Anna Modji Basse

Épilepsie à pointes ondes continues du sommeil (POCS) : une cohorte sénégalaise de 63 enfants

Introduction L’epilepsie type POCS est une encephalopathie epileptique rare de l’enfant, âge-dependante, caracterisee par differents types de crises epileptiques, une deterioration neuropsychologique et un etat de mal electrique pendant le sommeil. Objectifs Evaluer les aspects biographiques, electro-cliniques, evolutifs et therapeutiques des enfants suivis pour epilepsie type POCS a l’hopital d’enfant Albert-Royer et a la clinique neurologique du CNHU de Fann. Methodes L’etude est retrospective, descriptive deroulee sur 10 ans allant de 2007xa0a 2017. Les donnees suivantes ont ete recueilliesxa0: identite, âge, sexe, antecedents personnels et familiaux. La date de debut des crises, nature, horaires et les signes associes. Les resultats de l’examen neurologique, de l’EEG veille et sommeil, de l’imagerie cerebrale. L’evolution avec le rendement scolaire. Le delai de suivi et les molecules administrees avant et pendant la periode de POCS. Les resultats obtenus. Resultats Soixante-trois enfants (38xa0garcons et 25xa0filles). L’âge moyen etait de 8,56xa0±xa02,911xa0ans. Au total, 73,02xa0% avaient presente un seul type de crise, 15,87xa0% deux types et 11,11xa0% trois types. Parmi, 46,03xa0% de deficit cognitif et 65,07xa0% avaient un index PO >xa085xa0% et 34,92xa0% compris entre 50xa0et 85xa0%. Les corticosteroides etaient utilises dans 60,30xa0% et les benzodiazepines 69,80xa0%. De plus, 69,80xa0% de crises arretees, 53,96xa0% des etats de mal electrique nettoyes, 25xa0% de deficit cognitif ameliore. Discussion La majorite etait de sexe masculin. Une predominance masculine est rapportee dans la litterature. La tranche d’âge de 6xa0a 12xa0ans etait la plus touchee. Il n’existait aucune difference clinique permettant de distinguer le groupe ayant un index PO compris entre 50xa0et 85xa0% et celui >xa085xa0%. Les formes idiopathiques initialement etaient correlees a des resultats plus favorables. Conclusion Le pronostic favorable de l’epilepsie type POCS passe par un diagnostic precoce, un traitement reevalue et un suivi regulier en sachant que l’objectif reste la preservation du potentiel neurocognitif.

EEG et convulsions fébriles au CHU Fann de Dakar

Introduction Les convulsions febriles, qui se distinguent de la maladie epileptique proprement dite, constituent un motif frequent de consultation EEG. Nous avons voulu evaluer les aspects EEG retrouves dans un contexte de convulsions febriles. Methodes Nous avons effectue une revue retrospective des enregistrements EEG d’enfants recus pour convulsions febriles a la consultation EEG du departement d’explorations neurophysiologiques du service de neurologie du centre hospitalier universitaire de Fann de Dakar entre janvier 2015 et decembre 2016. Nous avons recueilli les donnees personnelles des patients ainsi que les differents aspects retrouves sur les enregistrements EEG effectues. Resultats Sur 85 enfants recus pour convulsions dans un contexte febrile, 58 correspondaient a des convulsions febriles. Il s’agissait 36 garcons (62xa0%) et 22 filles (32xa0%). Leur âge variait entre 3 mois et 4 ans avec une moyenne de 2 ans 3 mois. Les tranches d’âge de 1–2 ans (31xa0%) et 3–4 (29xa0%) ans etaient les plus representees. L’EEG etait normal chez 88xa0% des patients, tandis que des anomalies paroxystiques focales etaient retrouvees chez 12xa0% (7 enfants), de localisation le plus souvent fronto-centrale. Un contexte pathologique etait mentionne dans 2 cas. Conclusion Les convulsions febriles sont a distinguer de la maladie epileptique proprement dite. Une anomalie EEG retrouvee dans leur contexte doit conduire a une reevaluation clinique plus poussee a la recherche d’un contexte pathologique pouvant expliquer celle-ci.

Clinical features and prognosis of amyotrophic lateral sclerosis in Africa: the TROPALS study

Objective We describe and compare the sociodemographic and clinical features, treatments, and prognoses and survival times of patients with amyotrophic lateral sclerosis (ALS) in Africa. Methodology We conducted a multicentre, hospital-based cohort study in Africa. Patients with ALS diagnosed in the neurology departments of participating hospitals from 2005 to 2017 were included. Subgroup analysis was performed by subcontinent. Survival analyses were conducted using the Cox proportional hazards model. Results Nine centres from eight African countries participated. A total of 185 patients with ALS were included: 114 from Northern Africa, 41 from Western Africa and 30 from Southern Africa. A male predominance (male to female ratio 2.9) was evident. The median age at onset was 53.0 years (IQR 44.5–64.0 years). The onset was bulbar in 22.7%. Only 47 patients (26.3%) received riluzole, mainly in Northern and Western Africa. The median survival from the time of diagnosis was 14.0 months (95%u2009CI 10.7 to 17.2 months). The median survival was longer in Northern Africa (19.0 months, 95%u2009CI 10.8 to 27.2 months) than in Western (4.0 months, 95%u2009CI 0.8 to 7.1 months) and Southern (11.0 months, 95%u2009CI 5.6 to 16.4 months) Africa (Breslow test, p<0.0001). Both subcontinental location and riluzole treatment independently affected survival. Conclusion More African patients with ALS were male and younger and exhibited a lower proportion of bulbar onset compared with patients with ALS from Western nations. Survival was consistent with that in Western registers but far shorter than what would be expected for young patients with ALS. The research improves our understanding of the disease in Africa.

Profil biologique au cours des accidents vasculaires cérébraux : série sénégalaise colligée au CHUN de Fann, Dakar - Sénégal

Introduction Les accidents vasculaires cerebraux (AVC) constituent des urgences diagnostiques et therapeutiquesxa0; la prevention passe par une identification etiologique precise, et la biologie y participe. Objectifs L’objectif de ce travail etait de decrire le profil biologique des patients atteints d’AVC avec evaluation pronostique. Patients et methodes Etude transversale de patients hospitalises pour AVC a la Clinique neurologique du CHU de Fann a Dakar entre janvier et mars 2014xa0avec recueil des donnees socio-demographiques, cliniques, biologiques avec correlation evolutivexa0; analyse uni et bivariee sur logiciel SPSS 13,0xa0avec calcul de proportions pour les variables qualitatives et de parametres de tendance centrale et dispersion pour les variables quantitatives. Resultats Sur 100xa0patientsxa0: predominance des hommes et maries (57xa0% et 87xa0%) et âge moyen de 64,7xa0ans (±xa014,2). Principaux antecedentsxa0: HTA (71xa0%), AVC (27xa0%), diabete (14xa0%), cardiopathie (7xa0%). Soixante-dix pour cent d’AVC ischemiques. Le cholesterol total etait aussi eleve (11xa0%) dans les 2xa0sexes, le HDL plus bas chez les femmes (36,11xa0% versus 12,75xa0%) et une hypertriglyceridemie chez 86,07xa0%. Hyperglycemie et anemie chez 35,4xa0% et 21xa0%. Augmentation ALAT et ASAT chez 13,25xa0% et 39,75xa0%. Discussion L’occidentalisation de nos modes de vie retentit fortement sur la modification de nos parametres biologiquesxa0; comme dans la litterature, on note une forte prevalence de l’hyperglycemie, de l’hypertriglyceridemie, et des perturbations renales, mais aussi ioniques, hepatique et infectio-inflammatoires. Nous confirmons la prevalence des AVC apres 60xa0ans, meme si un rajeunissement est note sur terrain d’HTA et/ou diabete. Conclusion L’evaluation biologique reste incontournable dans les AVC. Les principales perturbations concernent le profil lipidique, glycemique et anemiquexa0; interet sensibilisation efficace sur notre mode vie et meilleur suivi des antecedents.

Direct Complication of HIV on the Brain: A Case About a Recurrence of Stroke

Only 1% to 5% of HIV patients who develop a direct complications following. HIV infection can result in stroke via several mechanisms, including opportunistic infection, vasculopathy, cardioembolism, and coagulopathy. It is a rare association, here we report the case of a woman of 69 years immunocompromised who Stroke diagnosed without another etiology found despite an etiologic assessment of the most common causes in our context. The patient had received treatment with an overall favorable evolution. Before a stroke recurrent of unknown etiology should think of HIV as this will allow appropriate treatment. The mechanism can be related with syphilis (Vasculitis) or by direct action of the virus on the central nervous system.

Schistosomiasis complications in tropical neurology: A review

Nerve locations of schistosomiasis are exceptional. However, Schistosomiasis is a public health probem in more countries. Were doing here a literature review of epidemiology and the diagnostic difficulty of complications due to schistosomiasis in particular those of the nervous system and this in the context of sub Saharan Africa and some endemic areas. Schistosomiasis is endemic to sub-Saharan Africa, South America, Asia, the Middle East, and the Caribbean Islands. The majority of infections with Schistosoma haematobium, Schistosoma mansoni and Schistosoma intercalatum are found in sub-Saharan Africa. The typical clinical diagnosis, acute schistosomiasis (Katayama fever) typically includes fever, urticarial swellings, myalgias, eosinophilia, and bloody diarrhea. Symptoms may last for weeks but are uncommon in populations with endemic infection. However, diagnostic techniques are not developed in this area of Africa. Also the low level of life of patients does not always allow the already available techniques in Africa. It is necessary that the scientific societies of tropical countries may develop diagnostic criteria for these parasitic myelopathies to harmonize clinical research results and ensure continuous training of clinicians in the diagnosis and management of this disease entity. Correspondence to: Soumaila Boubacar, Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal, Tel: 971556864636; E-mail: abounadjma@yahoo.fr

Occurrence of Biermer's Disease After 8 Years of Follow-Up of Myasthenia Gravis: About a Clinical Case

The auto immune myasthenia comorbidity and Biermer disease is less documented and rarely brought in the literature. We bring back the observation of a Senegalese patient hospitalized in our department of Neurology at Fann hospital (Dakar). It concerned a patient aged 58 years followed up for auto-immune myasthenia to antibodies anti-receptors of acetylcholine Ac RACH since 8 years and having a benefit of recurrent blood transfusion with a blood group A rhesus positive. He was received on neurologic consultation for a tiredness associated to an effort dyspnea and a gastro esophageal reflux accompanied by vomiting. The interrogatory found palpitations which necessitated a hospitalization two month before. Physical examination had objective a myasthenia syndrome, an anemic syndrome on the other hand, sub icteric mucosa’s were noted but no melanodermia no glossite. The rest of the physical examination was without particularity. The diagnoses of the Biermer illness was carried out in front of the anemic syndrome, the chronicity of the symptomatology without notion of fluctuation and the complementary exams having as objective a low rate of hemoglobin and a deficit in vitamin B12. The origin auto-immune of this anemia was confirmed by the immunologic test which had put in evidence a high rate of anti-bodies anti- intrinsic factor. The patient benefited from a blood transfusion then a treatment from cobalamin (for life) was also installed associated to a symptomatic management of the patient. The evolution after 6 weeks of the treatment was favorable with a complete regression of the dyspnea, vomiting and the attenuation of the effort tiredness. Myasthenia gravis and Biermer disease comorbidity has to be discussed in front of every myasthenia patient presenting clinical signs of effort dyspnea to a chronic anemia because early diagnoses of this association of Biermer illness and myasthenia gravis favors a better prognosis and not to progress to the combined degeneration of the spinal cord. The autoimmune substratum of the mechanism of this comorbidity remains to be elucidated but in all cases multidisciplinary management is necessary.

Diagnosis Approach and Management of Rhombencephalitis: Literature Review

Rhombencephalitis refers to inflammatory diseases of the rhombencephalon. We present here a literature review of this pathology. It was originally described by Edwin Bickerstaff and Philip Cloake in 1951. The terms Rhombencephalitis and trunk encephalitis are interchangeable. It is a rare disease but potentially serious. The symptomatology is characterized, in some cases, by fever and alteration of consciousness, but also headache, nausea and vomiting sometimes. An involvement of the cranial nerves in the majority of the cases and or affected of the long ways. Paraclinically, cerebrospinal fluid and cerebral imaging can be normal in paraneoplastic causes or, on the other hand, be pathological in infectio-inflammatory causes. The etiologies are mainly distinguished in infectious, autoimmune and paraneoplastic pathologies. Treatment should be etiological by anti-infectives (antibiotics, antivirals, etc.) targeting curable germs such as listeria, mycobacterium tuberculosis or herpes, and/or symptomatic by corticosteroid or immunoglobulin IV. Rhombencephalitis is a rare nosological entity but is subject to severe neurological sequelae with a high mortality rate.