NUTRISEP: Assessment of the nutritional status of patients with multiple sclerosis and link to fatigue.

BACKGROUND: Fatigue is a common complaint in patients with multiple sclerosis (PwMS) and reduces quality of life. Several hypotheses for the pathogenesis of fatigue in MS are proposed ranging from neurological lesions to malnutrition, but none has been conclusively validated through clinical research. OBJECTIVES: The goal of this study was to examine the correlation between fatigue and nutritional status and dietary habits in PwMS. METHODS: This was a cross-sectional, multicenter study conducted at 10 French MS centers and enrolling PwMS with an Expanded Disability Status Scale (EDSS) score between 0 and 7. Plasma level of albumin, magnesium, calcium, iron, vitamin D and B12 evaluated nutritional status. A semi-structured eating behavior questionnaire has been developed to evaluate dietary habits. Evaluation of fatigue used specific questionnaire (EMIF-SEP). Quality of sleep was evaluated by visual analogue scale (VAS), depression with Beck Depression Inventory (BDI-II); dysphagia by DYsphagia in MUltiple Sclerosis questionnaire (DYMUS) and taste disorders by gustometry. Association between nutritional deficiencies and different data such as socio-demographic data, disease characteristics, swallowing and taste disorders, food intake, depression and sleep quality was investigated. RESULTS: A total of 352 patients mean age: 48.1±10.1 years, mean duration of MS: 15.3±9.1 years and median EDSS: 4 were analyzed. Bivariate and multivariate analyses showed a statistically significant correlation between fatigue and depression and use of sleeping pills, while none of the variables related to dietary habits or nutritional status correlated significantly with fatigue. CONCLUSIONS: Dietary habits and nutritional status have little impact on fatigue and general population nutrition recommendations remain the rule for PwMS. In cases of fatigue, specific attention should be paid to depression and use of sleeping pills.

[Discharge prescription for ischemic stroke patients]. / L'ordonnance de sortie après ischémie cérébrale.

Stroke is a major public health issue: it affects 120 000 people in France each year. The yearly recurrence rate is thought to reach 8 percent. Secondary prevention of stroke is thus crucial and focuses on controlling vascular risk factors most often associated with antiplatelet agents. Therapeutic objectives are set depending on the individual's global cardiovascular risk. The PROGRESS study has shown the relevance of systematic blood pressure lowering using an angiotensin-converting-enzyme inhibitor (perindopril) in combination with a diuretic (indapamide) in secondary prevention of stroke, including in normotensive patients. If possible, blood pressure should be below 130/85 mmHg. Statins are indicated in stroke patients with hypercholesterolemia, coronary heart disease, diabetes mellitus or carotid stenosis, the target LDL-cholesterol level being below 1 g/L (2.58 mmol/L). There is a wide consensus on treating patients with symptomatic carotid stenoses > or = 70 percent by thrombo-endarterectomy and stroke associated with atrial fibrillation by anticoagulants. Management should be global and include changes in dietary behavior, tobacco and/or alcohol withdrawal, and regular exercising. Patient-specific therapeutic education should be offered in order to improve compliance.

[Obsessive-compulsive behavior and progressive supranuclear palsy]. / Comportement compulsif d'allure obsessionnelle et paralysie supranucléaire progressive.

A case of progressive supranuclear palsy characterized by a loss of self-activation and a compulsive behaviour of the obsessive type is reported. The pathological examination was remarkable for the intensity of pallidal lesions and their diffusion to both the external and internal segments. While the loss of self-activation seemed to result from a damaged cortico-subcortical circuit forming a limbic loop, the compulsive behaviour of the obsessive type may have resulted from the interruption of a frontal-caudal-pallidal-luysian circuit.