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Sint-Niklaas, Belgium

Riekhoff A.G.M.,University of Antwerp | Jadoul C.,AZ Nikolaas | Mercelis R.,University of Antwerp | Cras P.,University of Antwerp | Ceulemans B.P.G.M.,University of Antwerp
European Journal of Paediatric Neurology | Year: 2012

Background: Chronic inflammatory demyelinating polyneuroradiculopathy (CIDP) is an autoimmune disease of the peripheral nervous system, causing demyelination and even axonal degeneration. In children, abnormal gait as a first sign of muscle weakness is a frequent reason to seek medical attention. Diagnosis is made on the basis of clinical characteristics, electromyography and nerve conduction studies, and elevated protein in cerebrospinal fluid. Aims: We present three new cases of CIDP. The literature was reviewed in order to obtain more information on presentation, outcome and treatment strategies world-wide. Results: The course of disease can be relapsing-remitting or chronic-progressive. From case series it is known that first-line immunotherapy (intravenously administered immunoglobulin, corticosteroids or plasmapheresis) is initially of benefit in most children with CIDP. There is little evidence, however, on second-line therapies as azathioprine, cyclosporine A, mycophenolate mofetil, methothrexate, cyclophosphamide and IFN alpha. Although the outcome of children with CIDP is generally regarded to be good, disease related disability can be severe. Conclusion: Childhood CIDP is rare. In general and in comparison to adults, children tend to have a more acute progressive onset, with more severe symptoms. Showing a higher tendency towards a relapsing-remitting course, children often show a better and faster improvement after therapy, and a more favorable outcome. Swift recognition of CIDP and empiric start of treatment are considered important to avoid potentially irreversible axonal damage and associated disability. Response to first-line therapies is usually favorable, however recommendations regarding the choice of second-line therapy can only be made on the basis of current practice described in case reports. Safety and efficacy data are insufficient. The cases described show that trial and error are often involved in finding an optimal treatment strategy, especially in those patients refractory to first-line treatment or with a prolonged course. Clinical experience with immunomodulatory treatment is paramount when treating children with CIDP. © 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved. Source

Costantini A.,Pain Clinic | Buchser E.,Pain Clinic | Van Buyten J.P.,AZ Nikolaas
Neuromodulation | Year: 2010

Objective: Chronic backand leg pain associated with lumbar spinal stenosis (LSS) is common in the elderly. Surgical decompression is usually performed when conservative treatments fail. We present an evaluation of the long-term outcome of patients suffering from symptomatic LSS treated with spinal cord stimulation (SCS). Materials and Methods: Data were collected prospectively in three independent registries in three European centers. Pooled data were analyzed retrospectively. Changes in pain intensity, functional status, and analgesic medication were compared at baseline and at the last available follow-up. Demographic data as well as details regarding the implantation procedure and any adverse events were systematically recorded. Results: Data were recorded in 69 patients with a mean follow-up period of 27 months. All patients showed clinically and statistically significant improvement in pain relief, the visual analog scale decreasing from 7.4 ± 2.3 to 2.8 ± 2.4 (p < 0.05). The use of analgesic medication decreased and the functional status improved. Conclusion: Spinal cord stimulation seems to be effective in the treatment of patients suffering from chronic pain associated with LSS. Being less invasive and reversible, SCS should be considered before surgical decompression, particularly in patients with increased risks associated with back surgery. © 2010 International Neuromodulation Society. Source

Van Buyten J.-P.,AZ Nikolaas | Linderoth B.,Karolinska University Hospital
European Journal of Pain Supplements | Year: 2010

Approximately 30% of patients experience persistent or recurrent low back and/or pain projecting into the legs following technically adequate lumbosacral surgery. Such pain conditions are often alluded to as the failed back surgery syndrome (FBSS). FBSS represents a significant clinical and economic concern. The treatment of FBSS presents a challenge to physicians, as conservative therapies and spinal reoperations are often unsuccessful - if not a significant cause (besides fibrosis) of the persistent pain syndrome is found at the post-operative examinations. Neuropathic pain radiating into the leg(s) is often the main component of this persistent and disabling syndrome. In this case, spinal cord stimulation (SCS) has been shown to be a successful therapeutic option. Studies have demonstrated that up to 60% of implanted patients experience 50% or more pain relief following SCS. Moreover, SCS has been shown to improve both quality of life and functional status in a significant number of patients. In order to address the challenge of managing both chronic back and leg pain, a multidisciplinary group of physicians experienced in pain management and spinal surgery assembled to discuss and formulate a treatment strategy for FBSS, based on a systematic review of the literature that focused on the role of SCS. The outcome of these discussions however remained unpublished why an update, taking into account also the moderns technologies has been performed.The development of new treatment algorithms should allow, easier, more rational and effective management of this common and clinically - as well as economically - important problem. © 2010 European Federation of International Association for the Study of Pain Chapters. Source

Intestinal obstruction is a common complication in patients with advanced abdominal or pelvic cancer. The synthetic somatostatin analogue octreotide can help relieve nausea, vomiting and pain in patients with inoperable obstruction. Here, we report a case of recurrent intestinal obstruction in a patient with adenocarcinoma. Although the obstruction was resolved after 3 days of treatment with octreotide, new episodes of obstruction occurred, resulting in a delay of the chemotherapy treatment. After 3 episodes of obstruction, we initiated treatment with a longer-acting somatostatin analogue, lanreotide Autogel® 120 mg, administered once every 4 weeks. The treatment with lanreotide Autogel is being continued, allowing for continuation of the chemotherapy without further episodes of intestinal subocclusion or obstruction. Until November 2013, the patient received eighteen 4-weekly injections of lanreotide Autogel and did not report side effects. This case report demonstrates the successful treatment of intestinal obstruction with lanreotide Autogel in a patient with adenocarcinoma. © 2014 S. Karger AG, Basel. Source

Van Buyten J.-P.,AZ Nikolaas | Linderoth B.,Karolinska University Hospital
European Journal of Pain Supplements | Year: 2011

In the mid of the 20th century various types of facial pains, not clearly originating from the teeth or the eyes, were often misdiagnosed as trigeminal neuralgia and treated with lesional techniques. Pains from the rest of the head were simply classified as " headache" and treated with the pharmaceutical means available at that time. For migraine there was often no effective therapy.Headache is a common reasons for patients to seek medical care. Migraine is the most common form of disabling primary headache that has been estimated to be the most costly neurological disorder in the European Community at more than €27 billion per year. While considerable developments have been made in understanding and treating primary headaches there remains a group of patients with difficult to treat headache problems. Facial pain is another complex pain problem and especially severe neuropathic facial pain with considerable deafferentation has been labelled " la bête noire" of pain surgery. Many of these headache and facial pain problems are refractory to pharmacotherapy. Interventional pain management using electrical stimulation techniques can be the solution for a selected portion of these patients. In this article we describe and discuss a " treatment ladder" from minimally invasive to more interventional stimulation techniques according to the diagnosis of the pain syndrome under consideration. For each type of procedure, indications, technique and complications are discussed based on the experience of the authors and a review of the literature. © 2011. Source

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