Biomedical subjects

Isabelle Benatru

Publications and source records attributed to Isabelle Benatru.

11 recordsLinked to original sources

PubMed2006

Trends in the incidence of transient ischemic attacks, premorbid risk factors and the use of preventive treatments in the population of Dijon, France from 1985 to 2004.

BACKGROUND: We describe the epidemiological trends of transient ischemic attack (TIA) in a 20-year population-based pilot study. METHODS: Trends in the incidence, risk factors and pre-TIA use of preventive treatments for TIA were observed from 1985 to 2004 according to the classic definition in the population of the city of Dijon, France (150,000 inhabitants). RESULTS: The raw and standardized incidence of TIA were stable over time. We observed a significant increase in the mean age at TIA onset in women only. The prevalence of hypercholesterolemia and diastolic blood pressure > or =90 mm Hg among patients with TIA increased significantly. This contrasts with falls in smoking and in history of previous myocardial infarction. CONCLUSION: The stability of classic TIA incidence, despite the rise in the proportion of elderly people, and the increase in the mean age at onset in women may be considered as a medical progress.

Age Distribution↗

PubMed2006

Stable stroke incidence rates but improved case-fatality in Dijon, France, from 1985 to 2004.

BACKGROUND AND PURPOSE: With the progress in stroke prevention, it is important to evaluate the epidemiological trends of strokes over a long period and from a nonselected population-based perspective. METHODS: We estimated changes in incidence, case-fatality rates, severity, risk factors and prestroke use of preventive treatments for first-ever strokes, from a continuous 20-year well-defined population-based registry, from 1985 to 2004. RESULTS: We recorded 3142 ischemic strokes, 341 primary cerebral hemorrhages and 74 subarachnoid hemorrhages. During the 20-year study, the age at first stroke onset increased by 5 years in men and 8 years in women. Comparing the 1985 to 1989 and the 2000 to 2004 periods, age- and sex-standardized incidences of first-ever strokes were stable except for lacunar strokes whose incidence significantly increased (P=0.01) and for cardioembolic stroke whose incidence significantly decreased (P=0.01). Twenty-eight-day case-fatality rates decreased significantly mainly for lacunar strokes (P=0.05) and for primary cerebral hemorrhages (P=0.03). The proportion of hypercholesterolemia and diabetes significantly increased (P<0.01). In contrast, the proportion of myocardial infarction significantly decreased (P=0.02). Prestroke antiplatelets and anticoagulants treatment significantly increased (P<0.01). CONCLUSIONS: The age- and sex-standardized incidences of first strokes in Dijon have been stable over the past 20 years and were associated with an increase in age at stroke onset, a decrease in case-fatality rates, and an increased use of antiplatelet treatments.

Aged↗

PubMed2006

[Consultation after cerebral infarction or intracerebral hematoma].

Hypertension is the principal risk factor for cerebral infarctions and intracerebral hematoma. The brain is the principal target of hypertension. The brain is the principal target of antihypertensive drugs. Controlling blood pressure and stopping smoking reduces the risk of cerebral infarction by 40%. Objectives of a consultation after cerebral infarction or intracerebral hematoma: validate diagnosis and cause, identify risk factors for recurrent cerebral infarction but also for myocardial infarction and lower limb arterial disease, begin treatment of the risk factors for recurrence, begin prevention of atherothrombotic complications and embolic heart disease, identify complications of cerebral infarction and intracerebral hematoma.

Adult↗

PubMed2006

[Air pollution and cardiovascular and cerebrovascular disease: Epidemiologic data].

Recent convergent data suggest that air pollution affects the risk of acute atherothrombotic events including both myocardial infarction and ischemic stroke. The principal epidemiologic studies begun in the 1990s first examined the respiratory effects of atmospheric pollution and then focused on how pollution peaks affected cardiovascular risk. These studies used data from large metropolitan areas in North America and Asia as well as several large European cities to demonstrate the clear existence of a relation between air pollution and cardio- and cerebrovascular mortality. They also observed an increase in hospital admissions for myocardial infarctions and cerebrovascular accidents on days with high air pollution levels. The pollutants involved have not yet been clearly designated, but it appears that fine suspended particulate matter (PM2.5) and gaseous pollutants such as ozone appear to contribute strongly to these harmful effects. A complete analysis of these data shows the need for a thorough evaluation of the cardio- and cerebrovascular risks associated with air pollution, especially in French metropolitan areas. Precise identification of those at high risk from specific pollutants is essential to improve targeting of prevention strategies.

Air Pollutants↗

PubMed2006

[Air pollution and cardiovascular and cerebrovascular disease. Pathophysiologic basis and groups at risk].

The pathophysiologic basis of the harmful action of air pollutants rests principally on their proinflammatory and prothrombotic effects. The principal pollutants currently identified as responsible for these effects are fine suspended particles (PM2.5) and ozone. Inflammatory effects, initially localized in the lungs, then become systemic. Analysis of groups at the highest risk of atherothrombotic events suggests the elderly may be most sensitive to the effects of air pollution.

Age Factors↗

PubMed2006

[Post-stroke depression, another handicap].

INTRODUCTION: Post-stroke depression is a severe complication affecting 30-50% of patients during the first year. Experienced medical and paramedical staff in stroke units, using validated scales, can now identify initial signs of depression in the first days after stroke onset. METHODS: This review of the literature is based on a Medline search for the terms stroke, depression, and epidemiology. It discusses problems of pathophysiology, diagnosis, prognosis, and therapeutics. RESULTS: Depression is an emergency in stroke patients because it impedes rehabilitation and family and social insertion. Early diagnosis is difficult, but possible with clinical somatic and cognitive symptoms. Post-stroke depression may also be a marker of pending cognitive decline. Management requires both antidepressants and psychotherapy. CONCLUSION: There is a pressing need for further research to improve clinical practice in this area of stroke care.

Activities of Daily Living↗

PubMed2005

Can chronic subthalamic nucleus stimulation induce de novo tremor in Parkinson's disease?

Subthalamic nucleus stimulation dramatically improves parkinsonian symptoms, notably the tremor. The occurrence of a tremor in the first 6 months after the surgical procedure in patients without tremor preoperatively is much less common. We report on the cases of 3 patients who developed such modification of their parkinsonian symptomatology. Physiopathological hypotheses are discussed.

Aged↗

PubMed2005

[Specificity of stroke in the elderly: clinical characteristics and impact on care].

Stroke in the elderly differs from stroke in younger adults in several points. It represents the most frequent consequence of atherothrombotic disease associated with hypertension, diabetes and hypercholesterolemia. It is also the main complication of cardiac arrhythmia. From a clinical point of view, epileptic seizure is frequently observed at the onset, and prognosis is darkened by a high risk of dementia occurrence (20%). Management of stroke in acute phase requires intensive care, which has been shown to decrease mortality and handicap by 20% in Stroke Units. Fibrinolysis with rt-PA can be carried out till 80 years. Primary and secondary prevention are still very efficacious in old patients and decrease not only the risk of stroke, but also the risk of dementia. Moreover, influenzae vaccination has been shown to decrease the risk of stroke in the following year in subjects over 65 years.

Acute Disease↗

PubMed2004

Adrafinil-induced orofacial dyskinesia.

We describe the first case of orofacial abnormal movements induced by adrafinil, a vigilance promoting agent of the same pharmacological class as modafinil. The dyskinesias did not spontaneously recover despite adrafinil withdrawal for a 4-month period. They were secondly dramatically improved by tetrabenazine, a presynaptic dopaminergic depleting drug which was introduced after the 4-month adrafinil-free period.

Aged↗

PubMed2004

Trends in utilization of antithrombotic therapy in patients with atrial fibrillation before stroke onset in a community-based study, from 1985 through 1997. From scientific evidence to practice.

BACKGROUND: Despite the significant beneficial effects of antithrombotic therapy in primary prevention of stroke in patients with chronic nonvalvular atrial arrhythmia, this prevention therapy is underutilized. We conducted this population-based study to determine the rates and the trends of utilization of antithrombotic therapy for stroke patients with atrial fibrillation before stroke onset, and to evaluate indirectly the impact of medical recommendations on physician practice. Our aim was not to evaluate the efficacy of such prevention therapy. METHODS: From 2,330 men and women of any age registered for a first-ever stroke from 1985 to 1997 in a community-based study, we selected 599 patients admitted for ischemic stroke or TIA, associated with prior atrial fibrillation. Previous antithrombotic treatment before stroke onset was recorded and we evaluated the ratio of stroke patients who had received antithrombotic treatment for atrial fibrillation, from 1985 through 1997. RESULTS: Our study was performed to evaluate the practice of physicians in the prevention of stroke, and not to evaluate the efficacy of the anticoagulants in the prevention of stroke. Atrial fibrillation before stroke onset was identified in 599 patients. Of these, 222 (37%) received no antithrombotic therapy, 65 (10.8%) received an anticoagulant alone, 147 (24.5%) received an antiplatelet agent alone and 10 (1.7%) received both anticoagulation and antiplatelet treatment. From 1985 to 1988, the proportion of treated atrial fibrillation before stroke was small (14.6%). This increased to 21.5% within the period 1989-1991, to 40.3% within the period 1992-1994 and then to 47.6% within the period 1995-1997. It appears that the most significant change occurred within the period 1992-1994 (14.6% of treated atrial fibrillation within the period 1985-1987 constituted to 40.3% within the period 1992-1994) (P < 0.05), with a current rate of utilization of antithrombotic therapy close to 50%. The logistic regression analysis concerning anticoagulant therapy before stroke onset as a dependent variable, found that the factors independently associated with the use of anticoagulants before stroke were the lack of arterial hypertension and a history of smoking. The factors independently associated with the use of aspirin before stroke were arterial hypertension and lower limb peripheral vascular disease. CONCLUSION: For primary prevention of stroke onset in patients with atrial fibrillation, therapeutic trials have changed medical practices although not to ideal levels because close to 50% of patients with atrial fibrillation experiencing an acute stroke or TIA received antithrombotic treatment. Therefore, clinical practice is inconsistent with the guidelines resulting from therapeutic trials. It is necessary to know the reasons for this inconsistency and to improve medical information about the cerebrovascular risk of atrial fibrillation and the efficacy of anticoagulants in stroke prevention in this condition.

Aged↗

PubMed2003

Atypical propriospinal myoclonus with possible relationship to alpha interferon therapy.

We report on a man who received interferon-alpha 2a therapy for kidney cancer and who subsequently developed propriospinal myoclonus. The myoclonus was noted at rest and during movement. The jerks were reinforced by cutaneous stimuli and tendon taps and spread to the spinal cord via polysynaptic propriospinal pathways. Cerebrospinal fluid analysis, spinal cord magnetic resonance imaging, electroencephalogram with back-averaging, and somatosensory-evoked potentials were normal. No antineuronal antibodies were found. Although the mechanism of interferon neurotoxicity remains unclear, the possible responsibility of interferon was considered, as no focal lesion or paraneoplastic pathology were disclosed.

Antineoplastic Agents↗