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Resume Les auteurs proposent le transfert retrograde du tendon distal du peroneus longus (PL) sur le tendon tibial anterieur (TA) afin de traiter le pied varus equin spastique de l’adulte. Leurs insertions tendineuses distales en miroir en font des antagonistes. L’objectif est de derouter en avant le tendon distal du PL, inactif, en l’amarrant au TA au tiers moyen de jambe, le transformant en flechisseur dorsal et renforcant son effet everseur. Le niveau de la suture permet d’eviter les conflits cutanes lors du chaussage, ainsi que les complications inherentes aux fixations transosseuses. Une serie preliminaire de 10 patients au recul moyen de 4,7 ans ne montre aucune complication. Le Foot posture index-6 a ete ameliore de 2,4 points en moyenne. Quatre patients ont recupere une flexion dorsale active. Tous ont diminue leur appareillage et le Goal attainment scaling montrait une amelioration chez tous les patients.

We describe a retrograde transfer of the distal tendon of the peroneus longus (PL) onto the tibialis anterior (TA) tendon to treat spastic equinovarus foot (SEVF) in adults. The fact that the distal tendon insertions of the PL and TA are a mirror image makes them antagonists. The aim is to divert the distal tendon in front the inactive distal PL tendon, by fixing to the TA in the middle third of the lower leg. This transforms it into a dorsiflexor and reinforces its eversion ability. The suture level helps to avoid skin impingement when wearing shoes, and the complications inherent to transosseous fixation. In a preliminary case series of 10 patients, we found no complications at a mean follow-up of 4.7 years. The Foot Posture Index-6 improved by an average of 2.4 points. Four patients had regained active dorsiflexion. All patients reduced their use of orthotics. All patients improved according to Goal Attainment Scaling.

Introduction HTLV-I associated tropical spastic paraparesis (TSP) and HTLV-I associated myelopathy (HAM) is an endemic disease in Caribbean Island. Bladder-sphincter dysfunctions are almost present. The objectives of the study are to describe clinic and urodynamic characteristics of voiding disorders in Martiniquan population, evaluate if there is a relationship between motor and urinary handicap, and evaluate prognosis factors of urologic complications. Methods Retrospective study of 60 patients suffering from HAM/TSP. Clinical, urodynamic datas, scale of urinary and motor handicap (Urinary Symptom Profile [USP] questionnaire and Osame Score) were collected. Results Storage symptoms were the most frequent (75%) whatever type of detrusor activity. Detrusor overactivity was the most frequent disorder (68.3%). Bladder compliance was normal in half percent of the cases. Urethral activity was increased in 47% of the cases. Detrusor sphincter dysynergia was found in 78% of the cases, post-void residual in 58% of cases. Sixty five percent of the patients present at least one urologic complication (morphologic and/or infectious) but there was no correlation with motor enablement (P = 0.3097), neither urodynamic study (P = 0.432 for detrusor overactivity, P = 0.107 for detrusor underactivity, P = 0.058 for high urethral activity, P = 0.893 for detrusor sphincter dysynergia, P = 0.850 for post-void residual volume), neither with evolution duration of HAM/TSP (P = 0.348). USP score was not in correlation with Osame score (P = 0.07). Conclusion Urologic symptoms are not always in relationship with urodynamic study: a systematic urodynamic study is necessary to evaluate HAM/TSP neurogenic bladder. No clinic or urodynamic criterias are predictive of urologic complications. These patients need a close follow up. Neurourol. Urodynam. 9999:XX–XX, 2016. © 2016 Wiley Periodicals, Inc.

International audience; Background: Guillain-Barré syndrome (GBS) has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies, mostly on the basis of serological tests, with the problematic cross-reacting antibodies of the Flavivirus genus. Some GBS cases do not exhibit a high level of diagnostic certainty. This prospective study aimed to describe the clinical profiles and the frequency of GBS associated with ZIKV during the ZIKV outbreak in Martinique in 2016.Methods: We recorded prospective data from GBS meeting levels 1 or 2 of diagnostic certainty for the Brighton Collaboration, with proof of recent ZIKV infection and negative screening for etiologies of GBS.Results: Of the sample of 34 patients with suspected GBS during the outbreak, 30 had a proven presence of GBS, and 23 had a recent ZIKV infection. The estimated GBS incidence rate ratio (2016 vs 2006-2015) was 4.52 (95% confidence interval, 2.80-7.64; P = .0001). Recent ZIKV infection was confirmed by urine reverse-transcription polymerase chain reaction (RT-PCR) analysis in 17 cases and by serology in 6 cases. Patients, 65% of whom were male, had a median age of 61 years (interquartile range, 56-71 years) and experienced severe GBS. Electrophysiological tests were consistent with the primary demyelinating form of the disease.Conclusions: ZIKV infection is usually benign, when symptomatic, but in countries at risk of ZIKV epidemics, adequate intensive care bed capacity is required for management of severe GBS cases. Arbovirus RNA detection by RT-PCR should be part of the management of GBS cases.

HTLV-I associated tropical spastic paraparesis (TSP) and HTLV-I associated myelopathy (HAM) is an endemic disease in Caribbean Island. Bladder-sphincter dysfunctions are almost present. The objectives of the study are to describe clinic and urodynamic characteristics of voiding disorders in Martiniquan population, evaluate if there is a relationship between motor and urinary handicap, and evaluate prognosis factors of urologic complications.Retrospective study of 60 patients suffering from HAM/TSP. Clinical, urodynamic datas, scale of urinary and motor handicap (Urinary Symptom Profile [USP] questionnaire and Osame Score) were collected.Storage symptoms were the most frequent (75%) whatever type of detrusor activity. Detrusor overactivity was the most frequent disorder (68.3%). Bladder compliance was normal in half percent of the cases. Urethral activity was increased in 47% of the cases. Detrusor sphincter dysynergia was found in 78% of the cases, post-void residual in 58% of cases. Sixty five percent of the patients present at least one urologic complication (morphologic and/or infectious) but there was no correlation with motor enablement (P = 0.3097), neither urodynamic study (P = 0.432 for detrusor overactivity, P = 0.107 for detrusor underactivity, P = 0.058 for high urethral activity, P = 0.893 for detrusor sphincter dysynergia, P = 0.850 for post-void residual volume), neither with evolution duration of HAM/TSP (P = 0.348). USP score was not in correlation with Osame score (P = 0.07).Urologic symptoms are not always in relationship with urodynamic study: a systematic urodynamic study is necessary to evaluate HAM/TSP neurogenic bladder. No clinic or urodynamic criterias are predictive of urologic complications. These patients need a close follow up. Neurourol. Urodynam. 36:449-452, 2017. © 2016 Wiley Periodicals, Inc.

HTLV-I –associated tropical spastic paraparesis (TSP) and HTLV-I associated myelopathy (HAM) is an endemic disease in Carribean Island. Bladder-sphincter dysfunctions are almost present. Functional disablement is major. Few studies are devoted to urinary disablement, responsible for urologic complications, that gives one of the elements of the severity prognosis of the disease. The objectives of the study are first to describe clinic and urodynamic characteristics of voiding disorders in Martiniquan population, secondly evaluate if there is a relationship between motor and urinary handicap, and thirdly evaluate prognosis factors of urologic complications.

Introduction L’enjeu du traitement du pied varus de l’adulte hemiplegique est de retablir une marche plantigrade stable et sans appareillage. Les techniques de correction du varus par hypertonie du tibial anterieur (TA) sont principalement l’hemitransfert du TA et le transfert du court fibulaire (CF) selon Bardot. Nous decrivons ici une nouvelle technique de transfert du long fibulaire (LF) par amarrage retrograde sur le TA. Materiel et methodes La technique chirurgicale consiste a prelever au tiers inferieur de jambe et transferer le tendon distal du LF et l’amarrer en tension maximale sur le TA. Nous avons mene une etude monocentrique retrospective sur les patients admis en orthopedie pour pied varus reductible avec paralysie des fibulaires entre janvier 2006 et avril 2016. Les gestes associes pouvaient etre une osteotomie de Dwyer, une tenotomie d’Achille ou des flechisseurs des orteils. Les patients ont ete revus par un examinateur independant qui a note les mobilites de cheville, les resultats au test de marche de Tinetti, la satisfaction des patients et les complications. Resultats Dix patients d’âge moyen 56,2 ans ont ete inclus avec un recul moyen de 4,7 ans. Deux patients ont eu une osteotomie de Dwyer associee, six une tenotomie d’Achille et sept une tenotomie des flechisseurs des orteils. Le score de Tinetti moyen etait de 22. Le varus a ete corrige chez tous les patients avec une amelioration moyenne de l’angle tibiocalcaneen de 15° et l’equin a ete ameliore en moyenne de 15° chez sept patients. Il n’y a pas eu de recidive. Tous les patients ont augmente leur perimetre de marche et diminue leur appareillage. Il persistait chez trois patients des griffes d’orteils. Il n’existait aucun conflit entre la cicatrice et le chaussage. Tous les patients etaient tres satisfaits. Discussion L’insertion plantaire du LF a la base du premier metatarsien se fait en miroir par rapport a celle dorsale du TA. D’autre part, le corps musculaire du LF plus court que celui du CF permet un prelevement tendineux plus long et une cicatrice plus proximale que dans la technique de Bardot. Ces deux arguments anatomiques justifient cette technique et expliquent la bonne correction du varus et l’absence de gene au chaussage. Conclusion Le choix du prelevement du LF en alternative au CF decrit dans la technique de Bardot permet de s’affranchir des complications cutanees et semble apporter les memes qualites de correction du varus. Ces resultats sont a confirmer par une serie plus consequente.

Objective Chikungunya is an arbovirus transmitted by Aedes mosquitoes. Significant epidemics have been reported in Reunion in 2005–2006 and the French West Indies whose Martinique in 2013-2014. Mainly, Chikungunya is characterized by polyarthralgia and fever. Patients also related overactive or hypoactive bladder. Those bladder dysfunctions have been described in literature just one time by an Indian team [1] in 2006–2007. The purpose of this study is to identify and describe these disorders. Methods Patients were enrolled using a screening urinary disorders questionnaire through Chikungunya consultation in academic hospital of Fort-de France from January 2015. Results Recruitment of 51 patients: urinary urgency (58%), nocturia (66%), stress urinary incontinence (45%), daytime urinary frequency (15%), enuresis (7%), dysuria (27%). Urodynamic studies show overactive detrusor (57%) with and without detrusor-external sphincter dyssynergia (42%), or intrinsic sphincter deficiency (42%). Dysuria (42%) at flow determination. Discussion Bladder dysfunctions in acute Chikungunya are frequent, and may become chronical. Hypothesis concerning aetiology are myelopathy or neuropathy. Evolution of symptoms is uncertain. A study evaluating the follow up of those patients is still going on.

Opinion/Feedback Arboviruses cause very recurrent epidemics, the oldest Dengue, known especially outside the flu-like syndrome with high fever mainly impacting vulnerable populations, may be responsible for severe hemorrhagic fevers, but also a few cases of Guillain-Barre syndrome. In 2014, the French Antilles occurred an outbreak of Chikungunya, following that of the Reunion's outbreak. During this period have been described, the articular and musculo-squellettic lesions, responsible for loss of autonomy in populations already carriers of chronic inflammatory joint damage or mechanical, but also a heavy impact on the autonomy of elderly and frail people. The Reunion experience has allowed the French Antilles to prepare for managing this epidemic by implementing an algorithm based on precise stripping algic and incapacitating phenomena. The role of the MPR in this dismemberment will allows distinguish true neurogenic damage to types of complex pain syndrome, combining autonomic neuropathy syndromes and tables of small fibers at the crossroads between diagnostic of arthropathy of periarthropaties, synovitis, tenosynovitis and tunnel syndrome on the rise during this epidemic period. And other complications such as bladder and sphincter disorders, and increase of spastic tables in patients suffering from chronic neurological disease. The reach of virus Zika shows an increased incidence of Guillain-Barre syndrome, brings interrogation with the appearance of atypical neurological damage such as myelitis, meningitis, cerebellites showing well this neurotropism. There are also atypical presentation on the neuro-urology plan that raises the question of the pathophysiology of such viruses. As has been the case for the Chikungunya, the overall vision of the MPR will allow better interpretation of pathological phenomena helping the understanding of the pathophysiology of these arboviruses. But it also plays a role in measuring the impact of emerging diseases on the autonomy of individuals.

Introduction: Martinique is a French territory considered medically understaffed compared to Nice, which offers a satisfying range of treatment. Multiple sclerosis (MS) shows an increase of its prevalence rate on these two French territories. This work aims to compare the patients suffering from multiple sclerosis in Martinique and Nice on a functional, social, psychological, medical and paramedical level, and also based on their standard of living. Material and method: this study was conducted at the general hospitals of Nice and Martinique from November 2019 to January 2021. It involves 81 patients in Nice and 82 patients in Martinique. The data were collected from a survey filled by the patients and followed by a clinical examination. The main assessment criterion is based on the comparison of the average multiple sclerosis severity score (MSSS) of MS patients between Nice and Martinique, with secondary assessment criteria based on the assessment of motor, sensory, cerebellar, visual, cognitive (using the CSCT), thymic and genito-urinary functions, as well as the record of their symptomatic treatment and background therapy and the assessment of their quality of life. Results: there is no significant difference between the average MSSS scores between Nice (3,22 ± 2,77) and Martinique (3,56 ± 2,63) (p = 0,2896). On a motor level, there are no statistically significant differences on the various assessments. On a sensory level, the patients from Nice show an alteration of the tactile sense that is more frequent than for the patients from Martinique. On a visual level, a more significant number of nystagmus can be found in the patients from Martinique (24) compared to those from Nice (9) (p=0,0058). As for the cognitive and genito-urinary assessments, there are no statistically significant differences between Nice and Martinique. On a thymic level, the patients in Nice present a higher Beck depression inventory (BDI) score (19,23 ± 13,69) than those in Martinique (9,51 ± 8,79) (p < 0,0001). The therapeutic assessment shows that FAMPRIDINE is prescribed more frequently in Nice, as well as BIOTINE. GILENYA and AUBAGIO are more often prescribed in Martinique compared to Nice. As for their treatment, the patients in Martinique consult more often their neurologist (4,86 ± 4,71 per year) compared to those in Nice (2,69 ± 3,49) (p = 0,003). The vitamin D levels, below 30 ng/ml on both territories, are non-comparative. All the Medical outcome study short form-36 (MOS SF 36) scores are statistically lower than the general population (9,91 ± 9,08) (p < 0,0001) except for the mental health perception in Nice which is higher. However, only the perceptions of physical limitations are higher in Martinique (50 ± 45,77) compared to Nice, and the perception of psychological limitations is higher in Nice (69,21 ± 8,21) compared to Martinique (62,5 ± 18,49) (p = 0,04). Conclusion: there is no significant difference between Nice and Martinique about the severity of patients suffering from MS. The differences have to do with some criteria including tactile sensitivities, higher depression criteria in Nice and nystagmus levels that are more frequent in Martinique. The patients in Martinique consult more often their neurologist and on both territories a low rate of multidisciplinary care can be found.; Introduction : la Martinique est un territoire français considéré en sous effectif médical comparé à Nice qui propose une offre de soin satisfaisante. La sclérose en plaque (SEP) présente une augmentation de sa prévalence sur ces deux territoires français. Le but de ce travail est de comparer les patients atteints de sclérose en plaque en Martinique et à Nice sur le plan fonctionnel, social, psychologique, médical et paramédical ainsi que sur leur niveau de vie. Matériel et méthode : étude menée au Centre Hospitalier de Nice et de Martinique de novembre 2019 à Janvier 2021 incluant 81 patients à Nice et 82 patients en Martinique. Les données furent recueillies à partir d’un questionnaire remplis par les patients suivi d’un examen clinique. Le critère de jugement de principal repose sur la comparaison des scores Multiple sclerosis severity score (MSSS) moyen des patients SEP entre Nice et la Martinique avec des critères de jugements secondaire reposant sur l’évaluation des fonctions motrices, sensitives, cérébelleuse, visuelles, cognitives par le Computerized speedcognitive test (CSCT), thymique, génito-urinaire ainsi que sur le relevé de leur traitement symptomatique et de fond et l’évaluation de leur qualité de vie. Résultat : Il n’existe pas de différence significative entre les scores MSSS moyen entre Nice (3,22 ± 2,77) et la Martinique (3,56 ± 2,63) (p = 0,2896). Sur le plan moteur, aucune différence statistiquement significative sur les différentes évaluation. Sur le plan sensitif, les patients niçois présentent une altération de la sensibilité tactile plus fréquente par rapport à la Martinique. Sur le plan visuel on retrouve un nombre plus important de nystagmus chez les patients en Martinique (24) par rapport à Nice (9) (p=0,0058). Concernant les évaluations cognitives et génito-urinaires aucune différence statistiquement significative entre Nice et la Martinique. Sur le plan thymique, les patients à Nice présent un score de Beck depression inventory (BDI) plus important (19,23 ± 13,69) par rapport à la Martinique (9,51 ± 8,79) (p < 0,0001). Sur le plan thérapeutique, le FAMPRIDINE est prescrit plus fréquemment à Nice de même que la BIOTINE. Le GILENYA ainsi que l’AUBAGIO sont plus souvent prescrit en Martinique par rapport à Nice. Concernant leur prise en charge, les patients en Martinique voient en moyenne plus souvent leur neurologue (4,86 ± 4,71 par an) comparativement à Nice (2,69 ± 3,49) (p = 0,003). Les taux de vitamine D tous deux inférieurs à 30 ng/ml sur les deux territoires sont non comparatifs. Tous les scores du Medical outcome study short form-36 (MOS SF 36) sont statistiquement plus faibles que la population générale (9,91 ± 9,08) (p < 0,0001) hormis le ressenti de la santé mentale (MH) à Nice qui y est supérieur). Cependant seuls les ressenties des limitations physiques est supérieur en Martinique (50 ± 45,77) par rapport à Nice et le ressenti des limitations psychique qui est supérieur à Nice (69,21 ± 8,21) par rapport à la Martinique (62,5 ± 18,49) (p = 0,04). Conclusion : il n’existe pas de différence significative entre Nice et la Martinique concernant la sévérité des patients atteints de SEP. Les différences relèvent de quelques critères dont des troubles de la sensibilité tactile, des critères de dépressions plus importants à Nice et des taux de nystagmus plus fréquents en Martinique. Les patients en Martinique voient plus souvent leur neurologue et sur les deux territoires on retrouve un faible taux de prise en charge pluridisciplinaire.