Antilles Guyane University

Pointe-à-Pitre, Guadeloupe

Antilles Guyane University

Pointe-à-Pitre, Guadeloupe
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Lannuzel A.,University Hospital | Lannuzel A.,Antilles Guyane University | Lannuzel A.,French Institute of Health and Medical Research | Mecharles S.,University Hospital | And 6 more authors.
Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration | Year: 2015

Our objective was to evaluate the epidemiological and clinical characteristics of amyotrophic lateral sclerosis (ALS) in the Caribbean island of Guadeloupe, using a retrospective study covering 15 years (1996-2011). Sixty-three cases of ALS were reported, with a frequency of 0.93/100,000/year. The incidence was 4.5-fold higher (3.73/100,00/year) on Marie-Galante, a small island in the Guadeloupe archipelago. ALS was associated with Parkinsonism in 23.8% of the cases. Other phenotypes were typical ALS (47.6%), bulbar forms (20.6%), limb-onset variants (6.3%) and ALS associated with frontotemporal dementia (1.6%). Onset of ALS-Parkinsonism was significantly later than in typical forms of ALS (68 vs. 54 years; p = 0.012) and affected males more frequently than did bulbar ALS (80% vs. 23.2%; p = 0.003). After one year of disease duration, the clinical profile of ALS-Parkinsonism included a symmetric akineto-rigid Parkinsonian syndrome unresponsive to levodopa, supranuclear oculomotor palsy (50%), dementia (66.7%) and signs of both lower (100%) and upper (86%) motor neuron involvement, including bulbar signs (100%). In conclusion, a new cluster of ALS-Parkinsonism and a geographical area with a high frequency of ALS were identified in Guadeloupe, suggesting that they result from environmental or genetic factors. Further studies are needed to explore these hypotheses. © 2015 Informa Healthcare.


Galanth S.,University Hospital of Pointe a Pitre | Tressieres B.,French Institute of Health and Medical Research | Lannuzel A.,University Hospital Pointe itre | Lannuzel A.,Antilles Guyane University | And 4 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2014

Objective To evaluate functional outcome and quality of life 1 year poststroke in a Caribbean population.Design Prospective study of patients with a first hemispheric stroke admitted consecutively between December 2010 and February 2011. The patients were evaluated (1) in the emergency department, (2) when discharged from the hospital, and (3) 1 year poststroke.Setting A university hospital.Participantsg Of the 140 consecutive patients with stroke, 78 (42% women, 24.4% hemorrhagic stroke) were included in the study.Interventions None.Main Outcome Measures Patients were evaluated using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), FIM, and Medical Outcomes Study 36-Item Short-Form Health Survey.Results The mean age of the participants was 62.1±17.7 years; 70.5% of patients had hypertension, 29.4% had diabetes, and 23.6% had chronic renal failure. At 1 year poststroke, the mortality rate was 29.4%, and the recurrence rate 2.6%. We evaluated 39 of the 55 survivors (71%). Score evolution (emergency department vs 1y later) is as follows: for the NIHSS, it was 6.2±4.9 versus 3.3±3.9 (z=-3.578; P<.001); and for the mRS score ≤2, it was 54.2% versus 66.7% (χ;bsupesup P=.25). The FIM score on discharge from the hospital versus 1 year later was 103.2±28.2 versus 101.7±31.5 (z=-1.008; P=.313). Multivariate analysis showed that aphasia, hemianopia, and incontinence significantly influenced the 1-year FIM score (P<.001). Quality of life, a patient-reported outcome measure of health-related quality of life, was significantly altered concerning vitality, role physical, and role emotional.Conclusions One year after a first stroke, despite significant improvement of neurologic impairment, the level of dependency did not change and quality of life was altered. Aphasia, hemianopia, and incontinence significantly influenced functional state. ;copy; 2014 American Congress of Rehabilitation Medicine. © 2014 American Congress of Rehabilitation Medicin.

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