La méthadone est utilisée dans de nombreux pays comme traitement antalgique des douleurs liées au cancer. Nous rapportons le cas d'un patient ayant bien répondu à la méthode d'analgésie autocontrôlée préconisée comme méthode d'équilibration par le protocole de l'Afssaps 2010.Methadone is currently used in many countries for the relief of cancer-related pain. We report the case of a patient in palliative care who was successfully treated with patient-controlled methadone analgesia protocol, the French National Drug Agency.

Maladie invalidante, la sclérose en plaques touche de nombreuses personnes en France. Les premiers traitements, qui présentaient une efficacité variable associée à de lourds effets indésirables, se sont vus remplacés par les biothérapies injectables, plus efficaces et moins dommageables mais nécessitant une chaîne du froid constante. Dorénavant, une forme orale des biothérapies offre aux patients une plus grande liberté dans leurs déplacements.A debilitating disease, multiple sclerosis affects many people in France. Early treatments, which varied in effectiveness and were associated with strong side effects were replaced by injectable biotherapies, more effective and less damaging but requiring a continuous cold chain. Nowadays, oral biotherapies offer patients greater freedom in their movements.

There are now a growing number of sites with a range of proxies that enable a reconstruction of the human habitats of Early and Middle Pleistocene sites in northern Europe. This paper reviews the British record from these periods and concludes that humans were able to survive in a range of climatic and vegetational zones from the earliest occupation in the Early and early Middle Pleistocene. The likely source areas for colonising populations in southern Europe and the probable habitats to which they were adapted in these source areas is discussed. It is argued that colonising populations would need new strategies to cope successfully with northern latitudes, with technological innovations, such as clothing, shelter and possibly fire, being more likely than seasonal migration or physical adaptation. Finally, it is suggested that the earliest evidence prior to 500 ka reflects pioneering populations, perhaps of Homo antecessor, with only sporadic occupation of northern Europe. However, by 500 ka new technologies and other adaptive strategies enabled Homo heidelbergensis to have a more sustained occupation in northern latitudes.

Prevalence of restless legs syndrome (RLS), a clinically defined disorder, varies from 2.5 to 15% among populations. In the French adult population, prevalence is estimated to be 8.5%. RLS is often secondary to a variety of disorders. Neurological conditions usually associated with RLS are neuropathies and Parkinson's disease. There are few studies of its association with multiple sclerosis (MS). The aim of this study was to estimate RLS prevalence in a population of French MS patients. During one month, 17 neurologists from the G-SEP group prospectively recruited 242 patients who fulfilled the Mc Donald criteria for MS. Each patient underwent a standardised questionnaire to verify the international criteria of RLS. We collected date of birth, gender, MS course (relapsing remitting, primary progressive and secondary progressive) and MS duration. Forty-one subjects (18%) met the criteria for RLS. Comparing the RLS group with the group without RLS, no significant differences were found in age, gender and MS duration. RLS was more prevalent in the relapsing remitting MS group. Prevalence of RLS seems to be doubled in MS patients compared to the general population. This finding warrants further study. Identification of this syndrome in MS patients might lead to specific treatments.

La fréquence du syndrome des jambes sans repos (SJSR), affection définie cliniquement, varie de 2,5 % à 15 % selon les populations. Une étude canadienne relève une prévalence atteignant 38 % dans la sclérose en plaques (SEP). L'objectif de notre étude fut d'évaluer la prévalence du SJSR au sein de la population de patients atteints de SEP des régions Nord Pas de Calais et Picardie. À l'aide d'un questionnaire standardisé, les neurologues membres du réseau G-SEP furent invités à recueillir prospectivement sur un mois, chez tous les patients se présentant en consultation et porteurs d'une SEP définie selon les critères de Mac Donald, les données suivantes : les 4 critères diagnostiques internationaux du SJSR, l'âge, le sexe, l'ancienneté et la forme de la SEP (rémittente, progressive primaire et secondaire). Du 14 juin au 13 juillet 2006, 17 neurologues (5 libéraux et 12 hospitaliers) recueillirent 242 questionnaires. On relevait 67 % de SEP rémittentes, 27 % secondairement progressives et 6 % progressives primaires. Le sexe ratio était d'environ 2 femmes pour 1 homme. Les critères diagnostiques du SJSR étaient réunis chez 43 patients (18 %). Il n'était pas retrouvé de liaison statistique avec l'âge, le sexe et l'ancienneté de la SEP mais on relevait une proportion plus élevée de SJSR dans le groupe rémittent. Le sexe ratio et la proportion relative des différentes formes de SEP dans notre population sont conformes aux données classiques. La prévalence du SJSR (18 %) dans notre population paraît plus faible que dans l'étude canadienne. On relève cependant une prévalence élevée à 16 % dans le groupe contrôle canadien, alors que la prévalence dans la population française est estimée à 8,5 %. La prévalence du SJSR dans la SEP paraît doublée par rapport à la population générale, justifiant des études complémentaires. La reconnaissance de ce syndrome peut faire envisager une thérapeutique spécifique.

In Western countries, vascular dementia is considered the second most common cause of dementia after Alzheimer's disease. Diagnosis criteria for vascular dementia are various and questionable. The aim of the present study was to describe clinical and imaging characteristics of out-patients attending a memory clinic with the clinical diagnosis of vascular disease and to compare several sets of clinical criteria.

A 38 year-old woman, without previous medical history, presented, since 1993, several paraplegic fits carrying herself progressively through to a severe paraplegia. Diagnoses successively proposed were spinal cord compressions by slipped discs, spinal cord infarct and multiple sclerosis. In November 1998, the patient presented back pain and fever. Spinal cord magnetic resonance imaging (MRI) revealed a mildly enlarged dorsal cord with signal abnormalities. The lesions were isointense on T1-weighted images, hyperintense on T2-weighted images and showed a ringlike contrast enhancement. A lumbar puncture showed a trouble cerebrospinal fluid (CSF) with leucocytes 600/mm(3) (85 p.100 polynuclear), protein 6.7 g/l, glucose 0.26 g/l, chloride 109 mmol/l. The patient was first treated with parenteral unspecific antibiotherapy. Microbiological studies of blood and CSF were negative. CSF examination with polymerase chain reaction (PCR) was positive for Mycobacterium tuberculosis. Clinical (pain and fever) symptoms and CSF abnormalities decreased after antituberculous treatment. However, paraparesis remain severe. Spinal tuberculous localizations often lead to diagnostic and therapeutic errors. Improvement of spinal cord MRI sequences and using of PCR technics in CSF would contribute to reduce these difficulties.

Objectives - The aim of our study was to evaluate the prevalence of antithrombin, protein C and protein S deficiencies in consecutive ischemic stroke patients under 45. Material and methods - We studied 127 consecutive patients with a mean age of 34.4 years admitted for an ischemic stroke, over a 2-year period, after exclusion of those with arterial dissection. Antithrombin, protein C and protein S levels were measured in all patients at the acute stage of the ischemic stroke and measurements were repeated in case of abnormality. Results - We found abnormal levels in 9 patients. Seven had an acquired cause of deficiency (pregnancy, oestrogen, acute inflammation). Two had no obvious acquired cause of deficiency but further controls were normal. Conclusions - Hereditary deficiencies of coagulation inhibitors are rare in ischemic stroke patients under 45 and their systematic detection seems to be of poor interest.

The patient was a 30 year-old man. He had no previous history. For several months he experienced a slowly progressive horizontal diplopia which was the expression of a bilateral third cranial nerve palsy with an intact intrinsic component, Muscular or neuro-muscular pathology as myasthenia was initially suspected but not confirmed. CT scan and MRI revealed an atypical left temporo-insular lesion which led us to discuss a chronic inflammatory pathology as sarcoidosis or a tumoral process. Finally cerebral biopsy showed a high grade oligodendroglioma. Symptomatology was attributed to infiltration of the peduncles from this tumor. Such a case has never been seen before, Early neuroradiological explorations would be useful in case of clinical suspicion of cranial nerve palsy.

The patient was a 30 year-old man. He had no previous history. For several months he experienced a slowly progressive horizontal diplopia which was the expression of a bilateral third cranial nerve palsy with an intact intrinsic component. Muscular or neuro-muscular pathology as myasthenia was initially suspected but not confirmed. CT scan and MRI revealed an atypical left temporo-insular lesion which led us to discuss a chronic inflammatory pathology as sarcoidosis or a tumoral process. Finally cerebral biopsy showed a high grade oligodendroglioma. Symptomatology was attributed to infiltration of the peduncles from this tumor. Such a case has never been seen before. Early neuroradiological explorations would be useful in case of clinical suspicion of cranial nerve palsy.