Rev Neurol France
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Brain death diagnosis is based upon several clinical and paraclinical criteria that have been legally defined. There is a medico-legal protocol when brain death diagnosis is made in order to allow organ removal for a possible transplantation. ⋯ However all the criteria have been made using conventional paper EEG, while numerized is now used. The comparison of EEG recording using both analogical and numerised acquisition allow us to report several recommendations to use EEG for brain death diagnosis.
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Pain is an unpleasant and intrusive sensation, warning of actual or potential tissue damage. Over the last fifteen years, functional cerebral imaging research has demonstrated the involvement of many cerebral structures in the experience of pain. ⋯ This close anatomical relationship between pain and emotions circuits could explain the powerful emotional impact of pain as well as the reciprocal modulatory effect of emotions on pain observed in clinical and experimental studies. More specifically, this modulatory effect might reflect interactions between emotional and nociceptive systems in the prefrontal and cingulate cortices, ventral striatum, amygdala and hippocampal regions. Taken together, these observations further attest to the emotional nature of pain experience.
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In the intensive care unit (ICU) patients sometimes develop diffuse neuromuscular deficit resulting in flaccid tetraparesia with a more or less severe prognosis. ⋯ The contribution of myopathic processes in ICU-acquired paresis is probably underestimated. Direct muscle stimulation enables better understanding of the mechanisms underlying acquired motor deficit in ICU patients. However, it remains to be determined whether this refinement could have a significant impact on prognosis and treatment.
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Amyotrophic lateral sclerosis is a neurodegenerative disease, without any curative treatment. Clinical expression is variable and related to loss of motor neurons in the cortex, brain stem and spinal cord. ⋯ Only stretching exercises, proprioceptive neuromuscular facilitation techniques and functional mobility training seem to have a real benefit in terms of spasticity, quality-of-life and pain. The main objective of physical therapy appears to be the preservation of optimal quality-of-life throughout the course of this incurable degenerative disease.
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Involvement of respiratory muscles is a nearly constant feature of neuromuscular disorders, leading to respiratory failure. A careful respiratory follow up adapted to the variable time course of each disease is therefore mandatory. As the first step, a systematic clinical evaluation is essential to detect the subtle respiratory symptoms and signs related to respiratory muscle failure. ⋯ A screening nocturnal oxymetry is useful to detect sleep apneas and hypoventilation. Criteria defining significant desaturations remain however controversial. Suspicion of obstructive sleep apnea syndrome on clinical grounds or oxymetry findings should be confirmed by a conventional polysomnography.