Register-based incidence of multiple sclerosis in Brittany (north-western France), 2000-2001.

OBJECTIVES: To report on multiple sclerosis (MS) incidence in Brittany, north-western France. MATERIALS & METHODS: From 2000, we set up a population-based register for patients presenting a putative incident MS (PIMS), that is first symptoms compatible with MS onset. We used 3 medical sources of case ascertainment (neurologists, CSF, regional MS-Clinic). Eligibility criteria required both clinical onset and being permanent resident of Brittany in 2000 or 2001. From 2010, all medical records were tracked, the 10-year follow-up allowing previously reported data to be updated. RESULTS: Of 313 eligible PIMS, there were 208 definite MS (both McDonald and Poser criteria), 41 CIS-probable MS (Poser criteria), 32 CIS-possible MS and 32 non-MS. Our incident cohort of 249 MS cases with definite/probable MS (sex ratio 2.95) gave a crude annual incidence of 4.28 per 100,000 inhabitants (6.22 for women, 2.23 for men), and age-standardized rates (adjustment to the European population) of 4.41 [3.32-5.51], 6.68 [4.75-8.60], and 2.21 [1.12-3.31], respectively. Age-specific rates by gender and initial course showed that attack onset MS peaked at 25-29 years and progressive onset MS at 40-44 years in women (20-24 years and 45-49 years in men, respectively). CONCLUSIONS: Brittany is confirmed a high-risk region for MS. Our data show marked differences in sex-specific pattern of MS incidence by clinical course and point out 25- to 29-year-old women as having the highest MS risk. While temporal variations cannot be excluded, comparison with overall French data suggests that other factors rather than latitude may influence the MS risk in France.

[Dorsal medulla oblongata stroke after a wasp sting]. / Infarctus dorsal du bulbe dans les suites d'une piqûre de guêpe.

INTRODUCTION: Although wasp stings can cause local reactions such as pain, flare, edema, swelling and severe reactions, including anaphylaxis; neurological vascular complications are rare. CASE REPORT: We report a case of a 36-year-old male who developed focal neurological symptoms after a wasp sting. The brain MRI showed an infarct in the left dorsal medulla. The blood test has showed an elevated level of venom-specific IgE antibodies and the skin test with wasp venom was highly positive. Improvement occurred rapidly after treatment with methylprednisone. The postulated mechanisms include vasoconstriction and platelet aggregation secondary to an injection of distinct allergens contained in wasp venom. CONCLUSION: It would thus be important to ask patients about any recent wasp sting, in order to provide appropriate treatment.

Effects of nicardipine and clonidine on cognitive functions and electroencephalography in hypertensive patients.

The aim of this study was to investigate the cognitive and electroencephalography (EEG) short-term effects of a calcium antagonist, nicardipine, compared to placebo and clonidine (which, having known sedative effects, acted as a negative control) for 15 days in elderly hypertensive patients with memory complaints. Nicardipine and clonidine were compared with placebo in a double-blind, randomized, three-way cross-over controlled study after a 2-week placebo run-in period. This was a phase II clinical study carried out on out-patients in a single research centre. Fifteen elderly (63 +/- 10 years) hypertensive patients, without dementia but with memory complaints, were included. Psychomotor performance and cognition were assessed using both an extensive battery of validated psychometric tests (which evaluated attention and vigilance, body sway and memory) and an EEG profile. Cardiovascular parameters measured were blood pressure and heart rate. No detrimental effects of nicardipine were found on attention, vigilance, body sway or memory. Nicardipine produced a significant increase in alpha EEG energies, which may indicate possible alerting effects. In contrast, clonidine induced well-known deleterious sedative effects in psychometric tests and in EEG analysis (decrease in alpha and increase in delta and theta waves). The two drugs produced equivalent decreases in blood pressure at steady state. In conclusion, clonidine induced well-known sedative effects, while nicardipine did not impair central nervous system activity and may have had some short-term alerting effects in elderly hypertensive patients with memory complaints. This study supports the hypothesis of a dissociation between blood pressure and direct drug effects on the central nervous system.

[Mild Cognitive Impairment: potential therapeutics]. / Le déclin cognitif modéré ou le mild cognitive impairment (MCI): perspectives thérapeutiques.

Mild Cognitive Impairment (MCI) is an emerging concept used to describe memory decline and probably attention disturbances in otherwise intellectually intact individuals. MCI may be considered in 12 to 15 p. 100 of the cases as announcing an Alzheimer's Disease (AD). Although still speculative, the debate concerning the drugs susceptible to normalize symptoms of MCI or to stop conversion to AD must be raised. For that purpose, several long term clinical trials are running (antioxidants, nootropics, anticholinesterasics.) and new molecules in the pipe-line should be assessed in patients with the diagnosis of MCI.

Fourier Transform Spectroscopy of the O(2) Herzberg Bands. III. Absorption Cross Sections of the Collision-Induced Bands and of the Herzberg Continuum.

Absorption spectra of molecular oxygen were measured in the laboratory under temperature and pressure conditions prevailing in the Earth's atmosphere. Spectra of pure O(2), O(2) + N(2), and O(2) + Ar were recorded in the 41 700 to 33 000 cm(-1) region (240-300 nm) at a maximal optical path difference of 0.45 cm using a Fourier transform spectrometer and a multiple reflection gas cell. The different components of the spectra, namely the discrete bands of the three Herzberg systems, the Herzberg continuum, and the collision-induced diffuse Wulf bands, were separated. The contribution of the Herzberg bands was first subtracted using the line parameters determined previously [A. Jenouvrier, M.-F. Mérienne, B. Coquart, M. Carleer, S. Fally, A. C. Vandaele, C. Hermans, and R. Colin, J. Mol. Spectrosc. 198, 136-162 (1999)] from high-resolution data. Spectra recorded at various pressures then made it possible to determine by linear regression the intensity of the Wulf bands and the Herzberg continuum. The characteristics of the Wulf bands have been investigated in details: vibrational analysis, pressure effect, foreign gas effect, and a simulated spectrum are reported. The Herzberg continuum cross section is determined below the dissociation limit. A comparison with literature data is given. The new O(2) absorption cross sections and O(2)-O(2) collision-induced absorption cross sections are useful in connection with atmospheric measurements of ozone and other trace gases in the UV spectral region. Copyright 2000 Academic Press.

Fourier Transform Spectroscopy of the O(2) Herzberg Bands.

From absorption spectra obtained at high resolution by coupling a Fourier transform spectrometer to a long-path multiple reflection cell [A. Jenouvrier, M.-F. Mérienne, B. Coquart, M. Carleer, S. Fally, A. C. Vandaele, C. Hermans, and R. Colin, J. Mol. Spectrosc. 198, 136-162 (1999)] the intensities of the O(2) Herzberg bands (A(3)Sigma(+)(u)-X(3)Sigma(-)(g), c(1)Sigma(-)(u)-X(3)Sigma(-)(g), A'( 3)Delta(u)-X(3)Sigma(-)(g)) have been studied at ambient temperature. The integrated cross section values are given for the lines of the (v'-0) bands in the A(3)Sigma(+)(u)-X(3)Sigma(-)(g), c(1)Sigma(-)(u)-X(3)Sigma(-)(g), and A'( 3)Delta(u)-X(3)Sigma(-)(g) transitions with v' = 0-11, v' = 2-19, and v' = 2-12, respectively. The band oscillator strengths have been deduced and transition moments have been calculated. The total absorption values in the region of the Herzberg bands together with the photoabsorption values determined previously above the dissociation limit can be modeled by a single curve, in agreement with the continuity relationship of the cross sections through the dissociation limit. Copyright 2000 Academic Press.

Absorption cross-sections of atmospheric constituents: NO2, O2, and H2O.

Absorption spectroscopy, which is widely used for concentration measurements of tropospheric and stratospheric compounds, requires precise values of the absorption cross-sections of the measured species. NO(2), O(2) and its collision-induced absorption spectrum, and H(2)O absorption cross-sections have been measured at temperature and pressure conditions prevailing in the Earth's atmosphere. Corrections to the generally accepted analysis procedures used to resolve the convolution problem are also proposed.

[A focus of multiple sclerosis in Bretagne: HLA markers and evaluation of consanguinity]. / Etude d'un foyer de sclérose en plaques en Bretagne: marqueurs HLA et évaluation de la consanguinité.

In a previous study, we established the overall prevalence of multiple sclerosis at 25 per 100,000 inhabitants in the French province of Brittany and found that the geographical distribution was uneven with four circumscribed high prevalence areas with more than 45 per 100,000. We conducted the present study to try to ascertain whether the existence of such clusters of MS could be explained by genetic factors, using two ways: the major histocompatibility markers and the frequency of intermarriage. Among the four areas of high prevalence, we examined the one with the highest prevalence, exempt from migratory movements over the last 100 years. We compared this studied population to a sample of 1005 healthy unrelated individuals coming from all over Brittany, designated as general Brittany population. A large sampling (about 25%) of the population accepted to take part in the study. Regarding HLA markers, we observed in the high prevalence area an increases percentage of B7, B8, B12, DR4 and a decreased percentage of B5, compared with the Brittany control population. The consanguinity coefficient in the population of high MS prevalence area was steadily much higher than the one in neighbouring areas with a low MS prevalence during a long period from 1896 to 1945. Under the reserve of non-randomized sampling of individuals for HLA marker study, our findings yielded a double argument in favor of genetic factors influencing the presence of clusters of MS cases: the particularities of HLA phenotype pattern and the increased consanguinity coefficient. The particularities of HLA polymorphism observed in the high prevalence area are likely to be the consequence of the intermarriage habits of this population.

[Long-term immunosuppression in multiple sclerosis: evaluation of treatments begun before 1972]. / Immunosupression au long cours dans la sclérose en plaques: évaluation des traitements commencés avant 1972.

Multiple sclerosis patients have been continuously treated by azathioprine. Only severe progressive forms were selected. The protocol of inclusion and follow-up is detailed. All cases started before 1972 have been reviewed, i.e. 102 cases. Of these 102, 35 stopped azathioprine during the first years and the reasons for this drop-out are analysed. Sixty seven treatments have been maintained for more than 5 years. An evaluation of these 67 patients through the Kurtzke scale shows that the 40 cases with a remittent progressive course have been stabilized as long as they were under treatment. Relapses were observed after discontinuing the therapy. In such cases azathioprine was restarted, leading again to stabilization. Twenty seven cases following a continuous progressive course at the time azathioprine was started showed no evidence of a benefit and kept on worsening. Complications related to treatment (as observed on 240 patients from 1967 to 1982) are detailed with special reference to infections, liver disease and malignancy. Even if the results observed on the course of severe remittent progressive forms of MS are in favor of continuous therapy by azathioprine, this should not be extended to all cases of MS at their first manifestation. It has to be limited to rapidly worsening cases, appreciated after a period of evaluation, when a threatening loss of autonomy may justify some limited risks.