Pain Modulation Mechanisms in ASD Adults.

We tested endogenous pain modulation mechanisms in adults with autism spectrum disorders (ASD). Nineteen ASD adults without intellectual disabilities were included, matched with 19 healthy volunteers on the basis of sex and chronological age. An experimental pain model was used to measure excitatory and inhibitory pain mechanisms in a single session. Statistical analyses indicated that endogenous pain modulation mechanisms in ASD group did not differ significantly from those of healthy adults. The pain scores were very disparate in ASD group with a greater range of extreme scores than in control group. Unlike schizophrenic patients, there was no systematic dysfunction of endogenous excitatory pain modulation mechanisms, but the high variability requires to be wise to interpret the results and formulate conclusion.

[A bilateral diaphragmatic paralysis due to Parsonage and Turner syndrome--its evolution over eight years]. / Paralysie diaphragmatique bilatérale imputable à un syndrome de Parsonage-Turner. Evolution à huit ans.

The diaphragmatic paralysis is a rare disease whose causes and evolving forms are numerous. We report the development to eight years of paralysis diaphragmatic bilateral attributed to a Parsonage-Turner syndrome: the lack of recovery is proved by respiratory functional follow-up. The therapeutic possibilities, limited, are discussed.

[Perineural fibrosis of the median nerve at the wrist. Treatment by neurolysis and dermal-hypodermal graft]. / Fibrose périneurale du médian au poignet. Traitement par neurolyse et greffon dermo-hypodermique.

UNLABELLED: In the treatment of multiple recurrences of carpal tunnel syndrome due to fibrosis, following repeated nerve release, the authors propose interposition of a composite dermal fat graft raised from the inguinal region, and report four clinical cases using this technique. The objective of this study was to evaluate the efficacy of the graft in terms of clinical and electromyographic results and determine the course of the graft by a postoperative MRI study and a longer follow-up. CLINICAL RESULTS: Nocturnal paraesthesiae resolved in 2 patients, was improved in one patient and remained unchanged in another patient. Objectively, neurological examination showed improvement in 3 cases and no change in 1 case. Electromyographic results: At last follow-up, EMG was improved in only one case. Magnetic resonance imaging: MRI visualized the graft with a fat signal on T1-weighted sequences in every case, with an increase in size over time in 3 cases. The efficacy of the dermal fat graft may seem disappointing, as none of the patients were cured. However, with a mean follow-up of more than two years, we have not observed any deterioration of the clinical features, and no surgical revision for carpal tunnel syndrome. This technique appears to increase graft survival, as the blood supply to the subdermis is restored more rapidly via the dermis, which is anatomically a very vascular tissue. There is nevertheless a discrepancy between the clinical results, and EMG and MRI findings, which could be explained by the anatomical lesion of the median nerve, surgically released several times, and by alterations of the perineurium.

Assessment of a newly recognized association. Carotid sinus hypersensitivity and denervation of sternocleidomastoid muscles.

BACKGROUND: Carotid sinus syndrome has been reported recently to be associated with chronic denervation of the sternocleidomastoid muscles. To further understand the relationship between carotid mechanoreceptors and sternocleidomastoid denervation, the present study investigated the relation between the results of carotid sinus massage and electromyographic activity of the sternocleidomastoid muscles in patients without syncope. METHODS AND RESULTS: Patients were selected prospectively if they fulfilled strict exclusion criteria, particularly the absence of a history of syncope, pacemaker implantation, or drugs known to modify the behavior of the autonomic nervous system. A right and left carotid massage was performed for 10 seconds in 30 patients (22 men; mean age, 67.3 +/- 6.5 years). The results (monitoring for heart rate and blood pressure) were classified as normal, doubtful, or hypersensitive carotid sinus. Sternocleidomastoid electromyography activity was recorded from the right and left sides, and the results were classified as normal, moderate denervation, and severe denervation. Carotid sinus massage was normal in 13 patients (43%), doubtful in 9 (30%), and abnormal in 8 (27%). Electromyographic activity of the sternocleidomastoids was normal in 13 patients (43%) and revealed moderate denervation in 7 (24%) and severe chronic denervation in 10 (33%). The results of carotid sinus massage and sternocleidomastoid electromyography were highly concordant in each patient (kappa = .592, P < .00001) and in each side (right, kappa = .381, P < .03; left, kappa = .390, P < .01). CONCLUSIONS: Carotid sinus hypersensitivity and chronic denervation is a common finding in individuals older than 50 years of age. These two entities are significantly related, suggesting a pathophysiological relation of one to the other.

New insights into the pathophysiology of carotid sinus syndrome.

BACKGROUND: The pathophysiology of carotid sinus syndrome remains poorly understood. Currently, two main hypotheses are provided: a lesion at the level of carotid sinus receptors or a central defect at the level of the nuclei of the autonomic nervous system. The objective of our study was to present arguments in favor of one of these two hypotheses. METHODS AND RESULTS: Test selection was guided by the following hypothesis: a degenerative central or local lesion could be associated with dysfunctions in the structures surrounding or comprising the baroreflex centers or their pathways. To test this hypothesis, brain stem auditory-evoked potentials; somatosensory-evoked potentials; blink reflexes; sympathetic skin responses; and styloglossus, sternocleidomastoid, and superior trapezius muscle electromyography were systematically performed from the right and left sides in 17 patients with carotid sinus syndrome and in 17 sex- and age-matched control subjects. Similar responses were found in the two groups for the "central" tests. Contrasting with this result, the electromyographic analysis of the sternocleidomastoid muscle differed significantly between the groups: 13 (76%) had pathological responses in the carotid sinus syndrome group compared with only 4 (23.5%) in the control group (P < .01). Furthermore, the abnormality was found on the right and left sides in 9 patients (53%) in the study group and in none of the control group (P < .005). CONCLUSIONS: This study strongly suggests that the neuromuscular structures surrounding the carotid mechanoreceptors are involved in the carotid sinus syndrome; however, the exact mechanism remains speculative.

[Presymptomatic injury of the recurrent laryngeal nerve in benign thyroid disease: contribution of electromyography]. / Atteinte récurrentielle présymptomatique au cours d'affections bénignes de la thyroïde: apport de l'électromyographie.

Diagnosis of recurrent laryngeal nerve palsy is usually possible through a clinical, laryngoscopical and electromyographical approach, but at a critical stage of the nerve injury. We observed four cases of benign thyroïd tumoral processes with a preoperative electromyographic examination showing neurogenic abnormalities in the thyroarytenoid muscle without any clinical symptoms. We presume that only laryngeal electromyography permits the diagnosis of mild, even asymptomatic laryngeal recurrent nerve injury. A recurrent laryngeal nerve palsy occurs in thyroid tumors, most often in malignant conditions, rarely in benign ones. Nevertheless early forms of nerve injury with benign thyroïd pathology could be underrated. Since the functional prognosis of symptomatic laryngeal nerve palsy is doubtful, laryngeal electromyography, through its ability to diagnose early nerve injury, provides helpful indications in thyroïd benign tumoral diseases for the therapeutic decision.

[Central pontine myelinolysis disclosed by severe pseudobulbar syndrome without motor involvement of the limbs]. / Myélinolyse centro-pontine révélée par un syndrome pseudo-bulbaire sévère sans atteinte motrice des membres.

A young alcoholic man, receiving diuretics, developed a marked pseudo bulbar syndrome after rapid correction of hyponatremia. Magnetic resonance imaging demonstrated a central pontine myelinolysis, associated with extra-pontine lesions in both thalami. The patient fully recovered, despite persistent radiologic abnormality.