title: [Anaesthetic management of patient with neurological disease: Focus on regional anaesthesia].
abstract: Anaesthesia of patients with neurological disease is feasible but each specific disease requires specific adjustments accordingly. A preoperative evaluation of neurological status is required and patients should be informed of the potential harms in the perioperative period. Regional anaesthesia is commonly considered as contraindicated in these patients although it is commonly not. General anaesthesia has not been demonstrated to worsen cognitive dysfunction in patients suffering from Alzheimer's disease but these dysfunctions may disturb postoperative rehabilitation. Regional anaesthesia has no special benefit in these patients. In patients with Parkinson's disease, inability to use the oral route in the postoperative period may impair the administration of the treatment. Multiple sclerosis is not a contraindication of epidural anaesthesia especially in obstetrics, since there is no evidence that it may trigger relapse of the disease especially in the postpartum period. Regional anaesthesia is doable in patients with a dysimmune demyelinated lesions out of the regeneration phase of the disease. In peripheral hereditary or acquired neuropathies regional anaesthesia is also feasible. Epilepsy, spina bifida and traumatic pathologies of the spine are not contraindications to regional anaesthesia but the latter require technical adjustment.
authors.affiliation: CHU de Reims, pôle URAD, hôpital Maison-Blanche, service d'anesthésie-réanimation, 51092 Reims cedex, France. Electronic address: jmmalinovsky@chu-reims.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Malinovsky
authors.affiliation: CHU de Reims, pôle URAD, hôpital Maison-Blanche, service d'anesthésie-réanimation, 51092 Reims cedex, France.
authors.forename: Armine
authors.initials: A
authors.lastname: Hamidi
authors.affiliation: CHU de Reims, pôle URAD, hôpital Maison-Blanche, service d'anesthésie-réanimation, 51092 Reims cedex, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Lelarge
authors.affiliation: CHU de Reims, pôle URAD, hôpital Maison-Blanche, service d'anesthésie-réanimation, 51092 Reims cedex, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Boulay-Malinovsky
mesh_terms: D000765:Anesthesia, Conduction / Q000379:methods; D006801:Humans; D009422:Nervous System Diseases; D010523:Peripheral Nervous System Diseases