Rev Neurol France
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The influence of pregnancy in multiple sclerosis (MS) has been a matter of controversy for a long time. Women with MS were often discouraged to envisage pregnancy. The Pregnancy in Multiple Sclerosis (PRIMS) study was the first large-scale prospective study aimed at assessing the possible influence of pregnancy and delivery on the clinical course of MS. ⋯ It seems unwise therefore to use this kind of model to select women that would benefit from a putative preventive therapy. The PRIMS study had other major consequences: it fostered the development of specific therapeutic strategies to prevent post partum relapses (IV immunoglobulins, IV methylprednisolone), and suggested a potential role of sexual hormones in the natural history of MS during pregnancy and the post partum, therefore identifying them as a preferential target for prevention. The preventive effect of progesterone combined with estradiol on post partum relapses will be tested in a large-scale randomized and placebo-controlled European trial, the POPART'MUS study.
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Multiple sclerosis (MS) has been described for more than a century, but its cause remains unknown. Numerous reports have been written concerning borderline types of the disease. In the present paper we present the pseudo-tumoral variants of MS (so called Balo's, Marburg's and Schilder's forms), demographic variants (young and elderly onset of MS), related disorders (neuromyelitis optica and acute demyelinating encephalomyelitis). We also discuss the differential diagnosis with other auto-immune diseases.
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The cramp-fasciculation syndrome is a rare clinical entity in comparison with the frequency of cramps and isolated fasciculations in the general population. It is recognized as a benign syndrome without weakness and atrophy, however a few reports suggest that it may precede the occurrence of a motor neuron disease. Most often, the cramp-fasciculation syndrome is idiopathic and may be a component of a hyperexcitable peripheral nerve syndrome including other activities such as myokymia and neuromyotonia where antibodies to voltage-gated potassium channels (VGKCs) appear to be one of the effector mechanisms. ⋯ The central nervous system is also concerned with anti-VGKC antibodies found in Morvan's disease and limbic encephalitis which is often a paraneoplastic condition. These findings extend the spectrum of the anti-VGKC syndrome that may be associated with other auto-immune diseases, chiefly myasthenia gravis with thymoma. Carbamazepine and phenytoin cause reduction of the clinical and electrophysiological signs of the nerve hyperexcitability, and plasmapheresis and (or) immunosuppressors are useful when an auto-immune origin is considered.
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Review Historical Article
[Peripheral nerve repair: 30 centuries of scientific research].
Nerve injury compromises sensory and motor functions. Techniques of peripheral nerve repair are based on our knowledge regarding regeneration. Microsurgical techniques introduced in the late 1950s and widely developed for the past 20 years have improved repairs. However, functional recovery following a peripheral mixed nerve injury is still incomplete. ⋯ This review presents the recent advances in understanding of neural regeneration and their application to the management of primary repairs and nerve gaps.
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Migraine is a heterogeneous condition both clinically and genetically. Genetic and environmental factors are involved in migraine with and without aura. In most cases, genetic susceptibility has a polygenic pattern of inheritance with the exception of familial hemiplegic migraine (FHM) which is a mendelian, autosomal dominant, condition. ⋯ These two genes do not seem to be involved in the other forms of migraine. A number of association and linkage studies have pointed to several loci and/or genetic variants. However most of these data need confirmation.