[Neuroimaging in pediatric epilepsy]. / L'imagerie par résonance magnétique dans l'exploration des épilepsies de l'enfant.

The main causes of epilepsy in children are cortical malformations (hemimegalencephaly, cortical dysplasia, lissencephaly, etc.) and phakomatosis (tuberous sclerosis, Sturge-Weber disease, neurofibromatosis type 1, etc.), perinatal ischemia, traumatisms, infections, mesial temporal sclerosis, metabolic diseases, and tumors. Imaging indications are precise, including partial seizures and a pathological electroencephalogram. Twenty-five percent of these epilepsy cases are pharmacoresistant. Indeed, MRI is essential to consider surgical treatment, allowing one to localize potential epileptogenic anatomic lesions. The protocol includes sequences in three planes of space, weighted in T1, T2, Flair, T1 inversion-recovery, and T1 after gadolinium injection. MRI findings are characteristic for some tumors, but most malformations are subtle. Consequently recent techniques (spectroscopy, diffusion, etc.) are crucial when conventional MRI is not sufficient. The aim of this article is to illustrate, with a substantive image revue, this wide diversity of etiologies in pediatric epilepsy, in order to help the attendee recognize MRI findings, also discussing the role of newer imaging modalities in this field.

[Economic evaluation of acute paediatric rotavirus gastroenteritis in France]. / Evaluation du coût de la prise en charge pédiatrique des gastroentérites aiguës à rotavirus.

BACKGROUND: Acute paediatric rotavirus gastroenteritis (RVGE) is the leading cause of paediatric gastroenteritis worldwide. The objective of the study was to assess the average cost of a RVGE episode in children between 0 and 5 years in France. METHOD: An epidemiological study performed in Dijon provided the amount of resources used in the case of a RVGE episode. Their evaluation was based on current national local tariffs. Three different care settings were included: RVGE cases taken in charge only by community health care providers, RVGE cases leading to an emergency visit without hospitalisation, and cases leading to hospitalisation. This evaluation considered direct and indirect costs. RESULTS: Ninety-nine children with rotavirus gastroenteritis were included in the epidemiological study, 30 patients after hospitalisation, 50 patients in emergency departments, and 19 were included by physicians. The average French social security costs for one episode of rotavirus gastroenteritis was 1,270 euro for hospitalised cases, 80 euro for emergency cases and 34 euro for community health care cases. The part of costs not reimbursed by the social security was mainly due to loss of productivity. It amounted to 287, 254 and 255 euro for emergency visit cases, hospitalised cases and community health care respectively. CONCLUSION: This cost of disease study demonstrated that paediatric rotavirus gastroenteritis results in high expenditures for the French social security as well as for society. The implementation of a vaccination programme would reduce the economic burden of gastroenteritis disease in France.

Treating hot flushes in menopausal women with homeopathic treatment--results of an observational study.

OBJECTIVE: There is great controversy concerning treatment for menopausal symptoms. We evaluated homeopathic treatments for hot flushes and their effect on quality of life in menopausal women. METHODS: Open, multi-national prospective, pragmatic and non-comparative observational study of homeopathic treatments prescribed and their effectiveness, observing their impact on quality of life. RESULTS: Ninety-nine physicians in 8 countries took part in this study and included 438 patients with an average age of 55. Homeopathic medicines were prescribed to all patients; 98% of the prescription lines were for homeopathic medicines. Lachesis mutus, Belladonna, Sepia officinalis, Sulphur and Sanguinaria canadensis were the most prescribed. A non-homeopathic treatment and/or food supplement prescribed for 5% of the patients. This observational study revealed a significant reduction (p<0.001) in the frequency of hot flushes by day and night and a significant reduction in the daily discomfort they caused (mean fall of 3.6 and 3.8 points respectively, on a 10cm visual analogue scale; p<0.001). Ninety percent of the women reported disappearance or lessening of their symptoms, these changes mostly taking place within 15 days of starting homeopathic treatment. CONCLUSIONS: The results of this observational study suggest that homeopathic treatment for hot flushes in menopausal women is effective. Further studies including randomized controlled trials should be conducted.

Pharmacoeconomic comparison between homeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in children.

OBJECTIVES: A pharmacoeconomic study to compare, in terms of: medical effectiveness, quality of life and costs two treatment strategies ('homeopathic strategy' vs 'antibiotic strategy') used in routine medical practice by allopathic and homeopathic GPs in the treatment of recurrent acute rhinopharyngitis in 18-month to 4-year-old children. METHODS: Statistical analysis of data obtained from a population of 499 patients included in a previous 6-month prospective, pragmatic study. The patients were regrouped according to type of drug prescribed. Medical effectiveness was assessed in terms of (i) episodes of acute rhinopharyngitis, (ii) complications, (iii) adverse effects. Quality of life was assessed using the Par-Ent-Qol scale. Direct medical costs (medical consultations, drug prescriptions, prescriptions for further tests) and indirect medical costs (sick-leave) were evaluated from three viewpoints (society, patient, Social Security) using public prices and French Social Security tariffs. RESULTS: The 'homeopathic strategy' yielded significantly better results than the 'antibiotic strategy' in terms of medical effectiveness (number of episodes of rhinopharyngitis: 2.71 vs 3.97, P<0.001; number of complications: 1.25 vs 1.95, P<0.001), and quality of life (global score: 21.38 vs 30.43, P<0.001), with lower direct medical costs covered by Social Security (88 Euros vs 99 Euros, P<0.05) and significantly less sick-leave (9.5% of parents vs 31.6% of parents, P<0.001). CONCLUSIONS: Homeopathy may be a cost-effective alternative to antibiotics in the treatment of recurrent infantile rhinopharyngitis.

Study of the practice of homeopathic general practitioners in France.

Little is known about the practice of homeopathic general practitioners (GPs) in France. We report a descriptive, cross-sectional study on this subject. The aim was to acquire a clearer idea of (1) the type of patients who consult homeopathic GPs and (2) the type of treatment provided by such GPs, in terms of diagnoses, prescriptions and costs. The survey was carried out on a representative sample of the French homeopathic GP population and covered three seasons of the year. The data was collected by means of a questionnaire which GPs completed for each consulting patient. It emerged that the type of patients who consult homeopathic GPs are chiefly women, between the ages of 20 and 54, living in an urban environment, not in employment, covered by National Health Insurance for Salaried Workers, and belonging to a Mutual Benefit Association. The most common reasons for consultation were ENT disorders, stress and anxiety. The homeopathic GPs mainly used homeopathy to treat these disorders. On average, four medicinal products per patient were prescribed per 2-month course of treatment, for an average reimbursed cost of 3.78 Euros.

Study of the practice of homeopathic general practitioners in France

Little is known about the practice of homeopathic general practitioners in France. We report a descriptive, cross-sectional study on this subject. The aim was to acquire a clearer idea of the type of patients who... (AU)