Thierry Deltombe

Catholic University of Louvain | UCLouvain · Faculty of Medicine and Dentistry

Literature regarding cases of pregnant patients with hereditary spastic paraparesis (Strumpell-Lorrain disease) and those treated by intrathecal baclofen therapy is sparse. There are currently no specific guidelines to manage pregnancy and delivery in these patients. A 42-year-old woman presented to our clinic with hereditary spastic paraparesis an...

Context: Serotonin syndrome is a drug-induced condition related to an increased level of serotonin in the brain, which may induce neuromuscular, autonomic and mental symptoms. Case report: A 40-year-old woman with hereditary spastic paraparesis (Strumpell-Lorrain disease) with an implanted intrathecal baclofen pump for severe spasticity. Two day...

Objective: The clinical and electrophysiological profile of spastic muscle overactivity (SMO) is poorly documented in patients with disorders of consciousness (DOC) following severe cortical and subcortical injury. We aim at investigating the link between the clinical observations of SMO and the electrophysiological spastic over-reactivity in pati...

Objective: To discuss the effectiveness, indications, limitations and side effects of botulinum toxin type A and selective neurotomy for treating focal spastic muscle overactivity to help clinicians choose the most appropriate treatment. Methods: Expert opinion based on scientific evidence and personal experience RESULTS: Botulinum toxin type A...

Introduction/Background Patients with chronic hemiparesis following stroke or traumatic brain injury (TBI) often necessitate a quadripod crutch to improve the balance during gait. The quadripod crutch, by inducing a 3-step gait participates to an asymmetric and slow walking speed. This study aims to assess changes in gait parameters and balance in...

Introduction/Background Patients with chronic hemiparesis following stroke or traumatic brain injury (TBI) often experience restricted walking performance. Our previous double-blind (DB) trial of 388 patients demonstrated that abobotulinumtoxinA (aboBoNT-A) treatment improves muscle tone and functional outcomes in adults with lower limb spastic par...

Background: Neuro-orthopaedic surgery is recognized as an effective treatment to improve walking capacity in case of spastic equinovarus foot. However, the effect of surgery on the 3 domains of the International Classification of Functioning, Disability and Health (ICF) has never been studied. Aim: To assess the efficacy of the neuro-orthopaedic...

Background: Spasticity is a frequent complication after severe brain injury, which may prevent the rehabilitation process and worsen the patients' quality of life. Objectives: In this study, we investigated the correlation between spasticity, muscle contracture, and the frequency of physical therapy (PT) in subacute and chronic patients with dis...

Presented at the Annual Meeting of the American Association of Neuromuscular and Electrodiagnostic Medicine, September 13–16, 2017, Phoenix, AZ, USA. Previously presented at TOXINS, January 18–21, 2017, Madrid, Spain.

Objective Gait kinematics evaluation is mandatory to assess the effect of rehabilitation and treatments in spastic patients. Three-dimensional (3-D) analysis in gait laboratory is considered as the gold standard. In clinical practice, video assessment is a low cost alternative making two-dimensional (2-D) analysis with software an alternative. To t...

Objective Few studies have assessed the treatment interval during repeated injections of botulinum toxin. In a double-blind (DB), single-treatment study followed by a long-term open-label (OL) extension study, abobotulinumtoxinA (aboBoNT-A, Dysport®) was efficacious and did not generate unexpected safety findings (Esquenazi et al. Am Acad Phys Med...

Objective: To assess the efficacy and safety of abobotulinumtoxinA in adults with upper limb spasticity previously treated with botulinum toxin A (BoNT-A). Design: A post-hoc analysis from a Phase 3, prospective, double-blind, randomized, placebo-controlled study SETTING: 34 neurology or rehabilitation clinics in nine countries. Participants:...

Objective: To present interdisciplinary practical guidance for the assessment and treatment of spastic equinovarus foot after stroke. Results: Clinical examination and diagnostic nerve block with anaesthetics determine the relative role of the factors leading to spastic equinovarus foot after stroke: calf spasticity, triceps surae - Achilles ten...

Objective: To develop a clinically useful patient-reported screening tool for health care providers to identify patients with spasticity in need of treatment regardless of etiology. Design: Eleven spasticity experts participated in a modified Delphi panel and reviewed and revised 2 iterations of a screening tool designed to identify spasticity s...

Resistance from antagonistic muscle groups might be a crucial factor reducing function in chronic hemiparesis. The resistance due to spastic co-contraction might be reduced by botulinum toxin injections. We assessed the effects of abobotulinumtoxinA injection in the upper limb muscles on muscle tone, spasticity, active movement, and function. In th...

Introduction Milking effect is widely search in manual drainage technique. Since 1993, some pumps can work in a similar retrograde mode. Objective Our aim was to compare the effects of three light retrograde drainage options: 2 pneumatic and one manual one's. Method We used a fragmentation program with a seven-compartment i-Press® 10th serial (Ma...

To assess the effectiveness of soft splints on spasticity and hand opening in chronic patients with upper limb spasticity and disorders of consciousness (vegetative state/unresponsive wakefulness syndrome-VS/UWS and minimally conscious state-MCS). In this prospective single-blind controlled trial, a blind evaluator assessed spasticity (Modified Ash...

Objective: The aim of the study was to compare the effect of diagnostic motor nerve block with anaesthetics and of selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic adults. Methods: In this prospective observational study, 30 hemiplegic adults with spastic equinovarus foot benefited from a diagnostic nerve blo...

Introduction The main problem optimizing the conservative treatment of a resistive lymphdema is the choice of the effective compression. What has complicated the problem is that the compression value of a pneumatic pressotherapy has been presented to be in excess between cuff and the skin. This has led to block the therapeutic pressure to low value...

Background: Spasticity is a frequent complication after severe brain injury, which may impede the rehabilitation process and diminish the patients' quality of life. Aim: We here investigate the presence of spasticity in a population of non-communicative patients with disorders of consciousness. We also evaluate the correlation between spasticity...

We report the case of a 62-year-old man who developed Guillain-Barré syndrome (GBS) following Hantavirus infection. Only three similar cases have been described in the literature so far. GBS is an autoimmune disease characterized by progressive symmetrical weakness of lower limbs extending to upper limbs and face and low or absent tendon reflexes....

Background: The imbalance between tibialis anterior and peroneus activation in the swing phase of gait after stroke is responsible for an ankle varus leading to foot instability and poor quality of gait. In such case, a split anterior tibialis tendon transfer (SPLATT) procedure is indicated to correct imbalance. The aim of the study was to prospect...

Pressotherapy is widely used but is often said to have lesser compression yield than manual drainage in upper limb secondary lymphoedema. This idea is difficult to wipe out. One of the main complaints is to find in the anterograde mode of nonprofessional material used or using. Since 1993, some pumps can work in a retrograde mode. Objective: Our ai...

Background: Selective neurotomy is a permanent treatment of focal spasticity, and its effectiveness in treating spastic equinovarus of the foot (SEF) was previously suggested by a few nonrandomized and uncontrolled case-series studies. Objectives: This study is the first assessor-blinded, randomized, controlled trial evaluating the effects of th...

Objectives: To evaluate the effect of ankle-foot orthosis on lower limbs kinematic segmental covariation (KSC) among stroke patients. Methods: Ten chronic hemiparetic spastic stroke patients presenting with a lack of ankle dorsiflexion were assessed with instrumented gait analysis under three conditions: wearing a shoe, with a prefabricated ankl...

Spastic equinovarus foot is a major cause of disability for neurorehabilitation patients, impairing their daily activities, social participation and general quality of life. Selective tibial nerve neurotomy is a neurosurgical treatment for focal spasticity, whose acceptance as treatment for spastic equinovarus foot remains controversial. We perform...

To assess the long-term efficacy of selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients. Intervention study (before-after trial) with an observational design and 2-year follow-up. Spasticity group in a university hospital. Hemiplegic patients (N=30) with spastic equinovarus foot. A selective neurotomy was...

We carried out a systematic review of the literature on treatment of genu recurvatum in hemiparetic adult patients by searching the PubMed, Pedro, Trip Database and Science Direct databases. The following keywords were used: (recurvatum or hyperextension or knee) and (hemiplegia or hemiparesis). Nine articles met our selection criteria. Four assess...

The purpose of this study was to study the effect of Botulinum toxin type A (BoNT-A) injections in spastic upper limb muscles on impairment, activity, participation and quality of life in chronic stroke patients. BoNT-A (Dysport) was injected into several upper limb spastic muscles in a group of 20 patients. Neurological impairment (muscle tone and...

A group of clinicians from across Europe experienced in the use of botulinum toxin type A for the treatment of spasticity following acquired brain injury gathered to develop a consensus statement on best practice in managing adults with spasticity. This consensus table summarizes the current published data, which was collated following extensive li...

To quantitatively evaluate the effect of motor nerve branch block and neurotomy of the soleus nerve on triceps surae spasticity, reviewing 2 cases. Beside clinical assessment, we carried out a quantitative measurement of the stiffness of the ankle flexor muscles. The path length of the phase diagram between elastic and viscous stiffness quantifies...

Walking is an essential activity for daily life and social participation, and it is frequently limited after stroke. A lack of knee flexion during the swing phase (stiff knee) is one of the impairments that restrict walking ability among patients with hemiparetic spasticity. Our purpose was to study the effect of Botulinum toxin type A (BoNT A) inj...

To assess and compare, clinically and electrophysiologically, the effects on muscle innervation and spasticity of selective anaesthetic nerve block and selective neurotomy of the motor-nerve branch to the soleus muscle in patients with spastic equinus foot. Eleven hemiplegic patients were studied before and after anaesthetic tibial-nerve block, and...

To describe the diagnosis and treatment of adhesive capsulitis of the hip (ACH). A literature review and consideration of three case reports. Adhesive capsulitis of the hip is a supposedly rare but probably underestimated condition which predominantly affects middle-aged women. Clinical assessment reveals a painful limitation of joint mobility. The...

Objectif Revue de la littérature concernant la capsulite rétractile de hanche à partir de trois cas cliniques. Méthode À partir de trois cas cliniques, décrire la démarche diagnostique et la prise en charge thérapeutique. Discussion La capsulite de hanche, pathologie rare mais probablement sous-estimée touche préférentiellement les femmes d’âge m...

To study the effect of botulinum toxin type A (BTX-A) injection in the rectus femoris on the decreased knee flexion during the swing phase of gait (stiff-knee gait) in people with stroke. Intervention study (before-after trial) with an observational design. Outpatient rehabilitation clinic and gait laboratory. Nineteen chronic hemiparetic adults pr...

This retrospective study included 105 acute stroke patients with neurological persistent deficit who were admitted in the rehabilitation service between January 2000 and December 2003. Among these 105 patients, 61 performed a Fiber optic Endoscopic Examination of Swallowing (FEES). Among these 61 patients, 32 presented clinical dysphagia signs (CDS...

Dysphagia is a common complication after stroke which usually resolves within a few weeks but, in some cases, may persist for months or permanently. Dysphagia is responsible for aspirations, airway obstruction, aspiration pneumonia that increase morbidity and mortality in stroke patients. There are no established specific and sensitive methods to d...

We conducted a reliability comparison study to determine the intrarater and inter-rater reliability and the limits of agreement of the volume estimated by circumferential measurements using the frustum sign method and the disk model method, by water displacement volumetry, and by infrared optoelectronic volumetry in the assessment of upper limb lym...

Spastic equinovarus foot (SEF) is a major cause of disability in stroke patients. Treatments are multimodal and include rehabilitation, orthosis, botulinum toxin injections, alcohol and phenol nerve blocks, functional neurosurgery (neurotomy and intrathecal baclofen) and orthopedic surgery (tendon transfer or lengthening). Precise knowledge of the...

To objectively assess the decrease in spasticity and the improvement in gait after tibial nerve neurotomy performed to treat spastic equinovarus foot. Before-after trial with a 2-yr follow-up. Three hemiplegic patients with spastic equinovarus foot were treated with a selective peripheral neurotomy of the tibial motor nerve branches (soleus, latera...

Single case report. To present an unusual cause of fever in a patient with spinal cord injury (SCI). University Hospital, Belgium. A 52-year-old man with a complete T9 paraplegia was admitted to hospital with a 7 day history of fever above 39 degrees C without pain and without gastrointestinal, urinary, or respiratory complaints. The patient had ha...

Diagnostic tibial nerve block with anesthetics is a common and safe procedure for the management of the spastic equinovarus foot. Side effects have been rarely reported. We present the case of a hemiplegic patient with a spastic equinovarus foot who presented with an avulsion fracture of the calcaneum at the insertion of the Achilles tendon consecu...

To identify the location of the motor nerve branches to the soleus and tibialis posterior muscles in relation to anatomic surface landmarks for selective motor nerve blocks in the management of the spastic equinovarus foot. Descriptive study by computed tomography (CT) scan of 12 hemiplegic legs. Spasticity group at a university hospital. Twelve pa...

Deltombe T, De Wispelaere J-F, Gustin T, Jamart J, Hanson P. Selective blocks of the motor nerve branches to the soleus and tibialis posterior muscles in the management of the spastic equinovarus foot. Arch Phys Med Rehabil 2004;85:54–8.

External iliac artery endofibrosis (EIAE) is an uncommon disease that affects a large number of athletes. The pathogenesis of EIAE is unclear. We offer an additional possible cause, with a direct relationship between EIAE and psoas muscle hypertrophy.

To determine the protective effect of gel padded glove on median nerve compression in the carpal tunnel. Median nerve conduction parameters, skin temperature, laser Doppler flowmetry and pain modifications were measured during and after a 30-min carpal tunnel external compression protocol performed with and without glove in a random order on six he...

Spasticity is usually treated by rehabilitation, orthosis, chemical denervations, orthopaedic surgery and neurosurgery. Selective fascicular neurotomy is a neurosurgical procedure consisting in partial section of selected motor nerves innervating spastic muscles. Neurotomy is indicated in cases of localised disabling spasticity without musculotendi...

The authors report three cases of thoracic radiculoneuropathy disclosing neuroborreliosis. All three patients had low back and abdominal pain and two had marked abdominal wall paresis. EMG confirmed a motor involvement of the lower thoracic roots and CSF analysis revealed a lymphocytic meningitis in all three cases. Antibodies against Borrelia burg...

Cervical spinal fracture and pseudarthrosis are previously described causes of spinal cord injury (SCI) in patients with spondylarthropathy. SAPHO (Synovitis Acne Pustulosis Hyperostosis Osteitis) syndrome is a recently recognized rheumatic condition characterized by hyperostosis and arthro-osteitis of the upper anterior chest wall, spinal involvem...

A 58-year-old woman, suffering from radicular-like pain in the left arm for 3 years, presented an entirely negative cervical imaging. Careful clinical examination disclosed Tinel's sign in the axilla. This clinical finding led to further investigation of this region. Computed tomography and magnetic resonance imaging disclosed a small tumour highly...

The retrospective analysis of 202 blocks performed within an evaluation and treatment unit of spasticity and dystonia emphasized the value of this technique in the approch of motor behavior disorders and in the elaboration of treatment protocol.One hundred and one selected patients, over a 2 years period, were admitted as outpatients, after a speci...

The influence of skin temperature on latency and amplitude of the sympathetic skin response (SSR) was studied in 10 normal subjects. SSRs were elicited in all four limbs of each subject by electrical stimulation after cooling of the right arm and after cooling of the right hand only. At low skin temperature, the latency was prolonged and the amplit...

Histologic studies of Charcot-Marie-Tooth disease, type I, show a contrast between the lesions of myelinated fibers and the normality of unmyelinated fibers. Conventional electrophysiologic tests only demonstrate the alteration of myelinated fibers but do not study unmyelinated fiber function. We present routine clinical tests that are easily avail...

Several recent studies have attributed the occurrence of acute myopathy in intensive care unit patients to the combination of corticosteroids and neuromuscular junction blocking agents (NMBAs) used for mechanical ventilation. We present 4 patients who developed acute myopathy after administration of high doses of glucocorticoids during sedation wit...

Lyme borreliosis is responsible for a large variety of peripheral neurologic manifestations including axonal polyneuropathy, radiculopathy, and facial nerve palsy. The prevalence of the disease must draw our attention on the possible responsibility of Borrelia burgdorferi in the pathogenesis of such symptomatology. Electrophysiologic studies demons...

Lyme borreliosis is responsible for a large variety of peripheral neurologic manifestations including axonal polyneuropathy, radiculopathy, and facial nerve palsy. The prevalence of the disease must draw our attention on the possible responsibility of Borrelia burgdorferi in the pathogenesis of such symptomatology. Electrophysiologic studies demons...

Since 1830, more than eighty cases of spinal cord abscesses have been reported. In half of these cases, it was unfortunately a post-mortem diagnosis. Magnetic resonance imaging (MRI) now gives new possibilities in the diagnosis and treatment of this rare pathology. We report here a case of cervical spinal cord abscess due to Streptococcus milleri....

Since 1830, more than eighty cases of spinal cord abscesses have been reported. In half of these cases, it was unfortunately a post-mortem diagnosis. Magnetic resonance imaging (MRI) now gives new possibilities in the diagnosis and treatment of this rare pathology. We report here a case of cervical spinal cord abscess due to Streptococcus milleri....

Pressure sores prevention means reduction of duration and intensity of pressure on cutaneous and sub-cutaneous tissu under bony proeminences. Nursing and specialized support surfaces achieve such aims. Mattress or cushion, static or dynamic system, specia-lized support surfaces represent a useful help in pressure sores prevention. The price and sop...

The study of 97 pelvic sores confirms the high frequency of associated etiological factors. The comparison between the surgical and medical treatment period shows a significant gain of time due to surgery (14 weeks at the sacral level P < 0.0005). However, the surgery treatment period could be shortened by the reduction of deferred health recovery.