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Introduction Les médicaments sont d’autant plus prescrits qu’ils ont une réputation d’être bien tolérés. Il y a très peu de données dans la littérature comparant les classes thérapeutiques en pratique clinique. Nous avons comparé les effets secondaires liés aux anti-infectieux à ceux liés aux autres classes thérapeutiques en analysant leur impact sur la morbi-mortalité. Matériels et méthodes Étude de cohorte monocentrique utilisant le tableau de bord d’hospitalisation d’un service d’Infectiologie de 34 lits. Ce dernier est renseigné pour chaque séjour par extraction de 28 paramètres issus du compte rendu, incluant données démographiques, comorbidités définies par leurs traitements, diagnostic et agent pathogène en cause, anti-infectieux prescrits et leurs effets secondaires définis par la nécessité d’un changement thérapeutique, les évènements indésirables observés dont les effets secondaires des autres thérapeutiques. La morbi-mortalité était évaluée par la durée de séjour, le recours à la réanimation et la survenue du décès. Résultats Au total, 14 642 séjours étaient analysés de janvier 2006 à décembre 2017 ; moyenne d’âge 61 ± 20 ans, sex-ratio H/F 1,50. Un total de 1917 séjours (13 %) concernait des patients sans comorbidité traitée. Les 2 principales comorbidités étaient cardiaques (39 %) et pulmonaires (23 %). Un total de 10 294 séjours (70 %) bénéficiaient de la prescription d’un anti-infectieux, menant à l’observation de 1007 effets secondaires (9,78 %). Les 2 molécules antibiotiques les plus fréquemment en cause étaient la rifampicine (170 cas) et le cotrimoxazole (96 cas). Le total des effets secondaires des autres thérapeutiques était de 688 (4,69 %). Les plus fréquemment en cause étaient les thérapeutiques des comorbidités cardiaques (350 cas) et les antalgiques (127 cas). La durée moyenne de séjour était de 8,9 ± 7,5 jours, de 16,4 ± 13,6 en cas d’effet secondaire d’un anti-infectieux et de 12,8 ± 10,5 en cas d’effet secondaire d’une autre thérapeutique ( p < 0,001). Le taux de recours à la réanimation était de 2,61 %, de 4,27 % en cas d’effet secondaire d’un anti-infectieux et de 4,07 % en cas d’effet secondaire d’un autre médicament. Le taux de décès était respectivement 2,53 %, 1,69 % et 1,31 %. Conclusion En infectiologie, les effets secondaires liés aux anti-infectieux sont plus fréquents que ceux liés aux autres thérapeutiques. La morbidité associée implique leur prévention par les choix thérapeutiques. [ABSTRACT FROM AUTHOR]

Introduction Du fait de notre organisation du système de santé, les premiers soins pour infections sévères sont le plus souvent mis en œuvre dans les services d’urgence. Les bactériémies sont usuellement associées à un sepsis sévère. Ces 20 dernières années, l’émergence des bactéries multi-résistantes (BMR), y compris dans les infections communautaires, impliquent de déterminer la meilleure antibiothérapie probabiliste, notamment lorsque le diagnostic est incertain. Notre objectif était de déterminé quelle pourrait être cette antibiothérapie probabiliste le plus souvent efficace pour une bactériémie communautaire (BC), considérant qu’en cas d’incertitude, la plupart des prescripteurs proposerait une association d’antibiotiques (A-ATB). Matériels et méthodes Étude rétrospective monocentrique basée sur l’utilisation d’un tableau de bord d’hospitalisation utilisé depuis juillet 2005. Tous les patients ayant présenté une bactériémie au cours d’une infection communautaire étaient inclus jusqu’à juin 2016. Ce tableau de bord inclus 28 paramètres de chaque patient hospitalisé, incluant les diagnostics, les comorbidités, les données microbiologiques, la distinction entre infections communautaires et infections associées aux soins, l’antibiothérapie instituée et l’évolution. Deux A-ATB étaient évaluées comme traitement probabiliste de ces BC : amoxicilline–ac. clavulanique (AMX-C) + gentamicine (G) versus cefotaxime (CTX) + gentamicine. Résultats Mille trois cent trente-cinq BC survenant chez 1203 patients étaient identifiées en 11 ans : moyenne d’âge 67 ± 18 ans, sex-ratio (H/F) 1,59. Un cancer et/ou une immunodépression était observé dans 164 cas (12 %). Les 4 principaux groupes homogènes de maladies étaient les infections urinaires ( n = 388, 29 %), les bactériémies sans porte d’entrée retrouvée ( n = 228, 17 %) et les endocardites ( n = 195, 15 %) et les infections ostéoarticulaires ( n = 148, 11 %). The 5 principales bactéries isolées étaient les entérobactéries ( n = 492, 37 %, among which 413 E. coli infections, and 61 ESBL positive strains), Streptococcus ( n = 305, 23 % including S. pneumoniae in 95 cases), Staphylococcus ( n = 263, 20 %), polymicrobial bacteremia ( n = 129, 10 %) and Enterococcus sp ( n = 44, 3 %). Ces bactéries étaient globalement résistantes à AMX-C dans 22 % des cas, à CTX dans 32 % des cas. L’A-ATB AMX-C + G était inefficace dans 1,4 % des cas comparativement à CTX + G inefficace dans 12,1 % of the cases. Le taux de décès était de 5,8 %. Conclusion Face à un patient présentant un sepsis d’étiologie indéterminé, AMX-C + G serait plus souvent efficace pour le traitement d’une bactériémie communautaire que CTX + G. [ABSTRACT FROM AUTHOR]

Introduction – objectifs Au cours des infections ostéo-articulaires (IOA) à staphylocoques une bi-antibiothérapie est recommandée. Les lincosamides et les fluoroquinolones sont des antistaphylococciques à bonne diffusion osseuse pouvant être administrés per os. L’efficacité de l’association de ces deux molécules est mal connue et mérite d’être mieux documentée pour justifier son utilisation. Matériels et méthodes Les patients pris en charge pour IOA dans notre centre sont inclus dans une base de données spécifique dans laquelle tous les antibiotiques prescrits ainsi que les effets indésirables (EI) associés sont référencés. Nous avons sélectionné entre 2007 et 2013 les patients ayant reçu l’association clindamycine + fluoroquinolone (C + F) pour une IOA à staphylocoque. L’efficacité thérapeutique a été déterminée rétrospectivement lorsque l’association C + F avait été prescrite durant au moins la moitié de la durée d’antibiothérapie programmée. Résultats Les étapes de sélection permettaient d’identifier 47 patients : 16 spondylodiscites (34 %), 13 IOA sur matériel (28 %), 11 arthrites (23 %) et 7 ostéites (15 %). S. aureus et les staphylocoques à coagulase négative étaient impliqués dans respectivement 78 % et 22 % des cas. Les F utilisées étaient la lévofloxacine (60 %), l’ofloxacine (36 %) et la péfloxacine (4 %). La durée d’antibiothérapie était de 48 jours en moyenne ; 7 patients (15 %) présentaient un EI imposant l’arrêt du traitement : 3 liés aux F et 4 liés à la C. Aucune diarrhée à C. difficile n’était enregistrée. L’association F + C avait été administrée durant 79 % de la durée totale d’antibiothérapie. Avec un recul médian post-antibiothérapie de 26 mois, la guérison était observée dans 87,5 % des cas, un échec dans 7,5 % des cas, 5 % des patients étant perdu de vue. Conclusion Au cours des IOA à staphylocoques l’association antibiotique F + C apparaît efficace et bien tolérée. [ABSTRACT FROM AUTHOR]

Competing Interests: J. Courjon déclare avoir été pris en charge, à l’occasion de déplacement pour congrès, par Eumedica et MSD. E. Demonchy déclare avoir été prise en charge, à l’occasion de déplacement pour congrès, par Basilea, Eumedica et MSD. P.-M. Roger déclare n’avoir aucun lien d’intérêts.

Competing Interests: J. Courjon déclare avoir été pris en charge, à l’occasion de déplacement pour congrès, par Eumedica et MSD. E. Demonchy déclare avoir été prise en charge, à l’occasion de déplacement pour congrès, par Basilea, Eumedica et MSD. P.-M. Roger déclare n’avoir aucun lien d’intérêts.

Twenty-two patients with partial status epilepticus were treated with phenytoin (DPH) intravenously (mean daily dose: 18,6 +/- 7,3 mg/kg). Benzodiazepines had been administered unsuccessfully in 18 cases before DPH. Seizures were stopped in 14 cases (less than 2 hours after the end of the initial dose in 13 cases). Failures were usually encountered in patients with severe brain damages. Adverse effects were observed in two patients: choreo-athetosic movements in one case with DPH plasma levels lower than 15 mg/l, cerebellar signs in the second patient whose DPH plasma level was 28 mg/l. As previously suggested by Cranford and al., the authors recommend a single slow intravenous infusion of 20 mg/kg (at a rate not exceeding 1 mg/kg/mn). The determination of DPH plasma concentrations demonstrated that with this procedure effective plasma levels are obtained during the 24 hours following the IV injection. In case of failure or of adverse effects determination of DPH plasma levels may be useful for adjusting the daily DPH dose.

Short-latency SEPs following stimulation of the median nerve at the wrist have been studied in 6 patients suffering from dyssynergia cerebellaris myoclonica (DCM). Cervical N14 and scalp-recorded P15 potentials were found to be normal in patients with appropriate recording conditions. The N20 potential, usually recorded in normals in the parietal region contralateral to the stimulated side, was recorded only in 3 cases out of 6. When present, the N20 potential was found to be normal in latency, amplitude and topography. These data suggest that the electrophysiological events related with information processing at the subcortical levels of the lemniscal pathways (N14, P15) are unmodified in DCM, and lend substance to the hypothesis of a cortical long-loop reflex responsible for the triggering of intention myoclonus in these patients.

Following stimulation of the median nerve at the wrist, SEPs, BAEPs and EEG activity were recorded during the same session in 20 comatose patients (13 head injuries, 6 comas of vascular origin, 1 anoxic coma). Patients were classified according to clinical data. In traumatic comas with clinically preserved brain stem reflexes (5 patients), BAEPs were all present, with preserved cervical N14 and scalp recorded P15 SEPs; the parietal N20 SEP was either present on both sides or unilaterally absent in case of hemispheric, possibly EEG silent, traumatic lesion. In comas with a reactive EEG and absent brain stem reflexes (8 patients), N14 and P15 SEPs were present when the parietal N20 component was absent on both sides. In these patients various aspects of BAEPs were observed, but in most cases (7 out of 8) either the BAEPs were completely absent or only peaks I or I and II were present. In brain-dead patients (7 cases) the cervical N14 was recorded in all cases, the P15 SEP was inconstant and the parietal N20 component was constantly abolished on both sides; in most cases (5 out of 7) all the BAEPs were absent. The practical use of evoked responses for the survey of comatose patients is discussed.

It is widely admitted that visual evoked potentials (VEPs) are clinically useful for diagnostic purposes in multiple sclerosis (MS). Delayed P100 component to pattern shift stimulation indicates a dissemination of the demyelinating process when routine ophthalmological investigations are normal. The delay of P100 may be observed early in the course of the disease following an attack of optic neuritis (ON); in the absence of previous ON the P100 latency may appear later after the onset. The P100 latency exceptionally returns to normal values. Compared with somatosensory or brain-stem auditory evoked potentials VEPs are the most efficient for the detection of silent lesions in MS. Longitudinal studies demonstrate that the percentage of MS patients with abnormal VEPs increases with time during the course of the disease. Delayed P100 component may also be recorded in patients with heredodegenerative or toxic optic neuropathies, but the clinical context is very different. The detection of bitemporal visual field defects with VEPs is more uncertain. In patients with cortical blindness VEPs may persist. When compared with usual campimetric investigations, VEPs do not represent a simple and reliable means of investigating lateral homonymous hemianopsia.

From October 1st 1970 to October 1st 1975, electrical and clinical post-operative observation of 1.700 operations under E.C.C. allowed record of E.E.G. and thus study incidents depending of cerebral embolism during their formation. 18 cases have been seen during E.C.C. and 2 at the stop of E.C.C. In 9 cases, it was an air embolus, in 4 others an atheromatous embolus. In the 7 remaining cases, origin of the embolus is uncertain, but probably gaseous. Semiology of the accident is first only E.E.G. In 10 cases, signs were minor, and moderate in 10 others, preceding a late but hard clinical symptomatology, frequently characterized by a delayed advent of epilepsy crisis. Later on, an annoying evolution of the accident was seen in 4 cases (1 death, 3 lasting neurologic deficiency). For the treatment, many observations confirm the highly beneficient part of early hyperbaric oxygen.

Visual (VEP), brainstem auditory (BAEP) and somatosensory (SEP) evoked potentials were recorded over a 6 year period in 917 patients with or suspected of multiple sclerosis according to Mc Alpine's criteria. Evoked potentials provided information of diagnostic relevance in detecting clinically unsuspected lesions (spatial dissemination). They also gave valuable informations in patients with atypical or borderline clinical features. When abnormal, VEP indicated clinically silent lesions in 45.1 p. 100 of patients with definite MS, 66 p. 100 of those with probable MS and 78 p. 100 of the possible MS. Less than 15 p. 100 of SEP and/or BAEP abnormalities were found in 83 patients with a simple or recurring retrobulbar optic neuritis. Thirteen patients with acute transverse myelopathy and no prior history of neurological disease were studied. All had normal visual and brainstem auditory evoked potentials. Abnormal VEPs helped to the clinical assessment of 88 patients with progressive spastic paraparesis 46,6 p. 100 of whom had abnormal VEPs demonstrating disseminated lesions and 36,1 p. 100 had abnormal BAEPs. The frequency of the various types of VEP, BAEP and SEP abnormalities was studied as well as their course on repeated recordings. Results of multivariate analysis are given. It was found that the longer the time interval between the first MS relapse and the evoked potential recording, the higher the incidence of abnormalities. The incidence of evoked potentials abnormalities was lower in patients with normal CSF and higher in patients with inflammatory CSF. The abnormalities were more frequent when patients had clinical evidence of lesions of the sensory pathways explored by the tests.

The historical reminder of the foundation of the French EEG Society and the changes which have occurred during its operation show the worry of the Society for a better efficiency all along this last fourty years. A general survey of the scientific activities disclose the contribution of the society in the papers first published in the Revue Neurologique, and, after 1971, in the Revue d'EEG et de Neurophysiologie clinique de Langue française. The French participation in other clinical neurophysiological or scientific meetings in France and abroad is underlined by the important role it has played in the life of the International Federation for EEG Societies. Training of specialized doctors and technicians in the domain of the functional exploration of the nervous system has been a standing preoccupation of the Society, with the teaching of the so-called "Attestation d'EEG" in French universities and the training of technical personnel in specialized schools.

In 65 patients with status epilepticus, we compared the clinical expression of isolated seizures and of status seizures. In 22 patients there was no relationship between status and isolated seizures. In addition the number of partial status is greater than that of partial seizures. In 9 patients, the type of seizures was modified after the status. From these results, status epilepticus seems to favor the eruption of secondary epileptogenic focuses, generally transitory.

The frequency of primary generalized epilepsies is less than 20% of the epilepsies which begin between the ages of 18 and 39. Clinical seizures are rare, apart from myoclonus. A favourable outcome is observed in 70% of the patients. Seizures of frontal origin (absences and secondary generalized aversive seizures) are frequent in this group and difficult to control with anticonvulsant drugs, as are all other kinds of partial seizures with or without secondary generalization. Rarely, an epileptic state, most often of partial character, is the first ictal manifestation of epilepsy. Head trauma is the most frequent aetiology, followed by cerebral tumours and chronic alcoholic intoxication. The aetiology of epilepsy beginning in this class of ages remains unknown in nearly 50% of cases. The CT scan tends to reduce the frequency of cases of unknown origin.

The present work is an evaluation of brainstem auditory evoked potentials (BAEP) as a tool for neurological diagnosis. Filtered alternate clicks with monaural stimulation and ipsilateral recording between the vertex and the ipsilateral mastoid have been used. Normative data of the laboratory established in 50 normal subjects, mean age 35 years, and criteria for interpretation are given. 155 patients had or were suspected of having multiple sclerosis. In definite multiple sclerosis (33 patients), BAEP were abnormal in 67 p. 100 of the cases, among them the 4 patients with an internuclear ophtalmoplegia. In probable multiple sclerosis (54 patients) BAEP were abnormal in 41 p. 100 of the cases and in possible multiple sclerosis (68 patients) there were 19 p. 100 with abnormalities. Results show that BAEP are clearly a useful tool for diagnosis in progressive paraplegia, in optic neuritis, and in cases in which symptoms and signs lead to discuss posterior fossa tumours. In 66 patients with suspected or proved tumours (acoustic neurinomas excluded) and in 25 patients with vascular disease, the contribution of BAEP to neurological diagnosis is of unequal interest. In some cases BAEP only confirmed the data of the clinical examination. When tumours were diagnosed with the CT scan, BAEP could help in pointing out the accurate relation of the tumour with the brainstem and the auditory pathways. In 36 patients the contribution of BAEP was important in establishing the rostral extension of bulbocervical tumours or, mainly, in indicating the presence or absence of infiltrating brainstem tumours which were not clearly apparent on the CT scan.

The volume-conducted responses of the lemniscal pathways to median nerve stimulation at wrist may be recorded on the scalp (far-field potentials). These positive far-field SEPs components are widely distributed on the scalp and their peaking latencies vary between 9 and 15 milliseconds. In normal adults a maximum of 4 far-field potentials (P9, P11, P13 and P14) may be individualized; two of them (P9 and P14) are constant. These SEPs were studied in two patients with lateralized somatosensory loss; one with a cervico-medullary traumatic lesion, the other with a thalamic infarct. These observations allow the following conclusions 1) the P9 component takes origin in the proximal part of the brachial plexus roots; 2) the P14 potential has a brainstem origin; 3) the contralateral N20 potential is generated in (or close to) the primary somato-sensory cortex (SI). Thus it is possible with a single channel to record the activity of the somatosensory pathways from dorsal roots up the parietal cortex.

Evoked visual potentials were studied in 12 subjects diagnosed or suspected of having MS. A comparison was made between these subjects and results obtained with single eye stimulation using a flash of light (101 subjects) or by using a reversible checker-board pattern (58 subjects). Reversible checker-board pattern simulation showed pathological unilateral or bilateral increase in the latency of the main positive spike in the response of 80% of the verified MS cases and 50% of the probable or possible MS cases. These percentages were 25% lower when flashes of light were used as stimulation. 58% of those patients who have never presented ophtalmological symptoms have abnormal latency in responses invoked by the reversible checker-board pattern, as opposed to 20% using flashes of light for stimulation. Study of E.V.P. in normal subjects indicates that the better results obtained with reversible checker-board stimulation can be attributed to greater reproductibility of the response. Analysis of the overall morphology of the responses significantly increases E.V.P. examination efficiency when using flashes of light as stimulation. However, in our series, it does not change the results obtained by only calculating the latency of response to reversal of a checker-board pattern.

Clinically evident epileptic seizures were observed in 145 patients during the first week of traumatic coma. They frequently occurred during the first day in young subjects in reactive coma, and were often isolated attacks. When ssen at a later stage they are more common in adults with non-reactive coma. The partial or generalised nature of the seizures, the depth of the coma, and the chronological order in which the seizures appear have no bearing on the etiology; the only positive finding was that recurrent seizures were more frequent in patients with intracranial hematoma (18,6% of the patients). The early appearance of seizures does not worsen the prognosis of reactive coma or non-reactive coma in young people. Critical discharges without clinical manifestations were present in 37 patients with traumatic coma during the first week. The average age of these injured patients was higher, and the prognosis for non-reactive coma worse in this group. The comatous state does not modify the clinical aspects or the etiological significance of these early post-traumatic discharges.

One or several status were observed in 90 chronic adult epileptics. Partial status, especially motor and of similar type, is rare in the clinical course of usual partial epilepsy. Generalized status, chiefly petit mal (PM) status, appears in more severe generalized epilepsies. Partial status epilepticus is observed in motor attacks and rarely in partial complex epilepsies, although the latter are more frequent. In 40% of cases the aetiology is unknown. Delay of the first status is variable, from 2 to 30 years. Status does not make previous epilepsy worse. Generalized status, mainly PM status, appears in patients with absences and generalized attacks, sometimes some decades after the beginning of the disease. In half of the cases PM status are frequent but are sometimes the only expression of the epilepsy.

Fifty adult patients with partial motor status epilepticus were treated with a single intravenous (i.v.) injection of diphenylhydantoin (DPH), 20 mg/kg body weight at a rate of 1 mg/kg/min. Seizures were controlled in 32 patients (64%) during the injection or within the following hour; in 13 of them previous (i.v.) injections out of benzodiazepines had been ineffective. DPH was effective in 10 patients of 11 with a previous history of epileptic seizures and without problems of consciousness during their epileptic status. In contrast, 13 failures out of 18 concern occasional status in patients deeply comatose because of head trauma, neurosurgical operation or intracerebral hemorrhage. Total plasmatic levels of DPH, when measured 24 h after the injection, were found between 38 mumol/l in all patients, and were in the range of 40 mumol/l-100 mumol/l in 77% of cases. Adverse effects were: pain at the injection site (6 cases), horizontal nystagmus during injection (5 cases), transient cerebellar symptoms (3 cases). This study confirms that single loading doses of DPH can maintain DPH plasmatic levels within the therapeutic range during 24 h, with minor or transient side effects, provided that cardiovascular contra-indications are respected.