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Short lasting
unilateral nevralgiform headache with conjunctival
injection and tearing
or SUNCT
syndrome
The trigeminal autonomic cephalgias (TACs) are a
group of primary headache disorders characterised by
unilateral trigeminal distribution pain that occurs in
association with ipsilateral cranial autonomic features.
This group of headache disorders includes cluster
headache, paroxysmal hemicrania and short-lasting
unilateral neuralgiform headache attacks with
conjunctival injection and tearing (SUNCT
syndrome). Despite their similarities, these
disorders differ in their clinical manifestations and
response to therapy, thus underpinning the importance of
recognising them.
SUNCT is a headache syndrome characterized by
short-lasting (usually 15-120 sec), unilateral head pain
paroxysms localized in the peri-ocular area, accompanied
by conjunctival injection, lacrimation, nasal stuffiness,
rhinorrhea, and subclinical forehead sweating, all on the
symptomatic side. Attacks are especially triggered by
touching the supraciliary and upper palpebral areas, and
by mastication, laughter,
yawning, and lateral
head movements.
The attack frequency varies from less than one attack
daily to more than 60 attacks per hour. The attacks are
predominantly diurnal, although frequent nocturnal
attacks can occur in some patients. The mean age at onset
is 50 years. Most patients are thought to have no
refractory periods. Episodic and chronic forms of SUNCT
exist.
Concerning the pathophysiology of SUNCT, hypothalamic
involvement ipsilaterally to the pain has been suggested
based on the clinical features and one functional imaging
case report.
Lamotrigine (125 to 200 mg daily), obtains a complete
remission in 20% of the patients and a substantial
reduction of attack frequency in about 80%. Surgery of
the trigeminal root and microvascular decompression
surgeries fail usally to give any benefit (see exception).
Céphalées
trigémino-autonomiques avec injection
conjonctivale et larmoiement
ou SUNCT
Syndrome
Les névralgies faciales regroupent des
syndromes d'hyperalgie caractérisés par des
zones douloureuses de la face reproduisant la
distribution anatomique des branches du trijumeau. Pour
certaines s'y associent des symptômes
neurovégétatifs. Malgré leur
parenté de localisation, il est possible de
distinguer différents tableaux en fonction du
déroulement de la crise, de l'évolution
dans le temps des épisodes algiques, de leurs
sensiblités différentes aux
traitements.
Le SUNCT syndrome est caractérisé par
des décharges paroxystiques brèves (15
à 120 s) unilatérales, localisées
à l'aire périorbitale, avec injection
conjonctivale larmoiement, congestion nasale obstructive
homolatérale et rhinorrhée, une
perspiration sudorale de la joue. Les attaques sont
déclenchées par le frottement
cutanée de la région du sourcil, de la
paupière supérieure, par la mastication,
les
bâillements,
les inclinaisons de la tête.
Ces paroxysmes peuvent se reproduire de façon
très variable, de une fois par jour à une
soixantaine à l'heure. Ils surviennent
essentiellement le jour, rarement la nuit. Le
début de ce trouble apparait le plus souvent au
cours de la sixième décade de vie.
Habituellement, aucune période réfractaire
n'existe.
D'un point de vue physiopathologique, l'hypothalamus
ipsilatéral parait impliqué d'après
la clinique et un travail d'imagerie fonctionnelle.
La lamotrigine (125 à 200 mg par jour) domme
une rémission complète chez 20% des
malades, et réduit la fréquence et la
sévérité des crises chez 80%. Le
plus souvent la chirurgie de décompression
vasculaire du V est inefficace. (Voir une exception)
Sjaastad
O, Kruszewski P. Trigeminal neuralgia and "SUNCT"
syndrome: similarities and differences in the clinical
pictures. An overview." Funct Neurol 1992;7(2):
103-107.
Matharu
MS, Cohen AS et al. Short-lasting unilateral
neuralgiform headache with conjunctival injection and
tearing syndrome: a review. Curr Pain Headache Rep
2003;7(4): 308-318.
Quelquefois nul prodrome n'annonce l'accès;
d'autrefois il est précédé par des
sensations sourdes d'un genre particulier dans le lieu
affecté, qui s'animent ensuite insensiblement; des
vibrations douloureuses, qu'on peut comparer à des
traits électriques, se font ensuite sentir dans
cette partie, d'où elles s'irradient en divers
sens, et simulent l'impression que ferait un instrument
tranchant qui parcouroit la même route.
Pendant la durée de l'attaque, les sourcils
sont froncés, les paupières fortement
rapprochées, la commissure des lèvres d'un
côté retirée vers l'oreille, comme
dans le ris sardonique, la mâchoire
inférieure immobile; il y a quelques fois chaleur
et rougeur vive à la pommette; la respiration est
lente et comme suspendue; souvent le malade s'interdit le
moindre cri, le plus léger mouvement dans
l'appréhension d'augmenter ou de prolonger ses
souffrances: il est, pour ainsi dire, dans un état
extatique.
Cette scène de convulsions et de douleurs se
renouvelle par saccades à des intervalles plus ou
moins rapprochés; les douleurs sont souvent
atroces et déchirantes [...] Lorsque le
tic s'est fixé sur l'oeil, un état
convulsif s'en empare; il devient douloureux, rouge
larmoyant....
The increased number
of yawns after tooth injuries in rats
Early changes in spontaneous behaviour (exploration,
grooming, freezing, rearing, jaw motion, yawning)
and body weight were measured at two and three days after
pulp exposure injury and implantation of Fluorogold (FG)
into molar teeth of rats.
Rats with FG and injuries to three teeth gained
weight less rapidly, explored less frequently and froze
more often than sham-operated rats. Yawning was
not observed in any rats prior to surgery and it was seen
more frequently in tooth-injured rats than in
sham-operated rats.
These results suggest that careful observation of
spontaneous behaviour after tooth injuries can be used to
assess dental pain in rats and may provide behavioural
markers to correlate with anatomical changes after
injury. The dental nerve cell bodies that had accumulated
transported FG were medium to large, and they only
co-localized calcitonin gene-related peptide (CGRP) in a
subset of the medium neurons. Chromatolytic or moribund
FG-labelled neurons were also found.
"A unique observation was
the increased number of yawns seen after tooth
injuries. Although the significance of yawning
following tooth injuries is unclear, it may be related to
stress. Yawning can be elicited in horses by
abdominal stress and in rats by foot shock stress.
Yawning is also a
symptom of some migraine
headaches in humans.
It is unlikely that the yawns after tooth injuries
were caused by damage to the jaw or temporomandibular
joint or to stress of the novel testing environment
because sham-operated rats did not yawn. Moreover,
because rats do not yawn following infraorbital
nerve injury, it is likely that yawning is made in
direct response to sensory information from the tooth.
The use of a rat strain
that displays a high frequency of yawning may help
resolve this question because such animals might display
a higher number of yawns following tooth injuries
and reduce the variability of this behavioural
marker."
Augmentation du
nombre des bâillements après extractions
dentaires chez le rat
Ce travail analyse le comportement de rats ayant subi
une extraction dentaire, afin de pouvoir décrire
un modèle animal de la douleur dentaire et du
stress secondaire à une extraction.
Alors que les rats, avant les soins dentaires, ne
présentaient que d'exceptionnels
bâillements, après extraction, des
bâillements répétés sont
apparus être le signe le plus constant
révélant la douleur et le stress. Comme le
suggère l'article ci-dessous, chez le cheval
également, douleurs et stress engendrent des
bâillements répétés. On peut
peut-être comparé ce comportement avec les
bâillements répétés
accompagnant la migraine
humaine.
Endogenous opioid
peptides have been implicated in the regulation of
pain perception, behavior, gastrointestinal activity and
other physiological responses. However, the functional
role of these peptides in the horse
has yet to be
elucidated. The opioid antagonist, naloxone, is often
administered to infer endogenous opioid effects.
In the present study,
naloxone (0.75 mg/kg bodyweight) was administered to
eight Thoroughbred racehorses and a number of behavioural
and autonomic responses were measured. Naloxone produced
rapid onset diarrhoea, restlessness, abdominal checking,
tachycardia, tachypnoea, paradoxical yawning and
diaphoresis.
These responses described
an acute abdominal distress syndrome similar to spasmodic
colic. Results from this study suggest that, in the
horse, endogenous opioids:
1) influence
behaviour
2) modify intestinal
activity and sensation
3) if perturbed, may be
involved in pathophysiology of colic.
Les peptides
opioïdes endogènes sont impliqués
dans la régulation de la perception douloureuse,
certains comportements, la motricité
gastrointestinale et d'autres processus physiologiques.
Jusqu'à présent, peu de recherches les ont
étudiés chez le cheval. La naloxone,
antagoniste opioïde, est souvent utilisée
comme modificateur d'effet. Dans cette étude, la
naloxone a été administrée à
des chevaux. Le comportement et différents
paramètres témoins de l'activité
autonomique ont été colligés.
Rapidement après l'injection, sont apparus de la
diarrhée, une agitation, une tachycardie, une
tachypnée, des bâillements
paradoxaux, une transpiration
profuse.
Neuroendocrine
correlates
of sleep
wakefulness
Cardinali DP.
Pandi-Perumal SR.
As the title suggests, and unlike other existing books on
sleep medicine,
Neuroendocrine correlates of sleep wakefulness
will be devoted primarily to endocrine regulation of the
behavioral state control.
It will address a wide spectrum of sleep./wakefulness
phenomena (both animals and humans), including
pathogenesis, diagnosis, and management. From molecular
biology to applied clinical therapy, sleep research has
been transformed in the last few years from a research
backwater to an important interdisciplinary field. Anyone
who regularly reads the literature on sleep, biological
rhythms, or neuroendocrinology is aware that one of the
subspecialties within sleep medicine, the neuroendocrine
correlates of sleep/wakefulness, has in particular
experienced a growth rate that is even faster than that
of the field as a whole. To a significant extent this has
been attributed to the introduction of new research
technologies.
The widespread adoption of a range of new methods in
sleep research has opened a window of opportunities to
explore at the cellular and molecular level, which
previously had been tightly closed. Therefore,
this volume promises to provide an exceptional
single source of detailed information related to this
topic. It will thereofre be of interest to advanced
graduate students and specialists in the field of sleep
medicine, neuroendocrinology, psychiatry, psychobiology
and neurobiology. The editors have selectively
identified a number of key articles having a citation
frequency, which is considerably above the norm or which
otherwise have contributed importantly to defining the
neuroendocrine perspective.
This new volume on Neuroendocrine Correlates of
Sleep/Wakefulness is an up-to-date resource of research
summaries and reviews written by major contributors to
the fields of sleep, biological rhythms and
neuroendocrinology. Its coverage is broad and its basic
and clinical science reviews are detailed. In this
volume, an international team of experts discuss their
latest ideas, concepts, methods, and interpretations with
supporting examples.
Comme son titre le suggère,
Neuroendocrine
correlates of sleep wakefulness est un livre
consacré préférentiellement à
une mise au point des connaissances sur les
régulations hormonales des mécanismes de
l'éveil et du sommeil.
Il couvre un large spectre de travaux, tant chez
l'animal que chez l'homme, de l'échelle
moléculaire et cellulaire jusqu'aux comportements.
Il témoigne de la vitalité de la recherche
dans un domaine largement interdisciplinaire tel les
rythmes biologiques, l'éveil et le sommeil normaux
et pathologiques. Ecrit par une équipe d'experts
internationnaux, leaders dans leur domaine, ce livre est
une mise au point novatrice et pertinente.
A noter le chapitre consacré au syndrome
de Smith Magenis, rédigé par Dr H. De
Leersnyder, pédiatre à Paris, qui a
réussi à trouver un traitement
pharmacologique de cette maladie génétique
(ce qui est exceptionnel).
Pingfu Feng, de l'université de Cleveland, a
rédigé le chapitre d'introduction "The
developmental regulation of wake/sleep system" où
l'on retrouve de nombreuses données sur
l'ontogenèse du sommeil, du sommeil paradoxal en
particulier, telles que développées dans
Fetal
yawning assessed by 3D and 4D sonography.
Psychologically we know that yawning has to do with
reminiscences of sleep; but, beyond that, it may indicate
also hunger and boredom and even pleasurable leisure. It
is a very contagious movement. One person is easily
induced by another's yawning to yawn himself. Sometimes
compulsive yawning is indulged in with pleasure-orgastic
pleasure. Some people yawn when they glide in their
rapidly speeding cars, behind the wheel, through the
landscape. The word "yawning" is direct onomatopoeia;
this makes us aware that it is part of a deeply-founded
body function. Yawning pleasure is seen in the infant,
not only when he is sleepy but also when he is
satisfied.
Yawning represents yearning for something archaic; it
is a remnant of a fetal
response. The reflex may last for many seconds, with deep
inspiration and expiration. It may be nearly unexpressed
behind the hand before the mouth.
Clinically, the writer found yawning in one patient
to be an initial sign preceding an epileptic fit. In the
analysis it was associated with a yearning for the
breast, or for something even more deeply nirvanic, and
was then followed by a furious epileptic attack because
of the denial.
How deeply yawning and yearning are related came to
the fore in a manic-depressive patient who went through
twilight states in which he experienced complete union
with the prenatal mother. Consciously, this was a
frightening experience for him. However, it always
announced itself by periods of compulsive yawning, making
it possible for him to go home and surrender more freely
to his reminiscences. In such a twilight state, the
patient had all kinds of telepathic experiences,
described in a former publication (Meerloo, 1949).
Yawning plays a greater role in the therapeutic
situation than is often realized. The therapist also
yawns. One cannot always interpret this as a form of
negative transference, because the increased
communication in the therapeutic situation may easily
lead to a common archaic fantasy.
Leçons sur la
physiologie générale et comparée du
système nerveux.
Germer-Baillière, Paris
1866
"Le bulbe rachidien, organe
central de la respiration, est naturellement aussi
l'organe central de tous les phénomènes qui
se rattachent au mécanisme respiratoire.
Voilà comme il gouverne le cri,
l'éternuement, la toux, le
bâillement, les efforts etc.. mouvements
très complexes, coordonnés, et exigeant le
concours d'un grand nombre d'agents nerveux et
musculaires, que vous ne vous étonnerez pas de
voir conspirer vers un but déterminé..."
En compagnie de Charcot à la
Salpêtrière, Edmé Félix Alfred
Vulpian (1826-1887), élève de Flourens, se
consacra à l'étude de la physiologie et de
la pathologie du système nerveux. Il étudia
la dégénérescence et la
régénération du système
nerveux ainsi que l'effet des drogues sur celui-ci. Il
apporta un nouvel éclairage sur la
neuropathologie. Il isola l'adrénaline.
Born and educated in France, Vulpian early in his
professional career reported on the vague origins of
Crania; nerves III to X. Together with Charcot, Vulpian
became co-director of the Salpêtrière. He
discovered the chromaffin system of the adrenal marrow by
the use of chromium salts. He studied and reported the
use of drugs such as curae, strychnime, pilocarpine,
nicotine and even ensthetics. He encouraged colleagues to
enter the field of pathological anatomy. Known as a
neuropathologist, he was also recognized as a clinical
physiologist.
" One can take the
ape out of the jungle, but not the jungle out
of ape "
" When people
commit genocide, we call them "animals". But
when they give to the poor, we praise them
from being "humane ".