Influence of the mode of walk on walking speed in multiple sclerosis: are you walking comfortably?

Poster (2013, June 10)

Introduction : Walking speed (WS) is the most frequent gait variable taken into account when measuring gait dysfunction in neurological diseases. Influences of the mode of walk instructed to the subject ... [more ▼]

Introduction : Walking speed (WS) is the most frequent gait variable taken into account when measuring gait dysfunction in neurological diseases. Influences of the mode of walk instructed to the subject, i.e. « as fast as possible » (AFAP) or « at a comfortable pace » (PrP) have not been well characterized in multiple sclerosis (MS). Objectives : to compare those 2 mode of walk in a population of persons with MS (pMS) and healthy volunteers (HV). Methods: WS was measured with a new automated device along a 25 foot distance (T25FW) as part of a multimodal evaluation of gait in an MS ambulatory department. Results: Baseline demographics between HV and pMS were comparable. Our first results demonstrate that (i) WS is obviously significantly higher in AFAP than in PrP both for pMS and HV (p < 0.001 for all comparisons) and (ii) the relative difference between AFAP and PrP WS is significantly higher in HV than in pMS (p < 0.001). The AFAP-PrP WS correlation is higher in pMS (r = 0.87, p < 0.001) than in HV (r = 0.51, p < 0.001). Finally, the relative difference between AFAP and PrP WS is significantly and negatively correlated with the PrP WS in HV (r = -0.41, p < 0.001) and pMS with mild to moderate disability (EDSS 0-3.5, r = -0.49, p < 0.01) but not in pMS with high disability (EDSS 4-5.5, r = 0.008). Conclusions : these results suggests that heatlhy subjects have access to a higher range of PrP WS than pMS and questions the regulation of PrP WS that might be under psychological or behavioural influences. The demonstration of a lower PrP-AFAP difference in MS suggests that pMS are either adopting a natural WS closer to their maximum WS, or alternatively that they can’t reach their maximum WS because of neurological impairments. Our results also emphasize the importance of the instructed mode of walk in the quantification of gait disorders both for routine clinical practice and clinical trials. [less ▲]

The Day George Avellis Met Miller Fisher – About the Unsual Presentation of an Anti-GQ1b IgG Antibody Syndrome

Poster (2013, March)

Objective: OBJECTIVE: To describe the clinical, laboratory and electrophysiological features of a patient who presented an Avellis syndrome as the initial feature of Miller Fisher syndrome (MFS ... [more ▼]

Objective: OBJECTIVE: To describe the clinical, laboratory and electrophysiological features of a patient who presented an Avellis syndrome as the initial feature of Miller Fisher syndrome (MFS). Background: BACKGROUND: Anti-GQ1b Ig antibodies are associated with an increasing spectrum of neurological disorders, including MFS and Guillain-Barre syndrome (GBS). Design/Methods: DESIGN/METHODS: Clinical case description. Results: RESULTS: A 67-year old woman was seen for subacute dysphagia and dysphonia, preceded by rapidly worsening paresthesia of the extremities and face, with a history of upper respiratory tract infection two weeks before admission. Nasotracheal examination showed a left velopalatine and left vocal cord paresis. Twelve hours later, sensory ataxia appeared and deep tendon reflexes weakened. Diffuse paresis affecting predominantly the axial muscles developped. Oculomotricity was preserved. Brain MRI was normal, while EMG suggested a mild sensory neuropathy. Within hours, dysphagia worsened and dyspnea appeared, prompting ICU admission for airway support. She developed a proximal paresis and dysautonomia, global areflexia. CSF findings were unremarkable. IVIg were administered at a dose of 0.2g/kg per day during five days. Control EMG showed signs of polyradiculoneuropathy. She gradually recovered and was discharged at home after 32 days, with only a slight velopalatal paresis and a mild fatigue. Anti-ganglioside antibodies screen was positive for IgG-GM3, GD1b, GD3, GQ1b, GT1a and GT1b. In front of this clinical and biological picture, the diagnosis of atypical MFS was retained. Thirty day after discharge, both clinical and electrophysiological parameters were normalised. Conclusions: CONCLUSIONS: This case highlights that (i) MFS can show atypical presentation (here a pure Avellis syndrome, never reported in the context of the anti-GQ1b syndrome to our knowledge) and should be considered in front of an isolated impaired cranial nerve function, even in the absence of the classical triad of ophtalmoplegia, areflexia and ataxia, and (ii) that the boundaries between MFS and GBS are usually neater in textbooks than in real life. [less ▲]

Detection and Quantification of Efficiency and Quality of Gait Impairment in Multiple Sclerosis through Foot Path Analysis

Poster (2012, October 11)

Introduction: Walking speed is generally considered as the best outcome measure in trials for people with multiple sclerosis (pMS). We recently designed a device based on range laser scanner capable to ... [more ▼]

Introduction: Walking speed is generally considered as the best outcome measure in trials for people with multiple sclerosis (pMS). We recently designed a device based on range laser scanner capable to track feet paths of walking subjects. Our purpose was to explore gait descriptors of pMS and compare them with those of healthy volunteers (HV). Methods: Fourty-four pMS (considered as moderatly or highly disabled according to a cut-off EDSS value of 3.0) and 28 HV performed 4 walking tasks along 2 trajectories in 3 walking modes. Twenty-six gait descriptors crudely dichotomized in « efficiency» and « quality » of gait were compared in the 2 populations using unpaired t-tests. Results: (i) apart from an older age in pMS, the two populations were comparable, (ii) efficiency of gait descriptors including walking speed distinguished HV from pMS, and pMS with moderate from pMS with high disability, (iii) quality of gait descriptors were also significantly altered in pMS, including in walking tasks where their walking speed was comparable to that of HV. Conclusions: RLS technology can distinguish pMS from HV according to (i) more efficiency of gait descriptors than the sole walking speed and (ii) quality of gait descriptors, including in subjects with a « normal » walking speed. [less ▲]

Motor fatigue measurement by distance-induced slow down of walking speed in multiple sclerosis

in PLoS ONE (2012), 7(4), 34744

Background: Motor fatigue and ambulation impairment are prominent clinical features of people with multiple sclerosis (pMS). We hypothesized that a multimodal and comparative assessment of walking speed ... [more ▼]

Background: Motor fatigue and ambulation impairment are prominent clinical features of people with multiple sclerosis (pMS). We hypothesized that a multimodal and comparative assessment of walking speed on short and long distance would allow a better delineation and quantification of gait fatigability in pMS. Objectives: To compare 4 walking paradigms: the timed 25-foot walk (T25FW), a corrected version of the T25FW with dynamic start (T25FW+), the timed 100-meter walk (T100MW) and the timed 500-meter walk (T500MW). Methods: Thirty controls and 81 pMS performed the 4 walking tests in a single study visit. Results: The 4 walking tests were performed with a slower WS in pMS compared to controls even in subgroups with minimal disability. The finishing speed of the last 100-meter of the T500MW was the slowest measurable WS whereas the T25FW+ provided the fastest measurable WS. The ratio between such slowest and fastest WS (Deceleration Index, DI) was significantly lower only in pMS with EDSS 4.0-6.0, a pyramidal or cerebellar functional system score reaching 3 or a maximum reported walking distance !4000m. Conclusion: The motor fatigue which triggers gait deceleration over a sustained effort in pMS can be measured by the WS ratio between performances on a very short distance and the finishing pace on a longer more demanding task. The absolute walking speed is abnormal early in MS whatever the distance of effort when patients are unaware of ambulation impairment. In contrast, the DI-measured ambulation fatigability appears to take place later in the disease course. [less ▲]

Multimodal evaluation of gait and stride dynamics in relapsing and progressive forms of multiple sclerosis

in Proceedings of the Belgian Royal Academies of Medicine (2012), 1

Ambulation measures are being increasingly recognized as highly relevant to the quantification of multiple sclerosis (MS) severity and response to treatment. Feet paths are highly informative for gait ... [more ▼]

Ambulation measures are being increasingly recognized as highly relevant to the quantification of multiple sclerosis (MS) severity and response to treatment. Feet paths are highly informative for gait analysis and we have recently designed a new system, which captures the position of the feet in real time. We use several range laser scanners (RLS) to analyze a horizontal slice of the scene in which each foot is considered as a point, and the vertical movements are ignored. Neat ambulation measures may be easily extracted such as walking speed, distance between feet over time, swing phase duration, and gait asymmetry in specific settings of walking recommendations. Our RLS platform is much cheaper than existing sensor-based and motion capture systems and may be more convenient for the development of multicentric clinical trials settings since patients can be easily and rapidly assessed without tags or sensors in the hallway of an outpatient clinic. We use 4 BEA LZR-i100 RLS arranged in a corridor of at least 10m long and 4m width, devoid of obstacle. The scanned plane is chosen to be located at 15 cm above the floor, which is right above the tibio-tarsal joint of the ankle in a barefoot configuration for adult individuals in stance phase. We expect further studies to validate and empower the meaning of non-intrusive RLS-derived gait measures that should pave the ground for major improvements in the way we will assess the efficacy of disease-modifying treatments (DMTs), physical therapy and symptomatic interventions on walking impairment, ataxia and fatigability in MS. RLS-derived gait measures may also reveal to be crucial in the near future for the development of treatments that would specifically target progressive forms of MS. [less ▲]

Construction and validation of the Dynamic Parkinson Gait Scale (DYPAGS).

in Parkinsonism & Related Disorders (2012)

The dynamic evaluation of Parkinson's disease (PD)-related episodic gait disturbances in routine is challenging. Therefore, the aim of our study was to assess the reliability/validity of the Dynamic ... [more ▼]

The dynamic evaluation of Parkinson's disease (PD)-related episodic gait disturbances in routine is challenging. Therefore, the aim of our study was to assess the reliability/validity of the Dynamic Parkinson Gait Scale (DYPAGS) composed of eight relevant items for the objective quantification of PD gait features: walking forwards/backwards/with dual-task, turning to both sides, imaginary obstacle avoidance with both legs and passing through narrow spaces. The scale was validated on thirty-five patients with mild to severe parkinsonism in their habitual "on-state". A shorter 6 item-version was designed on the basis of a principal component analysis. No significant floor/ceiling effect was detected. The internal consistency was excellent. The levels of interrater agreement, precision and minimal detectable change were adequate. The criterion-related validity was demonstrated by strong correlations with the DYPAGS scores and those at the gait subscales of the Tinetti Mobility Test and MDS-UPDRS. The construct validity was assessed by moderate-strong correlations with the Freezing of Gait Questionnaire, mobility index of the PD Questionnaire (PDQ-39), disease duration and levodopa equivalent daily doses. Statistical analyses using the coefficient of determination showed that both DYPGAS versions were superior to the other instruments to identify patients with gait disturbances with poorer response to dopaminergic treatment. Full and short DYPAGS are reliable instruments for the quantification of "on" PD-related episodic gait disturbances. The full version is sensitive to detect subtle disturbances in mild parkinsonism. The shorter one is easily administered and reliably quantifies gait disturbances in moderate to severe parkinsonism. We recommend their use for research and clinical practice. [less ▲]

Radiation-induced malignant peripheral nerve sheat tumors – a report of 2 cases

Poster (2011, May)

We discuss the case of two patients who developped delayed malignant peripheral nerve sheath tumor (MPNST) following radiotherapy. Case report: the first patient is a sixty year-old woman with a 2 years ... [more ▼]

We discuss the case of two patients who developped delayed malignant peripheral nerve sheath tumor (MPNST) following radiotherapy. Case report: the first patient is a sixty year-old woman with a 2 years history of right cervicobrachial pain and weakness. The neurological examination depicted severe weakness, atrophy and loss of sensation in the right C5 and C6 territories. A subclavicular hardened and enlarged lymph node was noted. Her past medical history was notable for a Hodgkin’s disease (HD) treated with radiation therapy (>40Gy) 35 years earlier. Brachial plexus MRI revealed a tumoral mass arising from the right brachial plexus. Biopsy of the subclavicular mass revealed a poorly differentiated malignant tumour consisting of spindle cells showing moderate polymorphism and a high mitotic index. Immunohistochemistry showed positivity for the S-100 protein, the CD56 and for the epithelial membrane antigen (EMA) and a diagnosis of MPNST of the brachial plexus was proposed. The second case is a 36 year-old man referred for a history of right sciatic neuralgia that appeared 3 years earlier. The medical history of the patient was notable for a right seminoma, treated by orchidectomy and prophylactic radiotherapy (24 Gy) 5 years earlier. The neurologic examination revealed right L5 and S1 radicular territories involvement, and the CT of the pelvis demonstrated a nodular mass at the level of the greater sciatic foramen. A surgical biopsy was performed and the neuropathological findings were consistent with a diagnosis of low-grade MPSNT. Discussion: MPNSTs are rare tumors accounting for 3 to 10% of all tissues sarcomas. Half of the cases described are sporadic, while the other half tend to appear in patients suffering from tumor prone conditions, such as neurofibromatosis type 1. Although secondary neoplasms are known complications of radiotherapy, descriptions of peripheral nerve sheath tumors (PNST) are scarce. The exact pathophysiology of radiation-induced PNSTs remains unclear but vascular alterations, direct damages to axon or Schwann cell and nerve compression by soft tissue fibrosis are thought to play a role. Although surgical removal sometimes followed by chemotherapy is the mainstay of MPNSTs, they usually carry a poor prognosis. Our 2 cases emphasize that the possibility of radiation-induced MPNST has to be kept in mind when investigating a localized neuropathy in a previously irradiated area. [less ▲]

Real maximum walking speed on short distance assessed by a corrected version of the Timed 25 Foot Walk Test (T25FW)

Poster (2010, September)

L'image du mois: Thrombus artériel pulmonaire proximal en échocardiographie

in Revue Médicale de Liège (2009), 64(1), 4-5

Strategies pharmacologiques de modulation de l'activite du systeme nerveux central.

in Revue Médicale de Liège (2008), 63(5-6), 238-44

There are multiple pharmacological targets in the central nervous system. After reviewing the synaptic physiology and the major neurotransmitter molecules, this article describes the main strategies used ... [more ▼]

There are multiple pharmacological targets in the central nervous system. After reviewing the synaptic physiology and the major neurotransmitter molecules, this article describes the main strategies used in neuropharmacology. The concept of specificity in the central nervous system is discussed, and allows a distinction between drugs according to the degree of specificity of their action. A catalogue of pharmacological targets is presented with therapeutic examples, and an emphasis on new agents having an original mechanism of action or acting on new targets. [less ▲]