Stroke is a major health problem worldwide, with numerous health, social, and economic implications for survivors and their families. One simple answer to this problem would be to ensure the best rehabilitation with full social reintegration. As such, a plethora of rehabilitation programs was developed and used by healthcare professionals. Among them, modern techniques such as transcranial magnetic stimulation and transcranial direct current stimulation are being used and seem to bring improvements to poststroke rehabilitation. This success is attributed to their capacity to enhance cellular neuromodulation. This modulation includes the reduction of the inflammatory response, autophagy suppression, antiapoptotic effects, angiogenesis enhancement, alterations in the blood-brain barrier permeability, attenuation of oxidative stress, influence on neurotransmitter metabolism, neurogenesis, and enhanced structural neuroplasticity. The favorable effects have been demonstrated at the cellular level in animal models and are supported by clinical studies. Thus, these methods proved to reduce infarct volumes and to improve motor performance, deglutition, functional independence, and high-order cerebral functions (i.e., aphasia and heminegligence). However, as with every therapeutic method, these techniques can also have limitations. Their regimen of administration, the phase of the stroke at which they are applied, and the patients’ characteristics (i.e., genotype and corticospinal integrity) seem to influence the outcome. Thus, no response or even worsening effects were obtained under certain circumstances both in animal stroke model studies and in clinical trials. Overall, weighing up risks and benefits, the new transcranial electrical and magnetic stimulation techniques can represent effective tools with which to improve the patients’ recovery after stroke, with minimal to no adverse effects. Here, we discuss their effects and the molecular and cellular events underlying their effects as well as their clinical implications.
Introduction La diplégie faciale révélant un syndrome de Guillain–Barré (SGB) est une manifestation neurologique qui émerge comme associée à l’infection virale émergente SARS-CoV-2. Observation Nous rapportons deux cas consécutifs de diplégie faciale en lien avec un SGB. Les patients remplissaient les critères cliniques (diplégie faciale, parésie, paresthésies symétriques des 4 membres et dysautonomie) ou paracliniques (hyperprotéinorachie, profil ENMG de neuropathie démyélinisante sensitivomotrice avec atteinte bilatérale du nerf facial). Ils présentaient des facteurs de mauvais pronostic : un diabète traité par antidiabétiques oraux pour les 2 cas, un SIADH dans un cas et un carcinome pulmonaire à petites cellules traité dans le passé par des sels de platine et des inhibiteurs anti-PDL1 dans l’autre cas. Les 2 patients ont été testés positifs par RT-PCR pour le SARS-CoV-2 alors qu’ils ne présentaient aucun des signes les plus fréquents de cette affection (anosmie, agueusie, signes respiratoires ou digestifs). Aucune autre cause infectieuse, auto-immune, néoplasique, infiltrative ou toxique de SGB et de diplégie faciale n’a été retrouvée sur le bilan étiologique. Ceci suggère l’implication du SARS-CoV-2 comme élément déclencheur d’un SGB révélé par une diplégie faciale. Les patients ont été traités par 2 g/kg d’immunoglobulines réparties sur 5 jours avec une bonne évolution clinique. Discussion À ce jour, la relation de cause à effet n’est pas établie entre le SARS-CoV-2et le SGB associée à une diplégie faciale. L’augmentation de l’incidence de cas similaires parallèlement à l’augmentation de l’incidence du virus ou la découverte d’un biomarqueur permettront d’établir le lien entre ces 2 cas décrits et le SARS-CoV-2. Conclusion L’absence d’une autre cause expliquant la diplégie faciale associée à un SGB et les critères chronologiques sont en faveur d’un lien entre le SARS-CoV-2 et ces manifestations neurologiques.
Multiple paraneoplastic syndromes are a rare clinical manifestation. We describe the case of an 82-year-old woman who presented with neurological (rapidly progressive cerebellar syndrome and combined sensory-motor neuronopathy) and rheumatological (palmar fasciitis and polyarthritis syndrome) paraneoplastic syndromes associated with two onconeural antibodies (anti-Yo and Zic4), that revealed an ovarian cancer. The involvement of multiple organ systems should be a clue to take into consideration a paraneoplastic etiology that could permit early detection of cancer. However, despite the existence of treatments, the prognosis of these conditions remains poor.
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