Author Archives: Stéphane Bastianetto

1. Dance movement therapy

   29 janvier 2023 19 h 39 min Leave a Comment

   Dance movement therapy is a form of psychotherapy that utilizes dance and movement to improve both mental and physical health. It’s based on the idea that the mind and body are interrelated, so when one is affected, the other will be too. Through this therapy, people can work towards improved wellness by developing strength, coordination, balance, flexibility, self-expression and social skills.

   In order to improve one’s overall wellbeing, dance movement therapy can be an expressive form of healing that encourages physical and mental health.

   People can use dance movements to express their feelings and emotions to facilitate self-expression, creativity, and connection with their inner selves through sessions with a trained professional.

   How does it work?

   It seems that dance therapy promotes health by unifying and coordinating all aspects of a person, such as:

   In dance, nonverbal communication is as important as verbal communication.

   Additionally to serving as a means of communication, movement can also be expressive, functional, or developmental.

   Assessment and intervention can both be accomplished through movement.

   Possible beneficial effects

   Research on the physical, mental, and emotional benefits of dance therapy is inconclusive. Although more studies are necessary, some evidence suggests it may be beneficial in the following areas:

   Mental Health

   The results of a 2019 meta-analysis that looked at 41 clinical trials and involved 2,374 participants indicated that dance therapy improves:

   There is also a possibility that these benefits might be long-term, including anxiety, depression, quality of life, and cognitive skills.

   Depression

   In contrast to the above meta-analysis, a 2019 review evaluated eight clinical trials that examined dance therapy’s effects on 351 adults struggling with depression.

   The authors characterized the evidence as moderate to high quality and concluded that the intervention might offer an effective treatment for adults with depression. As most of the included studies excluded children, teenagers, and older adults, they could not assess its effectiveness for these populations.

   Preventing falls

   By improving gait, balance, and muscle strength, the authors of a 2017 review examined whether dance, a popular pursuit among older adults, can help prevent falls. As falls are a leading cause of illness and death, the authors reviewed 10 clinical trials that explored the possibility of dance preventing falls. Total participant numbers were 680.

   The authors note that dance appears to be safe and demonstrates benefits for well-being among older adults, despite the preliminary nature of their results and the lack of long-term data.

   Parkinson’s disease

   A 2018 review examined 40 studies and five reviews investigating the effects of dance and music on the symptoms of Parkinson’s disease, which impairs gait, which can increase the risk of falls. The results indicated that the interventions might improve gait.

   Care for cancer patients

   As well as affecting physical health, cancer often affects emotions and socialization. In order to address these issues, current cancer care increasingly includes psychosocial interventions. A 2015 study examined three clinical trials involving 207 individuals with breast cancer in order to examine the benefits of dance therapy for cancer.

   In the data analysis, mixed results were found, but the intervention might help by:

   However, it found no evidence that dance therapy can reduce somatization, which is the presentation of multiple physical symptoms caused by psychological factors.

   A 2021 review found that dance therapy could improve quality of life for people with breast cancer, but noted that this therapy might be more effective when combined with other therapies.

   Blood pressure

   In 2020, a meta-analysis of five clinical trials examined the effects of dance therapy on blood pressure. Despite the small number of trials, the results indicated that the intervention could significantly lower systolic and diastolic blood pressure.

   A systolic blood pressure reading indicates pressure on the arterial walls during heartbeats, while a diastolic reading indicates pressure between heartbeats.

   People from Africa seem to benefit more from dance therapy than those from Europe or America, according to the results.

   Chronic heart condition

   Individuals with chronic, or ongoing, heart failure were compared with conventional therapy in an older 2014 study. It evaluated two investigations that involved 62 dance therapy participants, 60 exercise participants, and 61 control participants.

   A comparison of dance therapy with exercise and no exercise found that dance therapy increased exercise capacity and quality of life. According to the authors, dance therapy did not significantly differ from conventional exercise groups in terms of outcomes. Therefore, dance therapy should be included in cardiac rehabilitation programs.

2. Atrial fibrillation

   19 h 22 min Leave a Comment

   Atrial fibrillation, also known as AFib, is a common form of abnormal heart rhythm that occurs when the two upper chambers of the heart beat in an irregular fashion.

   Around 3.5% of people aged 65-74 years old are affected by this medical condition and it can be lifethreatening if left untreated.

   Common treatments for Atrial fibrillation include blood thinners to reduce the risk of stroke and other medications to control arrhythmias.

   Atrial fibrillation and stroke

   In addition to being diagnosed during a medical examination, atrial fibrillation can also be diagnosed as a result of a stroke, which makes it one of the most common causes of strokes.

   A stroke caused by AF is much more serious: one in three people die within 30 days, and one in two within one year. As a result of stagnation of blood in the atria, atrial fibrillation facilitates the formation of clots.

   Atrial fibrillation can cause strokes when these clots break off and travel to the brain’s arteries. The risk of stroke is multiplied by five in a patient with atrial fibrillation, depending on other risk factors, such as age, gender, high blood pressure and diabetes.

   A number of treatments are available to slow the heart rate and reduce AF, including anticoagulants (antivitamin K or oral anticoagulants). Stroke prevention with aspirin and platelet aggregation inhibitors is rarely prescribed for patients with AF. High blood pressure and other risk factors must be avoided or controlled by people at risk.

   The causes of atrial fibrillation

   Atrial fibrillation is a condition characterized by an irregular heartbeat caused by chaotic electrical impulses in the atria. It can be caused by high blood pressure, heart attack or valve disorders, thyroid disease, lung disease, diabetes, sleep apnea, alcohol use disorder, and other underlying conditions that can strain or damage the heart’s muscle tissue.

   Certain medications or substances can also trigger atrial fibrillation.

   Symptoms

   The main symptoms are: fatigue, shortness of breath, palpitations with irregular and rapid heartbeats, chest pain, unsteadiness, dizziness, sweating, and nausea. However, some patients are asymptomatic.

   The diagnosis

   If the patient has rapid, irregular heartbeats, the doctor asks about:

   • his medical history;
   • his health problems (does he have heart disease, thyroid problems?);
   • the frequency of symptoms experienced;

   Epidemiology

   The number of French people with AF is between 600,000 and 1 million. It is estimated at 350,000 in Canada. The annual incidence is 5/1000 around sixty and 20/1000 after 80 years.

   Blood thinners are recommended for people with atrial fibrillation

   An updated guide from the American Academy of Neurology recommends that individuals with atrial (or atrial) fibrillation take blood thinners to prevent the risk of stroke.

   This particularly concerns those who have already suffered a stroke or a transient brain attack.

   The danger of atrial fibrillation (irregular heartbeat) is explained by the fact that the blood stays longer in the atria, which favors the appearance of clots by coagulation phenomenon. The clots can then travel from the heart to the brain. One in 20 people with untreated atrial fibrillation is likely to have a stroke within the next year.

   Anticoagulants are medicines that help prevent clots from forming inside the heart and preventing them from traveling to the brain. The newer anticoagulants (dabigatran, rivaroxaban and apixaban) are as (if not more) effective than warfarin, the standard anticoagulant. In addition, the risk of bleeding with warfarin is greater. Source: American Academy of Neurology (AAN).

   Atrial fibrillation can accelerate memory problems

   Rapid, irregular heartbeats — signs of atrial fibrillation — are quite common in older people, which could trigger early problems with memory and reasoning.
   “This means that heart health is an important factor related to brain health. says lead study author E. Thacker (University of Alabama at Birmingham, USA).

   More than 5000 elderly people, with no history of atrial fibrillation or stroke, were followed for an average of 7 years. At the same time, they took cognitive tests every year. Of the 5,150 participants, 11% developed atrial fibrillation over the 7 years. The study showed that people with atrial fibrillation had lower scores on cognitive tests (memory, reasoning), compared to those without heart problems .

   If these results are confirmed, the next steps will have to determine the cause and the means to prevent this cognitive decline, adds Dr. Thacker.
   Source: American Academy of Neurology (AAN). Rapid, irregular heartbeat may be linked to problems with memory and thinking, 2013.

3. Méditation : peut-elle aider à ralentir l’apparition de la maladie d’Alzheimer ?

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   Il existe de nombreux avantages pour la santé associés à la méditation, autant physiques que mentaux, et c’est une pratique croissante. 

   Des études soulignent qu’elle peut améliorer le bien-être et la santé mentale en vieillissant, et notamment réduire le risque de maladies neurodégénératives : un atout qui pourrait s’avérer crucial compte tenu de l’espoir croissant de vivre, signe d’une population vieillissante.

   La méditation est un excellent moyen de cultiver l’attention mentale et le bien-être émotionnel. Asseyez-vous simplement dans une chaise confortable, respirez profondément par le nez, maintenez-le pendant quelques secondes, puis expirez complètement par le nez. Continuez ce processus de respiration intentionnelle pendant 10 à 15 minutes, en comptant chaque inspiration à haute voix. Gardez votre attention sur le cycle inspiration/expiration, en revenant au comptage chaque fois que votre esprit vagabonde. Il s’agit d’une technique de méditation connue sous le nom de comptage de la respiration.

   De nombreux types de méditation, tels que la réduction du stress basée sur la pleine conscience (MBSR), la Méditation Transcendantale® et la pratique du Koan, existent avec peu de preuves que l’un est supérieur à l’autre. La pratique la plus appropriée pour un individu est probablement celle avec laquelle il est le plus facile de rester cohérent. 

   Des études ont suggéré que la méditation peut améliorer certaines capacités cognitives. Cependant, il n’y a pas suffisamment de données pour déterminer si elle diminue les risques de développer la maladie d’Alzheimer ou si elle profite aux personnes qui en souffrent déjà. Dans l’ensemble, la méditation peut contribuer au bien-être général.

   Des bienfaits possibles de la méditation pour les personnes âgées

   Il y a des questions précises sur la santé des personnes âgées. Près de 15 % des adultes de plus de 60 ans souffrent de pathologies liées au vieillissement. Le nombre de personnes atteintes de la maladie d’Alzheimer ou d’autres maladies neurodégénératives augmente parallèlement à l’allongement de la durée de vie.

   Maintenir la bonne santé mentale de ce public est donc un défi, et toute stratégie de prévention doit être envisagée. Cependant, les effets réels de la méditation n’ont jamais vraiment été étudiés dans cette perspective.

   Toute une série de facteurs de risque des maladies neurodégénératives ont été identifiés : tabagisme, pollution, mauvaise alimentation, sédentarité… Il existe plusieurs moyens de les contrer : exercice physique, entraînement cognitif, alimentation saine (de préférence méditerranéenne), éducation à la santé cardiovasculaire… Ces méthodes ont été évaluées dans plusieurs études.

   La recherche a cependant largement sous-estimé d’autres facteurs de risque, dont certains sont amplifiés avec l’âge : dépression, stress, anxiété, troubles du sommeil (affectant une personne sur deux de plus de 60 ans), solitude et exclusion de la société. De plus, ces facteurs de risque psychologiques (socio-) émotionnels n’ont pas de programmes d’intervention préventive scientifiquement justifiés.

   En ce qui concerne les maladies neurodégénératives chez les personnes âgées, les facteurs de risque psycho-(socio-)affectifs restent peu étudiés. Cependant, la dépression, le stress, l’anxiété, les problèmes de sommeil et la solitude ont un impact réel.

   Le projet européen H2020 Silver Health Study vise à combler cette lacune en étudiant les effets de la méditation.

   Le projet de recherche européen H2020

   Le projet de recherche européen H2020, qui mobilise onze équipes de recherche dans six pays, doit étudier l’impact sur de multiples facteurs associés au vieillissement et à la maladie d’Alzheimer par le biais d’essais cliniques. Trois groupes de 137 participants de plus de 65 ans ont été divisés en trois : un recevant une formation à la méditation (45 personnes), un suivant une activité cognitive (ici, l’apprentissage d’une langue étrangère ; 46 personnes), et le groupe contrôle (pas d’activité spécifique ; 46 personnes) .

   Une période d’observation typique dans ce type d’étude est de 2 à 6 mois, et le taux d’attrition (c’est-à-dire le pourcentage de participants quittant l’étude) est d’environ 15 %.

   Les résultats sont mitigés

   Les régions cérébrales qui devraient être principalement suivies ont été identifiées dans des recherches antérieures.

   En plus du cortex cingulaire antérieur, qui intègre des processus affectifs – sentiment émotionnel, rythme cardiaque – avec des processus cognitifs tels que l’anticipation de la récompense, la prise de décision et le contrôle cognitif, l’insula (impliquée dans les émotions, l’intéroception, la dépendance, la conscience…) a également joué un rôle.

   L’étude d’interventions établies sur le mode de vie telles que la méditation pose un défi lorsqu’il s’agit de définir un groupe placebo approprié. Par exemple, dans de nombreux essais de méditation, le groupe témoin inclut soit l’écoute d’une musique apaisante, soit des personnes inscrites sur une liste d’attente. D’autre part, les essais cliniques sur les médicaments impliquent généralement qu’une moitié des participants reçoivent le médicament et l’autre moitié un placebo, une réplique exacte qui ne contient aucun médicament actif (appelée pilule de sucre). Il est important d’avoir de bons groupes placebo car avoir des attentes concernant l’obtention d’un traitement peut souvent créer une amélioration de l’état. Même certains contrôles placebo, y compris la musique, peuvent avoir des effets positifs.

   Il n’est pas certain que la méditation ait un impact direct sur la diminution du risque de maladie d’Alzheimer. Cependant, il existe d’autres conditions qui peuvent être aidées par son utilisation. Les niveaux de stress et d’anxiété peuvent être réduits et le sommeil amélioré, comme le risque cardiovasculaire et la tension artérielle. En prime, il est économique et sans stress à mettre en œuvre dans son style de vie. Il existe de nombreuses ressources en ligne, dans des livres et des cours qui peuvent aider à apprendre différentes techniques. Et, si s’éloigner de la technologie aide, il existe de nombreuses applications téléphoniques proposant un soutien à la méditation.

4. Meditation : can it Help Slow the Onset of Alzheimer’s Disease ?

   17 h 17 min Leave a Comment

   There are many health benefits associated with meditation, both physical and mental, and it is a growing practice. Studies are pointing out that it may improve well-being and mental health in aging, and particularly reduce the risk of neurodegenerative disease: an asset that could prove crucial given the increasing hope of life, which is a sign of an aging population.

   Meditation is a great way to cultivate mental attention and emotional wellbeing. Simply sit in a comfortable chair, take a deep breath through the nose, hold it for a few seconds, and then exhale fully through the nose. Continue this process of intentional breathing for 10-15 minutes, counting each inhalation aloud. Keep your awareness on the inhaling/exhaling cycle, returning to the counting whenever your mind wanders. This is one technique of meditation known as breath counting.

   Many kinds of meditation, such as mindfulness-based stress reduction (MBSR), Transcendental Meditation®, and Koan practice, exist with little proof that one is superior to another. The most suitable practice for an individual is probably the easiest one for them to stay consistent with. Studies have suggested meditation can improve some cognitive abilities, yet there is insufficient data to determine if it diminishes the chances of Alzheimer’s or benefits individuals already suffering from it. All in all, meditation may contribute towards overall well-being.

   The possible benefits of meditation for the elderly

   There are specific questions about the health of seniors. Almost 15% of adults over 60 suffer from pathologies associated with aging. The number of people affected by Alzheimer’s disease or other neurodegenerative diseases is increasing along with the increase in lifespan.

   Keeping the good mental health of this public is therefore a challenge, and any preventative strategy should be considered. However, meditation’s real effects have never really been studied from this perspective.

   In this paper, we present the results, and perspectives of a study conducted as part of the Age-Well project (Silver Health Study program).

   A whole series of risk factors for neurodegenerative diseases have been identified: smoking, pollution, poor diet, physical inactivity, etc. There are several methods to counter them: exercise, cognitive training, a healthy diet (preferably Mediterranean), cardiovascular health education… These methods have been evaluated in several studies.

   The research, however, has largely underestimated other risk factors, some of which are amplified with age: depression, stress, anxiety, sleep problems (affecting one out of two people over 60), loneliness, and exclusion from society. Furthermore, these psychological-(socio-)emotional risk factors do not have scientifically substantiated preventive intervention programs.

   In terms of neurodegenerative diseases among the elderly, psycho-(socio-)affective risk factors remain understudied. However, depression, stress, anxiety, sleep problems, and loneliness have a real impact.

   The European project H2020 Silver Health Study aims to fill this deficiency by studying the effects of meditation.

   The European research project H2020

   The European research project H2020, which involves eleven research teams in six countries, is to study the impact on multiple factors associated with aging and Alzheimer’s disease through clinical trials.

   Three groups of 137 participants over 65 were divided into three: one receiving meditation training (45 people), one following a cognitive activity (here, learning a foreign language; 46 people), and the control group (no specific activity; 46 people).

   A typical observation period in this type of study is 2 to 6 months, and the attrition rate (i.e. the percentage of participants leaving the study) is about 15%.

   Results are mixed

   Brain regions that should be tracked primarily have been identified in previous research.

   As well as the anterior cingulate cortex, which integrates affective processes – emotional feeling, heartbeat – with cognitive processes such as reward anticipation, decision-making, and cognitive control, the insula (involved in emotions, interoception, dependence, consciousness…) also played a role.

   Studying interventions based on lifestyle such as meditation poses a challenge when it comes to defining an appropriate placebo group. For example, in many meditation trials the control group involves either calming music or people put on a waiting list. On the other hand, drug clinical trials commonly involve one half of the participants receiving the medication and another half being given a placebo—an exact replica which does not contain any active drugs (known as a sugar pill). It is important to have good placebo groups since having expectations about getting a treatment can often create an improvement in condition. Even certain placebo controls including music may have positive effects.

   It is not definitive whether meditation has a direct impact on decreasing the chance of Alzheimer’s disease. However, there are other conditions that can be helped through its use. Stress and anxiety levels may be reduced and sleep improved, as can cardiovascular risk and blood pressure. As an added bonus, it is economical and stress-free to implement into one’s lifestyle. There are many resources online, in books and classes that may help with learning different techniques. And if getting away from technology helps, there are plenty of phone apps offering support with meditation.

5. Dizziness

   10 h 17 min Leave a Comment

   Many older people experience dizziness that can be acute (coming on suddenly) or chronic (continuing). 

   Dizziness can be the result of a specific disorder or a combination of several problems. 

   Symptoms of dizziness that occur before fainting are called presyncope. 

   Dizziness can be caused by medications, blood pressure changes, heart problems, neurological disorders, or inner ear problems.

   The causes of dizziness

   Dizziness is a common symptom that can be caused by several health issues. One of these conditions is orthostatic or postural hypotension, a sudden drop in blood pressure due to a quick change in posture from sitting to standing.

   Dizziness may also be associated with anxiety disorders, especially during panic attacks and periods of hyperventilation.

   In addition, some individuals may experience presyncope — sudden lightheadedness without loss of consciousness — which is particularly prevalent among those with chronic diseases like heart disease or diabetes.

   Symptoms

   Dizziness can be caused by a variety of issues related to the inner ear. Benign paroxysmal positional vertigo (BPPV) is the most commoncause in the elderly, which occurs when calcium crystals become dislodged from their normal position and incorrect messages are sent to your brain about head movement.

   Labyrinthitis, or acute vestibular neuritis, is an inflammation of the inner ear often afflicting elderly people. It can cause intense dizziness lasting days or even longer. Meniere’s disease results in a build up of fluid in the inner ear, while vestibular migraine causes prolonged lightheadedness between episodes of migraine headaches.

   Vestibular schwannoma is a rarer form that usually has slowly progressive hearing loss as one of its symptoms. Vertigo can also be indicative of strokes or multiple sclerosis.

   Diagnosis and tests for dizziness

   The therapy required to relieve dizziness depends on the causes detected after assessment of medical history and overall health.

   Benign paroxysmal positional vertigo is eased with the highly effective Epley maneuver which simply involves slow head and body movements intended to realign any calcium crystals stuck in inner ear semicircular canals; it’s pain-free and non-invasive although multiple sessions might be needed for lasting results.

   For labyrinthitis, motion sickness medicine will help reduce acute feelings of dizziness alongside anti-inflammatory medication for inflammation relief if necessary plus antibiotics in some cases. For Meniere’s disease medication like meclinizine (Antivert) will prove useful for controlling persistent vertigo along with diuretics & saline restriction to reduce fluid buildup within inner ears – however it’s classed as chronic so symptoms need minimizeeing rather than curing completely.

   If low blood pressure leads to feeling faint then a glance at medications needs looking into before alternative treatments like eating specifically outlining your diet.

   Suggested over-the-knee stockings might help improve circulation together with exercising more care when undertaking physical activities outside during hot days.

   Drugs such as fludrocortisone increasing bodily fluids and Midodrine raising blood pressure when standing also are helpful.

   NSAIDs and caffeine despite their associated risks may be useful.

   Lifestyle and management

   Dizziness can be caused by a wide range of lifestyle and environmental factors, ranging from lack of rest or dehydration to inner ear issues.

   However, managing these factors is essential in minimizing or completely avoiding dizziness.

   This could include drinking more water and getting enough rest, avoiding strong smells or sudden movements that may induce vertigo, as well as following any medical instructions prescribed by your physician.

   Adjustments to your diet

   One thing you can do to reduce or manage the feeling of dizziness is to make adjustments to your diet.

   Eating small and regular meals, ensuring you get enough vitamins and minerals in your diet, avoiding substances such as alcohol and caffeine, getting enough sleep and staying hydrated are all important for helping to maintain a healthy balance of fluids in your body, which can help reduce feelings of dizziness.

   If you suddenly have low blood pressure (orthostatic hypotension), you should:

   • Drink plenty of fluids every day.
   • Avoid alcohol.
   • Consider increasing your salt intake to promote fluid retention (if you don’t have high blood pressure between episodes of low blood pressure). Check with your doctor if it is safe for you to raise your salt.

   Complications

   Dizziness is a feeling of lightheadedness or unsteadiness that can range from subtle to intense and may signal a medical problem.

   It can be caused by factors such as dehydration, medication side effects, sudden drops in blood pressure, inner ear disorders, or underlying health conditions like hypoglycemia, stroke and heart disease.

   Treating dizziness usually depends on the cause and may include lifestyle changes, medications or physical therapy.

6. Post-Traumatic Disorder (PTSD)

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   Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that can develop in people who have experienced or witnessed a traumatic event. Knowing the signs of PTSD and finding effective, evidence-based treatments early are important for managing this disorder.

   What is PTSD?

   PTSD is an anxiety disorder that is caused by a traumatic event and can cause flashbacks, nightmares, physical sensations like heart palpitations, numbness and dissociation from emotions. It often leads to intense feelings of guilt and shame, heightened emotional reactions, lack of concentration and low self-esteem. People with PTSD can experience difficulty functioning in the world, leading to social isolation and impaired relationships.

   Symptoms

   Post-traumatic stress disorder can cause a wide range of symptoms, with the most common being intrusive memories, flashbacks and nightmares; avoidance behaviors such as refusing to talk about the trauma; negative thoughts or feelings related to the experience, such as guilt and shame; difficulty sleeping; increased irritability; hyper-vigilance and an exaggerated startle response. Other symptoms may include depression, fearfulness, reckless behavior, isolation from loved ones, refusal to leave home, mistrust of others and suicidal thoughts or ideation.

   Treatment Options

   Treatment for PTSD is typically tailored to the individual and their unique symptoms. Options include trauma-focused cognitive behavioral therapy (TF-CBT), medication management, exposure therapies, and eye movement desensitization and reprocessing (EMDR).

   In general, the goal is to identify triggers and create coping strategies, bolster support systems, provide valuable life skills and manage medications. It is important to remember that recovery from PTSD takes time, but with proper professional help it can be improved and even eliminated.

   Outcomes from Treatment for PTSD

   Treatment for PTSD can be successful and lead to numerous positive outcomes for those suffering from the disorder. Many people experience improved mental health, reduced suicidal thoughts and behaviors, an improved sense of control over their lives, strengthened relationships with family and friends, improved cognitive functioning, improved ability to manage stressful situations and triggers, improved physical well-being, decreased feelings of depression and anxiety, better coping skills in difficult times.

   Managing the Effects of PTSD on Your Life and Relationships

   PTSD can have wide-ranging effects on daily life and relationships, but the following strategies are beneficial for managing those effects. Counseling can help a person learn how to manage the symptoms of PTSD and develop better coping skills. Participating in activities that provide support, distraction, and relaxation can also be helpful in addressing the effects of PTSD.

   Additionally, developing good communication skills with close family members or friends is an important part of managing the disorder since it can help one better express their feelings, needs, and concerns. Finally, establishing healthy lifestyle habits like getting proper rest, exercising regularly, and eating nourishing foods will all contribute to improved mental health.

7. Lecanemab : un nouveau médicament contre la maladie d’Alzheimer ?

   9 h 14 min Leave a Comment

   L’agence américaine de santé américaine (Food and Drug Administration, FDA) a approuvé le médicament lecanemab, vendu sous le nom de marque Leqembi, dans le traitement de la maladie d’Alzheimer.

   Cette approbation a eu lieu début l2023, par le biais d’une « voie d’approbation accélérée ».

   Cette voie accélère les traitements cliniques prometteurs pour les maladies pour lesquelles il n’existe pas d’autres options actuellement efficaces.

   Le lecanemab est un anticorps monoclonal qui cible la bêta-amyloïde, une protéine naturelle qui devient toxique lorsqu’elle s’agglutine pour former les plaques caractéristiques qui s’accumulent dans le cerveau des personnes atteintes de la maladie d’Alzheimer.

   Le médicament est administré par perfusion intraveineuse toutes les deux semaines.

   Les anticorps sont des protéines circulant dans le sang et qui reconnaissent et neutralisent les substances présentes dans le corps qu’ils considèrent comme étrangères, telles que les bactéries et les virus.

   Un anticorps monoclonal est produit en clonant ou en faisant une copie d’un seul globule blanc de sorte que tous les anticorps dérivés soient dérivés de la même cellule et se lient à une cible spécifique. Dans ce cas, le lecanemab se lie uniquement aux protéines bêta-amyloïdes.

   Lecanemab se lie à une forme particulière de bêta-amyloïde lorsqu’elle s’agglutine, appelée protofibrille.

   Des études suggèrent que c’est l’espèce d’amyloïde qui est la plus susceptible de jouer un rôle dans le développement de la maladie d’Alzheimer.

   Des essais antérieurs impliquant d’autres anticorps monoclonaux n’ont pas réussi à démontrer un effet bénéfique, peut-être parce qu’ils ciblaient des formes plus précoces d’amyloïde.

   Le lecanemab : un traitement prometteur de la maladie d’Alzheimer ?

   Une étude, publiée début janvier 2023, a rapporté les résultats d’un essai clinique de phase 3 qui incluaient1 795 participants, dont la moitié recevait du lecanemab et l’autre moitié non.

   Le traitement par lecanemab a non seulement atteint tous ses objectifs cliniques, mais il a également réduit les quantités d’amyloïdes mesurées dans les tests d’imagerie et sanguins. Les chercheurs ont aussi constaté des réductions des niveaux de tau, la protéine responsable des enchevêtrements neurofibrillaires qui s’accumulent à l’intérieur des neurones chez les patients atteints de la maladie d’Alzheimer.

   Une autre étude publiée fin en décembre 2022 a rapporté les résultats d’une étude de phase 2 avec 856 participants. Le traitement par lecanemab a également entraîné des réductions significatives de plaques amyloïdes lors des tests d’imagerie cérébrale et sanguins.

   ---

   Les résultats des études

   Après 18 mois de traitement dans l’étude de phase 3, le lecanemab a ralenti la progression de la maladie de 27 % par rapport au groupe témoin.

   Par rapport à ceux qui n’ont pas reçu le traitement, les participants traités par lecanemab ont également montré une amélioration de 26 % aux tests cognitifs et un déclin plus lent dans les activités quotidiennes.

   L’étude a aussi rapporté une réduction marquée de la quantité d’amyloïde dans le cerveau chezceux qui ont reçu le traitement.

   Ces résultats sont parmi les effets les plus importants jamais observés dans un essai clinique sur la maladie d’Alzheimer.

   Bien qu’ils ne guérissent pas, ils donnent l’espoir qu’en ralentissant considérablement le déclin physique, cognitif et fonctionnel tout en éliminant l’amyloïde, l’évolution de la maladie pourrait être modifiée pour donner aux patients une meilleure qualité de vie.

   Il est important de rappeler que l’essai n’a été réalisé que sur 18 mois. Par conséquent, les bénéfices à long terme du lecanemab ne sont pas connus.
   

   Bien que le lecanemab ait montré des avantages évidents, il s’accompagne également d’effets indésirables potentiels notables qui doivent être étudiés.

   Dans l’essai clinique de phase 3, sur les 1 795 participants, 12,6 % prenant du lécanemab ont présenté un gonflement du cerveau à l’IRM, contre 1,7 % de ceux qui ont reçu le placebo. Dans l’ensemble, seuls 2,8 % des participants ont présenté des symptômes, principalement des maux de tête.

   De plus, 17,3 % de ceux qui ont reçu du lecanemab ont eu de petites hémorragies du cerveau observés à l’IRM, contre 9 % dans le groupe placebo.

   Le lecanemab diffère-t-il d’autres traitements ?

   Les traitements de la maladie d’Alzheimer actuellement disponibles – qui comprennent le donépézil, la rivastigmine, la galantamine et la mémantine – traitent principalement les symptômes. Ils ne s’attaquent pas aux mécanismes sous-jacents et présentent des avantages cliniques modestes.

   Un médicament qui traite la maladie, l’aducanumab, vendu sous le nom de marque Aduhelm, a été approuvé par la FDA en 2021 selon le même processus accéléré que le lecanemab. Mais il n’est pas devenu largement utilisé en raison de la controverse sur son efficacité et son prix

   Le lecanemab n’a pas été étudié et n’a pas été approuvé pour les personnes atteintes de stades modérés ou sévères de la maladie d’Alzheimer.

   Bien que le lecanemab ait reçu l’approbation de la FDA, il faudra plusieurs mois – du moins aux États-Unis – avant qu’il ne soit disponible pour une utilisation clinique.

8. Understanding How Lecanemab Can Help Manage Alzheimer’s Symptoms

   28 janvier 2023 18 h 34 min Leave a Comment

   Lecanemab is an antibody used to help reduce the effects of Alzheimer’s disease, a progressive condition that affects both the brain and memory. It has been shown to be effective in slowing down the progression of symptoms and helping patients retain their cognitive abilities for longer periods of time.

   What is Lecanemab?

   Lecanemab is an antibody-based treatment option for individuals with Alzheimer’s. It works by targeting and inhibiting a protein known as amyloid beta which accumulates in the brain, causing memory loss and cognitive decline. By preventing this buildup of protein, lecanemab can help improve or maintain the function of neurons in the brain.

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   How Does It Work?

   Lecanemab works by targeting and inhibiting the action of a protein known as amyloid-beta. This protein accumulates in the brain, leading to deposition of amyloid plaques which are associated with memory loss and cognitive decline. By preventing this buildup of protein, it can help improve or maintain the function of neurons in the brain. As a result, it is believed that the drug may be able to help slow down or halt the progression of Alzheimer’s disease.

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   What Are the Benefits of Lecanemab?

   Recent clinical trials have shown that lecanemab offers many benefits. These include improved memory, increased ability to handle day-to-day tasks, improved functioning in social and occupational settings, and a slowed decline in cognitive abilities. Additionally, the drug may also help reduce symptoms such as agitation, irritability, and depression. Thus, it may be an effective treatment for managing the symptoms of Alzheimer’s disease.

   Researchers also saw reductions in the levels of tau – the protein responsible for the neurofibrillary tangles that accumulate inside the neurons in patient’s with Alzheimer’s. And they found reduced levels of other proteins that measure brain injury and degeneration. This suggests that lecanemab could potentially address the disease by targeting it through both direct and indirect pathways.

   The first phase 2 study published in December 2022 enrolling 856 participants reported significant reductions in amyloid plaques on brain imaging tests, reductions in blood measurements of amyloid and tau protein and slowing of disease progression.

   The second study published in January 2023 and including 1,795 participants also showed beneficial effects, along with a reduction in the amounts of beta-amyloid measured in imaging tests and in the blood.

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   What Are Side Effects ?

   While lecanemab is generally well-tolerated, there are some possible side effects associated with this treatment. These include headaches, nausea, and dizziness. Additionally, people may also experience behavioral symptoms such as agitation and confusion. It is important to talk to your doctor about any side effects you experience while using lecanemab, as they may be a sign of an underlying problem that needs to be addressed.

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   Who Should Consider Taking Lecanemab?

   Lecanemab is approved for the treatment of Alzheimer’s disease in people aged 55 and older with mild to moderate symptoms. People who have early drug-naïve Alzheimer’s may receive the most benefit from this drug. Additionally, it may be beneficial for those whose disease has worsened despite taking other medications such as donepezil or memantine.

9. Facial numbness

   18 h 22 min Leave a Comment

   Facial numbness is an absence or loss of sensation in any part of the body.

   It can be a symptom of many health problems, such as migraine and allergies.

   Numbness usually occurs as a result of nerve damage or disruption of nerve function.

   Numbness is a loss of sensation in any part of your body.  Facial numbness is not a disease, but a symptom of something else. Most causes of facial numbness are related to nerve compression or nerve damage. 

   Nerve disorders can sometimes be due to poor health or an allergic reaction, but they can also simply be a response to cold.

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   Migraine: a possible cause of facial numbness

   Migraine is a possible cause of a numb face.

   Migraine is a condition that causes severe headaches and other symptoms. Some people experience facial numbness during a headache.

   Migraine has four phases:

   • Prodrome: early signs of migraine include unexplained mood changes, uncontrollable yawning, fluid retention and increased urination.
   • Aura: People experiencing aura may see flashing or bright lights or zigzagging lines. They may also experience muscle weakness. The aura stage may occur just before or during the headache phase, but not in everyone with a migraine.
   • Headache: The pain tends to be on one side of the head and usually worsens when the person moves. People may feel a painful throbbing or pulsing sensation. Other symptoms at this stage include numbness, nausea and strong sensitivity to light, sound and smell.
   • Postdrome: The person may feel exhausted, weak and with moments of confusion.

   There is no cure for migraine. However, individuals can take painkillers or prescription medications to decrease the frequency of episodes and reduce symptoms.

   During a migraine episode, a person can also:

   • rest with their eyes closed in a dark room.
   • place a cool cloth or ice pack on the forehead
   • drink plenty of water.

   The numbness from the migraine usually goes away after the episode is over.

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   Allergies

   An allergic reaction occurs when the body’s immune system reacts to an allergen, which is a foreign substance that is usually not a health hazard. An allergen can be something the person has eaten, inhaled, injected or touched.

   Some allergies can cause numbness in the face. Other typical symptoms of an allergic reaction include:

   • coughing
   • sneezing
   • itchy eyes
   • a runny nose
   • a sore throat
   • a rash
   • hives

   A severe allergic reaction, called anaphylaxis, is very dangerous. A person having a severe allergic reaction will need emergency medical attention. They may have:

   • Low blood pressure.
   • Difficulty breathing.
   • Swelling of the throat.

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   Bell’s palsy

   Bell’s palsy is a form of temporary facial paralysis. An affected facial nerve can cause this condition.

   Symptoms tend to appear suddenly and worsen within 2 days. They may include:

   • tics
   • weakness in the facial muscles
   • an inability to move one side of the face
   • a drooping eyelid
   • confusion
   • pain or discomfort around the jaw and behind the ear
   • ringing in one or both ears
   • headaches
   • increased sensitivity to sound
   • speech problems
   • dizziness
   • difficulty eating or drinking

   Doctors may recommend steroids, antiviral medications or pain relievers, such as aspirin, acetaminophen or ibuprofen.

   They may also suggest other non-drug therapies, including physical therapy, facial massage and acupuncture.

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   Stroke

   There are different types of stroke, but this condition always requires immediate medical attention.

   A hemorrhagic stroke occurs when a blood vessel that carries oxygen and nutrients to the brain bursts. An ischemic stroke usually occurs when a blood clot blocks one of these vessels or atherosclerosis narrows it.

   When the brain does not get the blood it needs, the neurons die.

   A stroke will occur suddenly and, in some cases, can cause numbness in the face. The person may also experience the following symptoms

   • confusion
   • difficulty seeing
   • difficulty moving
   • a sudden severe headache

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   Multiple sclerosis: a disease that can also cause facial numbness

   Multiple sclerosis (MS) is an autoimmune disease that affects the brain. MS damages the central nervous system and causes a variety of symptoms, including numbness.

   Some of the common symptoms of MS are:

   • numbness or tingling in the face, body, arms or legs
   • fatigue
   • weakness
   • dizziness and lightheadedness
   • sexual dysfunction
   • pain and itching
   • difficulty walking
   • spasticity (involuntary muscle stiffness or spasms in the limbs)
   • vision problems
   • loss of bladder or bowel control
   • problems thinking or processing information

10. Quel lien entre la sclérose en plaques et la dépression ?

    10 h 20 min Leave a Comment

    La sclérose en plaques (SP) est un trouble neurologique qui perturbe la communication entre les neurones en raison d’une inflammation, ce qui entraîne la destruction des gaines de myéline.

    Ces gaines de myéline sont des couches grasses qui servent de protection pour les cellules nerveuses et permettent la communication entre ces neurones. En raison de cette rupture de communication, les personnes atteintes de SP peuvent souffrir de dépression, d’anxiété et d’autres problèmes de santé mentale.

    Les circuits neuronaux associés à la dépression sont déréglés par les lésions causées par la sclérose en plaques (SEP). Une étude récente a utilisé une technique de cartographie pour examiner s’il existait une relation entre les lésions de la SEP et ces circuits.

    Les chercheurs ont découvert que les lésions de la SEP affectaient les mêmes zones du cerveau liées à la dépression.

    Pour une nouvelle étude  des chercheurs ont étudié le lien entre la sclérose en plaques et les symptômes de la dépression. Les données comprenaient des informations sur 281 personnes atteintes de SEP, notamment des scores de dépression autodéclarés, des niveaux d’incapacité et des données d’imagerie par résonance magnétique (IRM). 

    Les résultats fournissent une preuve supplémentaire du lien entre la SEP et les problèmes de santé mental tels que la dépression.

    Les chercheurs ont utilisé une technique appelée cartographie des réseaux de lésions pour examiner la prévalence de la dépression chez les personnes atteintes de sclérose en plaques.

    En comparant les images IRM de personnes atteintes de SEP à une base de données préexistante de connexions neuronales de 1 000 autres personnes, ils ont pu identifier les circuits neuronaux liés à la dépression. 

    Leurs résultats montrent que les participants atteints de SEP qui présentaient des lésions dans ces circuits neuronaux particuliers avaient tendance à avoir des scores plus élevés aux tests évaluant les symptômes dépressifs par rapport aux participants présentant des lésions situées ailleurs.

    Des études récentes ont mis en évidence le lien entre la sclérose en plaques (SEP) et la dépression. Il a été constaté que les lésions associées à la SEP sont connectées aux mêmes voies neuronales que celles affectées par un accident vasculaire cérébral, la stimulation magnétique transcrânienne (TMS) et la stimulation cérébrale profonde (DBS). Ces traitements, qui peuvent modifier les symptômes dépressifs, donnent un aperçu du lien entre la dépression et la SP.

    Le Dr Barbara Giesser, neurologue à l’Institut du Providence Saint John’s Health Center à Santa Monica, en Californie, déclare que sa récente étude a établi un lien entre la dépression liée à la sclérose en plaques et les lésions cérébrales structurelles (p. ex. AVC) présentes aux mêmes endroits du cerveau.

    Les personnes atteintes de sclérose en plaques (SEP) sont particulièrement susceptibles de souffrir de dépression. La dépression chez les personnes atteintes de SEP est généralement due à une combinaison de dommages structurels dans le cerveau, de prédispositions génétiques et de facteurs de stress environnementaux liés à leur maladie. 

    De plus, certains médicaments prescrits pour traiter la SEP peuvent également entraîner des sentiments dépressifs.

    Malgré les preuves de recherche encourageantes, des recherches supplémentaires sont encore nécessaires avant que l’utilisation de la stimulation cérébrale pour traiter la dépression chez les personnes atteintes de sclérose en plaques (SEP) devienne une pratique répandue. 

    Cette technique pourrait être utile pour traiter la dépression liée à la SEP, mais des études supplémentaires sont encore nécessaires pour bien comprendre son efficacité. 

    La dépression est généralement reliée à un vaste réseau de connexions de neurones dans le cerveau et ne peut donc pas être isolée dans une région du cerveau particulière.

    La communauté médicale suggère d’explorer la stimulation magnétique transcrânienne comme une option de traitement alternative pour lutter contre la dépression induite par la SEP.