Sarcoidosis of the spinal cord is a rare disease. The aims of this study are to describe the features of spinal cord sarcoidosis (SCS) and identify prognostic markers. We analyzed 20 patients over a 20-year period in 8 French hospitals. There were 12 men (60 %), mostly Caucasian (75 %). The median ages at diagnosis of sarcoidosis and myelitis were 34.5 and 37 years, respectively. SCS revealed sarcoidosis in 12 patients (60 %). Eleven patients presented with motor deficit (55 %) and 9 had sphincter dysfunction (45 %). The median initial Edmus Grading Scale (EGS) score was 2.5. The cerebrospinal fluid (CSF) showed elevated protein level (median: 1.00 g/L, interquartile range (IQR) 0.72-1.97), low glucose level (median 2.84 mmol/L, IQR 1.42-3.45), and elevated white cell count (median 22/mm(3), IQR 6-45). The cervical and thoracic cords were most often affected (90 %). All patients received steroids and an immunosuppressive drug was added in 10 cases (50 %). After a mean follow-up of 52.1 months (range 8-43), 18 patients had partial response (90 %), 7 displayed functional impairment (35 %), and the median final EGS score was 1. Six patients experienced relapse (30 %). There was an association between the initial and the final EGS scores (p = 0.006). High CSF protein level showed a trend toward an association with relapse (p = 0.076). The spinal cord lesion was often the presenting feature of sarcoidosis. Most patients experienced clinical improvement with corticosteroids and/or immunosuppressive treatment. The long-term functional prognosis was correlated with the initial severity.

No abstract

Background and objectives:Spinal cord sarcoidosis is a rare manifestation of sarcoidosis with a consequent risk of neurological sequelae for the patient. We investigated prognostic factors and efficacy of immunosuppressive treatments in a longitudinal cohort.Methods:We retrospectively studied patients with spinal cord sarcoidosis followed between 1995 and 2021 in seven centers in France. Patients with a definite, probable or possible spinal cord sarcoidosis according to the Neurosarcoidosis Consortium Consensus Group criteria and with a spinal cord involvement confirmed by MRI were included. We analyzed relapse or progression rate with a Poisson model, initial Rankin score with a linear model and change in the Rankin score during follow-up with a logistic model.Results:A total of 97 patients were followed for a median of 7.8 years. Overall mean relapse or progression rate was 0.17 per person-year and decreased over time. At last visit, 46 (47.4%) patients had a loss of autonomy (Rankin score ≥ 2). The main prognostic factors significantly associated with relapse or progression rate were gadolinium enhancement (relative rate [95% CI]: 0.61 [0.4, 0.95]) or meningeal involvement (relative rate [95% CI]: 2.05 [1.31, 3.19]) on spinal cord MRI, and cell count (relative rate [95% CI] per 1 log increase: 1.16 [1.01, 1.33]) on CSF analysis. Relapse or progression rate was not significantly associated with initial Rankin score or EDSS. TNF α antagonists significantly decreased relapse or progression rate compared with corticosteroids alone (relative rate [95% CI]: 0.33 [0.11, 0.98]). Azathioprine was significantly less effective than methotrexate on relapse or progression rate (relative rate [95% CI]: 2.83 [1.04, 7.75]) and change in Rankin score (mean difference [95% CI]: 0.65 [0.23, 1.08]).Discussion:Regarding the relapse or progression rate, meningeal localization of sarcoidosis was associated with a worse prognosis; TNF α antagonists resulted in a significant decrease compared to corticosteroids alone; and methotrexate was more effective than azathioprine.Classification of Evidence:This study provides Class IV evidence that in individuals with spinal cord neurosarcoidosis, TNF α antagonists were associated with decreased relapse or progression rate compared to corticosteroids alone, but other therapies showed no significant benefit.

Background: Whatever may be their clinical presentation, vasculitis syndromes (VS) have a bad prognosis in the very elderly. Objective: The aim of this work was to study VS particularities in very old people. Most published studies on VS in elderly people concern patients older than 60 years; studies concerning very old patients are unusual. Methods: We studied retrospectively subjects older than 75 years with a diagnosis of VS from the Departments of Geriatrics and Internal Medicine at Dijon University Hospital. These subjects were hospitalized between January 1995 and December 1999. Data were obtained from the medical files of these patients. Several aspects were considered: type of VS, associated diseases, treatment, complications, and outcome. Results: Twelve patients, 5 men and 7 women aged 79–91 (mean age 82.3) years, were included. Primary VS was observed in half of the patients and secondary VS in the others. The initial clinical presentation was often polymorphous and unspecific; 8 of the patients died, 2 developed progressive severe functional impairment, 1 was stabilized under therapy, and 1 patient with VS secondary to infection recovered. Most patients either died quickly or progressively deteriorated from infections, malnutrition, or functional impairment. Conclusion: The health of the majority of patients (83%) deteriorated dramatically, leading to death or severe functional impairment.

No abstract

No abstract

The objective of the present research is to understand the factors that initiate drug consumption and intervene in the escalation of drug consumption; in this sense, a wide range of etiopathogenesis of substance use disorders (SUD) was considered. Methods: In order to assess the risk factors involved in the onset and maintenance of SUD we compared two groups (the study group-60 people who admit that they have consumed drugs at least at a recreational level, and the control group, equivalent in terms of numbers, age, sex ratio, and use only of legal drugs). Methods: The methods of collecting qualitative data were: clinical interview, observation, diagnosis of drug disorder and other psychiatric diagnosis as according to Kid-SCID. A questionnaire was developed in order to collect data regarding age at the beginning of consumption, family, environment, pattern of drug consumption. For the quantitative data three questionnaires were applied: Cloninger Personality Test, the Constructive Thought Inventory and the Parental Stress Index. Results: The majority of users of psychoactive substances present a disharmonic family situation. The results of the Cloninger Personality Test describe the drug consuming teenager as shy, in search of new sensations, impulsive. In our study, the people in the experimental group have obtained significantly lower scores than the control group in: behavioural and emotional coping, conscientiousness (Constructive Thought Inventory). Conclusions: For an adequate result in the fight against drugs, the pronounced integration of etiopathogenic elements and of the basic mechanisms of consumption is needed.

Each person is part of a whole, a complex emotional unit (the family) and any change in a part of a family system influence the individual.The paper aim is to present an assessment of family functioning in patients diagnosed with Schizoaffective Disorder admitted for treatment in Child and Adolescent Psychiatry Department Cluj-Napoca between 2009–2010, and to estimate how the model of family functioning influence the onset and the evolution of the disease.We followed the identification of existing borders in the family, coalitions, rules, roles, taboo subjects, resources, expressed emotions (EE) in families taken in the study, positive remarks to the patient and warmth.Expressed emotion (EE) refers to a construct encompassing several key aspects of close interpersonal relationships. It reflects critical, hostile or emotionally overinvolved attitudes on the part of a family member toward a relative with a disorder or impairment.The studied families were shown to be heterogeneous in terms of structure, rules and roles assigned to the patients within the family, which has hampered the expression of general conclusions. However, the study revealed that the positive family involvement correlate with improvement in social functioning, while criticism and hostility are factors for relapse.