistically significant improvement of a score made up from six target items from the neurobehavioural rating scale. Improvement mainly concerned irritability and disinhibition. A statistically significant improvement was also found with the Agitated Behaviour Scale. Social functioning, as assessed by family or staff ratings of the Katz Adjustment Scale, also significantly improved. No modification of global cognitive functioning was found with the Mini Mental Status Examination. Individual analysis demonstrated that the beneficial effect was important in five cases, moderate in three patients and negligible in two cases. It is concluded that carbamazepine might help to reduce agitated behaviour in brain-injured patients. However, response to treatment demonstrated an important inter-individual variability.

Adult↗
PubMed1999

[Validation of procedures of rehabilitation after cerebrovascular accident].

There are several methodological difficulties in the assessment of the effectiveness of rehabilitation in stroke patients. Obviously, double-blind studies are not possible, and only single-blind procedures can used. It is difficult to control for non specific effects, such as spontaneous recovery, patient's and therapist's motivation, social environment. It is necessary to assess the effect non only at the level of impairments, but also on disability and handicap. However, there are now accumulating data in the literature suggesting that stroke rehabilitation has a significant, although mild, effectiveness. Patients treated in specialized stroke rehabilitation units obtain a better outcome, in terms of independence in daily-life activities, than those treated in general wards. They also have shorter hospitalisation durations and are more frequently able to return home. Treatment effectiveness is related to intensity and duration of rehabilitation, and also to stroke severity. Patients with moderate impairments seem to benefit more from treatment than patients with mild or severe deficits. However, significant improvements can still be obtained in very severe cases, and even late (up to two years) post stroke. Similarly, rehabilitation of cognitive deficits (aphasia and unilateral neglect) has also been found efficient in most studies, even if the beneficial effect is relatively small. Aphasic patients treated by speech therapists improve more than patients treated by non specialized therapists or by family members who received a short training. One limitation of neglect rehabilitation is the inconsistent generalisation of treatment effects to daily-life situations. These data are encouraging but further research is needed to find out what precisely works, and how, in the "black box" of rehabilitation.

Functional Laterality↗
PubMed1998

Side effects of chronic intrathecal baclofen on erection and ejaculation in patients with spinal cord lesions.

OBJECTIVE: Assess modifications of sexual function in men treated with intrathecal baclofen for spinal spasticity. DESIGN: Prospective before-after trial. SETTING: A rehabilitation department of a university hospital; follow-up was on an outpatient basis. PATIENTS: A convenience sample of nine consecutively recruited men with spinal cord injury or multiple sclerosis who were receiving intrathecal baclofen by an implantable pump; average follow-up was 44.4 months. MAIN OUTCOME MEASURES: A questionnaire focusing on: libido; ability to sustain reflexive and psychogenic erections; rigidity, evaluated by a visual analog scale; maximum duration of erection; possibility of ejaculation. RESULTS: Libido and the ability to obtain psychogenic or reflexogenic erections were not modified. However, eight patients reported a decrease of erection rigidity and/or duration. Ejaculation was possible in three cases before implantation. It disappeared in two patients, and was more difficult to obtain in the last one. It reappeared after treatment withdrawal. No differences were found between multiple sclerosis and spinal cord injured patients. CONCLUSION: Intrathecal baclofen may compromise erection and ejaculation. This effect is reversible. Patients should be informed of this effect.

Adult↗
PubMed1998

Intrathecal clonidine for refractory detrusor hyperreflexia in spinal cord injured patients: a preliminary report.

PURPOSE: We assessed the urodynamic effect of various doses of intrathecal clonidine on refractory detrusor hyperreflexia in spinal cord injured patients. MATERIALS AND METHODS: Doses of 15, 30 or 45 microg. intrathecal clonidine or placebo were given to 5 chronic complete spinal cord injured patients with detrusor hyperreflexia. Two cystometries were performed before and 5, 30, 60, 90, 120 and 180 minutes after each injection. RESULTS: A statistically significant dose dependent decrease in detrusor hyperreflexia was observed in each patient without significant side effect. CONCLUSIONS: Intrathecal clonidine may represent a conservative reversible treatment for detrusor hyperreflexia via a subcutaneous programmable pump, like that used for baclofen, for spasticity. The long-term efficacy needs to be evaluated.

Adrenergic alpha-Agonists↗
PubMed1998

Dysprosody after severe closed head injury: an acoustic analysis.

OBJECTIVES: Neurological speech disorders (dysarthria and dysprosody) are known to be frequent sequelae after severe closed head injury. These disorders may dramatically alter communicative intent and accentuate social isolation. The aim was to provide an instrumental evaluation for prosodic production in a group of patients with severe closed head injury and to determine the correlations between prosodic production and neurobehavioural status. METHODS: Fifteen patients, at the subacute stage after severe closed head injury, were studied and compared with 11 controls, matched for age, sex, and duration of education. Each subject was required to read aloud a French sentence "Je m'en vais samedi matin" (I am leaving saturday morning) under six different prosodic intonations (neutral, affirmation, interrogation, happiness, sadness, anger). The recorded sentences were analysed using a sound signal analysis software (Signalyse) allowing the measurement of signal intensity and fundamental frequency. Statistical analyses were carried out using repeated measures analysis of variance (ANOVA). RESULTS: Patients with closed head injury were significantly less able than controls to modulate speech output (pitch and intensity) according to prosodic context. This deficit was particularly pronounced for the intonation feature of anger, question, and statement. No consistent correlations could be found between prosodic production and cognitive or behavioural data. CONCLUSIONS: Acoustic analysis of pitch and intensity may show impairments of prosodic production after severe closed head injury, which may be useful in rehabilitation planning. This impairment does not seem to reflect the eventual cognitive and behavioural deficits of the patients, but rather a specific disorder of modulation of speech output.

Adolescent↗
PubMed1996

Intrathecal baclofen administration for control of severe spinal spasticity: functional improvement and long-term follow-up.

OBJECTIVES: To assess long-term efficacy and functional benefits of intrathecal baclofen for severe spinal spasticity. DESIGN: A prospective before-after trial. SETTING: A neurological rehabilitation department of a university hospital. Pump implantation was realized in neurosurgery; follow-up was carried out mostly on an outpatient basis. PATIENTS: Eighteen patients with severe and disabling spinal spasticity received intrathecal baclofen by an implantable pump; average follow-up was 37.4 months (range, 9 to 72). MAIN OUTCOME MEASURES: Spasticity (Ashworth and spasms frequency scores); disability (Functional Independence Measure [FIM]). RESULTS: A significant decrease in tone and spasms was observed in all patients. Tolerance appeared during the first 6 to 9 months. Later on, efficacy remained stable, except in cases of mechanical problems of the pump or catheter. Functional assessment found a highly significant (p < .001) increase of FIM score (particularly for bathing, dressing lower body, transfers, and in some cases, locomotion). This was particularly marked in patients with thoracic spinal cord lesion. In cases of severe upper limb dysfunction, FIM was only improved for wheelchair displacements, due to a better sitting position, but nursing became easier and life comfort was enhanced. Severe side effects (overdose) were observed in two cases. CONCLUSION: Efficacy remained stable after 6 to 9 months. Marked improvement of functional independence was observed in paraplegic patients. Improvement was less spectacular in patients with severe upper limb dysfunction, but nevertheless appreciable in terms of life comfort and use of attendants.

Activities of Daily Living↗