A Cross-Sectional Study of Treatments for Behavioral Disorders Following Traumatic Brain Injury: Comparison With French Recommendations.

OBJECTIVE: To give a cross-sectional overview of ongoing management of behavioral disorders following traumatic brain injury (TBI) in a region of France, to compare this with recent recommendations from the French Society of Physical Medicine and Rehabilitation (SOFMER), and to evaluate associations between treatments and participant characteristics. SETTING: Outpatients referred to medical or community-based facilities in a region of France. PARTICIPANTS: One hundred twenty-nine adults with moderate to severe TBI, in the postacute period (over 3 months postinjury). DESIGN: Cross-sectional cohort study. MAIN MEASURES: Sociodemographic data, ongoing interventions including psychotherapy and medication, behavioral disorders assessed by the Behavioral Dysexecutive Syndrome Inventory (BDSI). RESULTS: Thirty-three percent of participants received ongoing psychotherapy and 43% were on medication. The most prescribed medications were antidepressants (21%), neuroleptics (18%), anxiolytics (16%), and mood stabilizers (14%). Eighty-five participants (71%) presented a current Behavioral Dysexecutive Syndrome (BDS) according to the BDSI. These participants more frequently received treatment (P = .004), psychotherapy (P = .048), medications (often 2 or more) (P = .007), and particularly antiepileptic mood stabilizers (P = .037) compared with those without BDS. CONCLUSION: Although recommended as first-line treatment, few participants with BDS received psychotherapy. Medications were overused, especially neuroleptics in view of their potential adverse effects. In contrast, recommended medications, such as mood stabilizers and ß-blockers, did not appear to be highly prescribed whatever the evolution. Compliance with recommendations seemed insufficient.

The quality of life in genetic neuromuscular disease questionnaire: Rasch validation of the French version.

INTRODUCTION: Slowly progressive, genetic neuromuscular diseases (gNMDs) often lead to important motor deficiencies and functional limitations. The Quality of Life in Genetic Neuromuscular Disease Questionnaire (QoL-gNMD) is a new health-related quality-of-life questionnaire developed for these patients. The purpose of the present study was to validate the French version of the QoL-gNMD and to calibrate its measurement system. METHODS: Both the QoL-gNMD and a validated generic questionnaire (WHOQOL-BREF) were administered to patients. Validation was performed using item response theory. The partial credit model (Rasch) was used to calibrate each domain. RESULTS: Three hundred fifteen adult patients were included. All 3 domains showed adequate psychometric properties (internal consistency: person separation index >0.77; repeatability: test-retest intraclass correlation coefficient >0.75, scalability coefficient >0.38) and fitted the partial credit model. The QoL-gNMD also demonstrated adequate concurrent validity with the WHOQOL-BREF. DISCUSSION: The QoL-gNMD showed adequate psychometric properties and can be used in clinical settings. Although not anchor-based, the minimum detectable change tables help in interpreting score change. Muscle Nerve 56: 1085-1091, 2017.

Theory of Mind Impairments Highlighted With an Ecological Performance-Based Test Indicate Behavioral Executive Deficits in Traumatic Brain Injury.

Background: In view of the recent literature, the negative impact of traumatic brain injury (TBI) on social cognition remains a debated issue. On one hand, a considerable number of studies reported significant impairments in emotion recognition, empathy, moral reasoning, social problem solving, and mentalizing or theory of mind (ToM) abilities in patients with TBI. On the other hand, the ecological validity of social cognition tasks is still a matter of concern and debate for clinicians and researchers. Objectives: The objectives of the present study were 2-fold: (1) to assess social cognition in TBI with an ecological performance-based test which focuses on ToM ability, and (2) to study the relationship between performances on this task and behavioral disorders. To this end, 47 patients with moderate to severe TBI in the chronic stage were assessed with a ToM task, the Movie for the Assessment of Social Cognition (MASC), a film displaying social interactions in natural settings and asking for an evaluation of the emotions, thoughts, and intentions of the characters. Behavioral disorders were assessed with the Behavioral Dysexecutive Syndrome Inventory (BDSI), a structured interview of an informant in assessing changes compared with previous behavior in 12 domains. Results: Patients were significantly less accurate in mental state attribution than a demographically matched group of 38 healthy control subjects. Significant others of patients also reported more behavioral executive problems than controls' relatives on most of the domains of the BDSI. In addition, social cognition performance in the MASC was significantly correlated with behavioral dysexecutive problems rated by proxies on the BDSI. Conclusions: This study is the first to find association between impairments in mentalizing abilities in the MASC and behavioral impairments in patients with TBI, confirming the added value of this ecological task and that the recognition of social signals is a key element for adequate behavioral functioning.

Isotopic scintigraphy combined with computed tomography: a useful method for investigating inefficiency of intrathecal baclofen.

BACKGROUND: Intrathecal baclofen infusion is an established method for the treatment of generalized and disabling spasticity. The most frequent technical problems are due to catheter /pump disconnections, but diagnosis of dysfunction may be difficult. CASE REPORT: We report here the case of a 53-year-old woman with spastic paraplegia treated with intrathecal baclofen. Spasticity remained uncontrolled despite a gradual increase in baclofen dosage. On plain radiographs the distal end of the catheter was found to be pointing downwards with the catheter tip at level L5 and no apparent disconnection or failure. Indium111 diethylenetriamine penta-acetic acid (DTPA) scintigraphy combined with computed tomography revealed that the activity of the radioisotope was highest next to the first sacral vertebra and that there was no leakage. Radioisotope activity above the lumbar level was very low. The catheter tip was therefore repositioned to level T7. One month later, spasticity was well controlled and a second scintigraphy confirmed high activity of intrathecal radioisotope up to the basal cisterns. DISCUSSION: The combination of Indium111 DTPA scinti-graphy with computed tomography allows anatomical and functional investigation of intrathecal drug administration. In this case report this approach showed that the inefficiency of intrathecal baclofen was due to the caudal orientation of the catheter.