Biomedical subjects

M De Seze

Publications and source records attributed to M De Seze.

3 recordsLinked to original sources

PubMed2005

[The neurobehavioral rating scale-revised: assessment of concurrent validity].

UNLABELLED: Cognitive and behavioral impairment are a major source of disability in daily living of patients with traumatic brain injury (TBI). The Neurobehavioral Rating Scale-Revised (NRS-R) is a short, easy-to administer interview tool developed to improve assessment by clinicians. Data are available on its criterion validity and reliability, but the concurrent validity of the French NRS-R was not yet documented. OBJECTIVE: To assess the concurrent validity of the NRS-R with current psychometric tests. METHOD: One hundred and four patients with TBI enrolled in a community adjustment program underwent concurrent examination with the NRS-R, cognitive tests assessing memory, attention, and executive functions, and scales of anxiety (STAI) and depressive mood (CES-D). Intercorrelations were undertaken between these variables and the five factors of the NRS-R: F1, intentional behavior; F2, lowered emotional state; F3, survival-oriented behaviour/hightened emotional state; F4, arousal state; and F5, language. Patients were 82 men and 22 women, the mean age was 28.5 years, and 70% had severe TBI (Glasgow coma score [GCS] below 8 on admission). They were assessed 52 months on average after their injury. RESULTS: Factor F1 was correlated with results on the GCS (P<0.05), the Tower of London test (TL, P<0.01), the Trail Making Test (TMT, P<0.01), divided attention (DA) and inhibition (IN) subscales of the Zimmermann and Fimm's Attention battery (TEA) (P<0.01) and reverse digit span (DS, P<0.05). Factor F2 was positively related to age at injury, time since injury (TSI) (P<0.05) and CESD and STAI scores (P<0.001). Factor F3 was related to DA (P<0.01) TL scores and TSI (P<0.05). Factor F4 was related to TL, TMT, DA, flexibility, DS (P<0.05), TSI, duration of post-traumatic amnesia, CES-D score (P<0.05) and STAI scores (P<0.01). Factor F5 was related to GCS, DA (P<0.05), and reaction time on the subscales IN and Go/nogo (GO) of the TEA battery (P<0.01). The NRS-R total score was related to CESD, STAI scores, TMT score, DA (P<0.01) and TL score, IN and GO scores and TSI (P<0.05). DISCUSSION: As McCauley et al found with the English version of the NRS-R, significant relationships were found between NRS-R factor scores, cognitive tests and emotional scales. Relationships were also found between factor scores and indicators of injury severity and time since injury. These data suggest fair concurrent validity of the NRS-R.

Adolescent↗

PubMed2005

Sacral neuromodulation in lower urinary tract dysfunction.

Vesico-urethral dysfunction is a major problem in daily medical practice due to its psychological disturbances, its social costs and its high impact on quality of life. Recently, sacral neuromodulation, namely the electrical stimulation of the sacral nerves, appears to have become an alternative for radical bladder surgery particularly in cases of idiopathic bladder overactivity. The mechanism of action is only partially understood but it seems to involve a modulation in the spinal cord due to stimulation of inhibitory interneurons. Temporary sacral nerve stimulation is the first step. It comprises the temporary application of neuromodulation as a diagnostic test to determine the best location for the implant and to control the integrity of the sacral root. If test stimulation is successful, a permanent device is implanted. This procedure is safe in experienced hands. So-called idiopathic bladder overactivity still the major indication for this technique. Patients not likely to benefit from the procedure were those with complete or almost complete spinal lesions, but incomplete spinal lesions seemed to be a potential indication. This technique is now also indicated in the case of idiopathic chronic retention and chronic pelvic pain syndrome. When selection is performed, more than three-quarters of the patients showed a clinically significant response with 50% or more reduction in the frequency of incontinent episodes, but the results vary according to the author's mode of evaluation. From the economic point of view, the initial investment in the device is amortized in the mid-term by savings related to lower urinary tract dysfunction. Finally, this technique requires an attentive follow-up and adjustments to the electric parameters so as to optimize the equilibrium between the neurological systems.

Afferent Pathways↗

PubMed2003

[Anterior sacral root stimulation with dorsal rhizotomy (Brindley technique)].

Patients with spinal cord lesions are exposed to vesico-sphincter dysfunctions which can aggravate the vital or functional prognosis. The pathophysiological characteristics of these neurogenic bladders explains the usefulness of surgical treatment. The objective of the Brindley technique is to improve both voiding and effective continence. Any patient with a stable supra-sacral spinal cord lesion (paraplegia, tetraplegia) with a reflex bladder (incontinence, vesico-sphincter dyssynergia resistant to medical treatment with the risk of upper urinary tract involvement) can benefit from the Brindley technique. The electrodes are placed on the anterior sacral roots in order to obtain the desired micturation. Posterior sacral rhizotomies are indispensable to the technique as they suppress detrusor and sphincter hyperreflexia and improve continence thereby protecting the upper urinary tract. About 90% of the patients considered have an improved quality of life after implantation of the Brindley stimulator. The bladder capacity was constantly improved and the majority of the patients become continent. Micturation was excellent with low residual volume and low rate of urinary tract infections. Complications are analyzed in this review of the literature. The Brindley technique is an excellent alternative to medical treatment in these highly distressed patients. It restores satisfactory continence and improves psychological as well as economical constraints related to auto/hetero catheterisations performed several times a day.

Combined Modality Therapy↗