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Biomedical subjects

P Azouvi

Publications and source records attributed to P Azouvi.

35 records · Page 2Linked to original sources
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↗
PubMed1996

Working memory and supervisory control after severe closed-head injury. A study of dual task performance and random generation.

Survivors of severe closed-head injury (CHI) frequently suffer from slowed information processing. Whether supervisory strategies are additionally impaired remains a point of debate. The first part of this study employed a self-paced dual task; the second part, a random generation task, performed at a paced rate, under single and dual task conditions. A measure of information processing speed was used as a covariate in statistical analysis. In the first experiment, in addition to slow processing, patients performed slightly poorer than controls on each task. In the second experiment, patients' performance (one randomness index in single task condition, and processing of dual task) was impaired even after statistical control of slow processing. These results suggest that there is at least some degree of impairment in supervisory strategies in addition to, but independent of, slowed processing. The clinical significance of this finding is discussed.

Adolescent↗
PubMed1996

Late cognitive and behavioural improvement following treatment of disabling orthopaedic complications of a severe closed head injury.

Interactions of physical, emotional, cognitive and behavioural impairments after severe closed head injury (CHI) remain poorly understood. A 47-year-old man was referred to our department 13 months after a severe CHI. He demonstrated severe left hemiplegia and disabling orthopaedic complications (left hip infectious arthritis, after surgical treatment for heterotopic ossification). His hip was blocked and extremely painful. He was totally dependent for daily-life activities (Functional Independence Measure (FIM) score = 18). Moreover he exhibited severe cognitive and behavioural troubles, which had been stable for many months beforehand, e.g. complete disorientation for time and place, major memory disorders, agitation, anxiety, depression, irritability, disinhibition, aggressiveness and lack of initiative. Pain disappeared within a few weeks after treatment. Progressively, functional improvement occurred (sitting position, transfers, walking between parallel bars). The FIM score increased to 63. Aggressiveness, irritability and agitation disappeared. Surprisingly, neuropsychological assessment demonstrated parallel improvement of cognitive functions, especially in regard to orientation, and to a lesser degree attention and memory. Such an observation should encourage use of active treatment of physical disabilities, even in patients presenting with an apparently poor cognitive prognosis at a late stage of severe CHI.

Cognition Disorders↗
PubMed1993

Slowly progressive apraxia: two case studies.

Two patients with a slowly progressive and severe motor apraxia are presented. In one case, there was only apraxia; in the other there was moderate memory disturbance and a mild decline of global intellectual ability, suggesting a more widespread cognitive dysfunction. In this second case, recognition of the correct use of objects was also severely impaired, suggesting a disturbance of motor knowledge. In both cases, apraxia was asymmetrical, and associated with a contralateral atrophy of the upper parietal cortex, suggesting a differential involvement of separate action systems for each hand.

Aged↗
PubMed1993

Effect of intrathecal baclofen on the monosynaptic reflex in humans: evidence for a postsynaptic action.

Intrathecal baclofen is a very powerful antispastic agent. Its mechanism of action on the monosynaptic H-reflex in spinal patients was investigated. It could inhibit rapidly and profoundly monosynaptic reflexes in lower limbs, but did not modify Ia vibratory inhibition of the soleus H-reflex. To assess more precisely its effect on Ia afferents, an experimental paradigm using Ia heteronymous facilitation of the soleus H-reflex was used. Intrathecal baclofen did not modify the amount of monosynaptic facilitation of the soleus H-reflex brought about by stimulation of the femoral nerve. This demonstrates that the main part of the inhibitory effect of baclofen on the H-reflex in spinal patients is not due to a presynaptic effect, suggesting a postsynaptic site of action.

Adolescent↗
PubMed1989

[Acute and reversible axonal polyneuropathy in post-leptospirosis].

A 53 year old woman presented, one month after an anicteric leptospirosis, an acute, asymmetrical, sensorimotor polyneuropathy involving the lower limbs. Electrophysiological study showed evidence of severe denervation, with normal motor nerve conduction velocities, indicating an axonal degeneration. Neuro-muscular biopsy showed signs of wallerian degeneration and perivascular infiltrates of epineural vessels. She received a corticosteroid therapy during 6 months and there was a nearly complete clinical recovery.

Acute Disease↗
PubMed1988

Myoclonus in a patient with spinal cord transection. Possible involvement of the spinal stepping generator.

A patient with clinically complete cervical spinal cord transection developed rhythmic myoclonic movements of the trunk and lower limbs, demonstrating that, in man, such movements can be generated within the spinal cord itself when deprived of supraspinal control. Electromyographic (EMG) recordings used to define the features of the myoclonus, which had a frequency of 0.3-0.6 Hz, was bilaterally symmetric, and involved extensor muscles. The EMG bursts always appeared in phase in all muscles involved. Peripheral stimulation of flexor reflex afferents (FRA) could induce, slow or interrupt the rhythmic activity. When FRA stimulation induced a flexion reflex, it occurred between extensor EMG bursts and induced alternating flexion-extension activity which could be sustained for several cycles. Soleus and quadriceps monosynaptic reflexes were depressed during the silent period of the rhythmic activity. Several arguments, mainly the great sensitivity of the myoclonus to flexor reflex afferent stimulation, suggest that the myoclonus observed in this patient was due to partial release of a spinal stepping generator.

Adult↗
PubMed1988

[Pure sensory stroke caused by thalamic hematoma].

A 59-year-old hypertensive patient presented with dysesthesias and a pure sensory deficit involving face, arm and leg on the left side of the body. CT scan and MRI showed a small hematoma in the posterior and lateral part of the right thalamus.

Hematoma↗
PubMed1986

[The accessory deep peroneal nerve. Electrophysiologic study].

The extensor digitorum brevis muscle is innervated by the deep peroneal nerve. In some cases it has an additional innervation by the accessory deep peroneal nerve, a branch of the superficial deep peroneal nerve. The motor nerve conduction study with detection on the extensor digitorum brevis allows to detect such an anatomical variation. It has been found in twelve cases out of 67 subjects. In two cases it was bilateral and in two other cases the extensor digitorum brevis muscle was innervated by the accessory deep peroneal nerve alone. That anatomical variation has to be known in order to avoid errors in interpretating the peroneal motor nerve conduction velocity.

Adult↗
PubMedDate not supplied

[Physiopathology of spasticity and flexion spasms].

Spasticity, flexion and extension spasms occur after lesions of motor descending pathways. Three different mechanisms can explain these disorders of tone: pure muscular alterations, segmental synaptic sprouting and liberation of spinal reflex activity. This last mechanism, which is also the most classically described has been studied long ago. Amongst all hypotheses which can explain spasticity (hyperexcitability of alpha motoneuron, gamma motoneuron, or reduction of presynaptic inhibition) reduction of presynaptic inhibition is the only one to have been clearly demonstrated. A new treatment is proposed: intrathecal Baclofen. It seems to act by reducing the excitability of alpha motoneuron.

Baclofen↗