[A case of central pontine and extrapontine myelinolysis, without hyponatremia, during alcohol withdrawal with favorable outcome]. / Un cas clinique de myélinolyse centropontine et extrapontine, sans hyponatrémie, au décours d'un sevrage alcoolique et d'évolution favorable.

Central pontine and extra-pontine myelinolysis (CPM/EPM) is a rare neurological disorder, well documented for more than 50 years but whose pathogenesis remains obscure. The existence of predisposing factors occurs in the most cases; chronic alcohol abuse is one of the most commonly encountered, among many others. Alcohol withdrawal represents an additional vulnerability factor, being responsible for electrolyte imbalances which are not always demonstrable but are certainly involved in the development of CPM and/or EPM. CPM/EPM may be responsible for severe morbidity and is potentially life-threatening. The diagnosis of CPM/ EPM remains mostly clinical and is confirmed by magnetic resonance imaging of the brain. It should be considered in the setting of any unexplained neurological symptoms during the course of alcohol withdrawal or for any patient with chronic alcohol abuse, as promptly as possible, given the potentially fatal outcome.

[Treatment of depression with transcranial magnetic stimulation]. / La stimulation magnétique transcrânienne dans le traitement de la dépression.

Major depression disorder is a frequent psychiatric condition with serious consequences. Many patients don't respond to usual psychopharmacological and/or psychotherapeutic treatments. This observation has stimulated the research of alternative treatment options. Repeated transcranial magnetic stimulation (rTMS) is a recent therapeutic tool with few side effects. Its efficacy relies on stimulation of cortical networks through the application of a magnetic field on the skull. rTMS has been approved as a full therapeutic option for major depressive disorder by the FDA in 2008. It could therefore be routinely used in the future and complete the usual treatments in this condition. Our paper reviews what is currently known about the clinical use of rTMS in major depressive disorder.

[Evidence of a modification of the profile of addictive drugs consumption through the study of patients consulting a psychiatric emergency room]. / Mise en evidence d'une modification des habitudes de consommation de substances psychoactives au travers du suivi d'une activité d'urgence psychiatrique.

The consumption of psychoactive drugs is frequently the reason of consultation in a psychiatric emergency unit. We present here the evolution over time of the consumption pattern of patients consulting the psychiatric emergency unit of the Brugmann University Hospital. Major modifications were observed during this period. Mainly, problematic consumption of opiates was progressively overwhelmed by this of cannabis, psychostimulants and recently synthesis drugs. We suggest that this reflects the situation of psychoactive drugs consumption in the general population. This implicates a modification of prevention and treatment attitudes in drug consuming persons.

[Appraisal of treatment of the trigger points associated with relaxation to treat chronic headache in the adult. Relationship with anxiety and stress adaptation strategies]. / Evaluation d'un traitement des points triggers associé à la relaxation dans la prise en charge des céphalalgies chroniques de l'adulte. Relations avec anxiété et stratégies d'adaptation au stress.

UNLABELLED: Since the 1950's and even still today, the concomitance between headaches and psychological symptoms (anxiety and depression) is the subject of considerable research. Even so, headaches still pose a problem of difficult diagnosis related to their multiform aspect. Their understanding may be regarded as neurological, psychological or musculo-articular. This complexity explains the lack of effectiveness of anti-migraine treatments in certain cases. This situation encourages recourse to complementary procedures such as those used in physiotherapy. The questions that could be posed regarding physiotherapeutic treatment are: Is the treatment effective? How does it act on the level of pain? and How does it act at the psychological level? It is to answer these questions that the work, which is the basis of this article, has been carried out. METHODOLOGY: Two groups were studied during this research: a group of 25 patients and a reference group of 100 people. The headache patients were sent for physiotherapy by a GP or consultant neurologist. The pathologies retained for experimentation were: migraines without aura; Arnold's neuralgia; headaches of spinal origin; tension headaches and associated migraines. These pathologies are covered in International Headache Society Classification: Essential headache and in Section 45.4 of DSM IV: Painful problems . The physiotherapeutic treatments applied to the patients were: muscular massage and friction plus ultra-sound vibration of the trigger-points in the spinal, scapular, dorsal and facial regions; articular reharmonisation work on the spinal column; thermotherapy and relaxation as a technique allowing control of physical (muscular) and psychological (anxiety, fear of pain) tension to be regained. The treatment is evaluated by comparison of the periodicity and intensity of the headaches before and after treatment; comparison of anxiety (state and trait) before and after treatment and comparison of coping strategies before and after treatment. RESULTS: As far as the description of the headaches of the patient group is concerned, the periodicity/intensity evaluated each day of the week before the treatment and presented in graphical form, showed a heterogeneous distribution and did not exhibit any particular characteristics. In addition, the fact of having studied this periodicity/intensity during a period of one week reinforces the reliability of the values found and reinforces the impact, showing clearly that it is not just incidental. The headaches were hereditary in 32-64% of cases; the trigger factors related to stress were the large majority. As far as the treatment used in the population studied is concerned, medication was used punctually, as prescribed. This was in the form of analgesics/antipyretics (68%) or anxiolytics (20%). In 85% of the cases, at the end of the physiotherapy treatment, the person no longer used any medication. The effectiveness of the treatment is clearly illustrated by the fact that the periodicity/intensity of the headaches had diminished significantly after treatment. The physiotherapy treatment lasted for 10 to 20 sessions with an average duration of 14 sessions. The treatment results in a significant reduction in the anxiety trait and the anxiety state as well as a readjustment of the coping strategies. During periods of headache crisis, anxiety and coping strategies are modified significantly. The modifications to these coping strategies during crises are: an increase in auto-accusation, the search for social support, avoidance and strategies for the resolution of emotion prior to treatment; an increase in strategies for the resolution of the problem after treatment; co-ping self-control is diminished if the anxiety state increases and it increases if the anxiety trait increases. Apart from the headache crises, there are no differences in anxiety characteristics or coping strategies between headache sufferers and others except for a greater use of coping avoidance by the headache sufferer. CONCLUSION: Treatment by relaxation allows for a perceived increase in control of symptoms by the sufferer. Consequently, it reduces anxiety, improves the quality of life and the behavioural responses to stress. In turn, the treatment improves the long-term prognosis for the headaches as well as the health of the sufferer in general. The treatment described here addresses 3 types of people: 1. Sufferers with difficult headaches which do not respond well to medical treatment. 2. People for whom anxiety and coping strategies are very much modified by the headaches. 3. People who abuse medication for the treatment of their headaches.

[Alarming chest pains in the young adult. Apropos of a case]. / Les douleurs thoraciques alarmantes de l'adulte jeune. A propos d'un cas.

Presentation of an observation of alarming thoracic pain, during a panic attack. Actualization of this psycho-somatic pathology concerning the epidemiologic, etiopathogenic and therapeutic aspects as well as its cardiovascular repercussion.

[Rational use of antidepressants in general medicine]. / Pour un usage raisonné des antidépresseurs en médecine générale.

Depression is a common cause of morbidity and is frequently recurrent. Therefore, treatment must be oriented more and more to the prevention of relapses in addition to the cure of depressive episodes. Long-term administration of antidepressant drugs becomes thus the rule and, as a consequence, general practitioners are increasingly concerned by the prescription of such medications. The choice of an antidepressant is mostly oriented by the side-effects profile of the pharmacological class of the compound. Fortunately, more recent drugs like SSRIs (selective serotonin reuptake inhibitors) and reversible MAOIs (monoamine inhibitors) have a very higher security index than tricyclics and classical MAOIs.

Predictive value of 99mTc pyrophosphate bone scintigraphy for vitamin D trials in uraemia.

The usefulness of 99mTc-Pyrophosphate (99mTc-PPi) bone scintigraphy was evaluated in the follow up of 21 haemodialysed patients without clinical or radiological evidence of osteodystrophy. 99mTc-PPi bone scintigraphy was semi-quantitatively analysed using Fogelman's score. Patients were randomised to receive vitamin D analogues (1 alpha hydroxyvitamin D3 or dihydrotachysterol, n = 12) or to serve as controls (n = 9), both groups being given oral calcium supplements. Bone scintigraphy deteriorated in patients only on calcium therapy but not in patients treated by vitamin D-analogues. Vitamin D therapy reduced secondary hyperparathyroidism in all cases but induced rapid intoxication with normal doses in 4 of the 12 treated patients. Since intoxicated patients had significantly lower Fogelman's score than the patients who tolerated the treatment well, 99mTc-PPi bone scintigraphy is proposed as a screening test before vitamin D-analogues trials.