Constant Adjien

Lennox‐Gastaut syndrome with late‐onset and prominent reflex seizures in trisomy 21 patients

Purpose:  Lennox‐Gastaut syndrome (LGS) is a severe epileptic condition characterized by multiple seizure types including tonic seizures, slow spike‐and‐wave discharges on electroencephalography (EEG), and cognitive impairment. LGS can occur in apparently healthy subjects or in patients with preexisting brain damage. The onset peaks between 3 and 5 years of age and the prognosis is usually poor. Herein we report 13 subjects with trisomy 21 who developed LGS.

Epidemiology of epilepsy in rural Benin: prevalence, incidence, mortality, and follow-up.

Epilepsy is a major clinical and social issue in Africa. This study was conducted to estimate the prevalence, incidence, mortality, and therapeutic outcome in rural Djidja in Benin.

Prevention of venous thromboembolism among inpatients at Cotonou teaching hospital, Benin.

AIM The aim of this retrospective study was to evaluate the use and appropriateness of preventive measures for venous thrombosis among adult inpatients in a Benin teaching hospital. PATIENTS AND METHODS All patients were systematically enrolled. The risk of venous thrombosis was estimated according to international guidelines. Thromboembolic events were diagnosed using the Wells score and, when possible, by paraclinical investigations. The following variables were studied: the risk of venous thrombosis, the use and appropriateness of preventive measures, and the frequency of thromboembolic events. The data were analyzed with Epiinfo 6.04.fr and SPSS software, and significance was assumed at p=0.05. RESULTS The study population consisted of 487 patients recruited in four surgical wards, four general wards and one obstetric-gynecology ward. Mean age was 38.7+/-11.3 years and the sex ratio 0.51. The risk of thrombosis was considered low in 15% of patients, moderate in 60.8%, high in 21.1% and very high in 3.1%. Prophylactic measures were prescribed to 33.9% of the patients overall, 53.6% in the obstetric gynecology ward, 28.5% in the surgical wards and 12.9% in the general wards. The frequency of preventive measures rose with the level of risk (p<0.0001). Preventive measures consisted of passive mobilization, aspirin, enoxaparin and acenocoumarol. The prescriptions were appropriate in only 6% of cases. Among 198 patients who were monitored for two months after hospital discharge, 8% had a venous thromboembolic event. Such events were more frequent in the absence of prophylaxis (12% vs 3.3%, p=0.02). CONCLUSION The risk of venous thromboembolic is recognized but poorly managed in this Bénin teaching hospital.

Hypokalaemic periodic paralysis due to the CACNA1S R1239H mutation in a large African family

Hypokalaemic periodic paralysis (HypoKPP) is a skeletal muscle channelopathy caused by mutations in calcium (CACNA1S) and sodium (SCN4A) channel subunits. A small number of causative mutations have been found in European and Asian patients, but not in African patients yet. We have identified a large Beninese family in which HypoKPP segregated over five generations and was caused by the CACNA1S R1239H mutation. We report on the clinical and histopathological spectrum of the disorder in this family. A later age at onset (15.8+/-8.8years), and particular triggering factors due to specific African life conditions seem to be characteristic of our observation.

Slow Spinal Cord Compression Inducing by Malignant Peripheral Nerve Sheath Tumors in Cotonou

MPNST is a very uncommon malignant type of neoplasm. It is often associated with neurofibromatosis type 1 (von Recklinghausen disease). It involves large anatomical regions, and thus takes on varied clinical presentations. However, bone location of MPNST, particularly in the spinal canal has been poorly described in the literature. We hereby report the case of a 29-year old young man with MPNST in the spinal canal. He presented a slow spinal cord compression confirmed by spinal MRI. MPNST was revealed through histologic and immune histochemical features after tumor resection.

G - 36 Accident vasculaire cérébral et dépression en milieu hospitalier à Cotonou (Bénin)

Introduction La survenue d’une depression complique et influence la recuperation physique, cognitive et sociale chez les patients presentant un AVC. Objectifs L’objectif de ce travail est d’etudier le lien entre l’AVC et la depression en milieu hospitalier a Cotonou. Methodes Etude cas temoins transversale (Fevrier a juillet 2006) sur des sujets ayant presente un AVC confirme par un scanner, les temoins etant des sujets indemnes d’AVC (57 cas et 114 temoins). Les donnees ont ete saisies et analysees a l’aide du logiciel Epi info version 6.04 d fr. Les frequences ont ete comparees a l’aide du test de Khi 2. Un p = 0,05 a ete considere comme statistiquement significatif. Resultats La prevalence de la depression etait de 87,7 p. 100 chez les sujets atteints d’AVC versus 27,2 p. 100 chez les temoins (p Discussion La prevalence de la depression est bien plus elevee chez les patients atteints d’AVC dans notre echantillon que dans plusieurs autres etudes ou la prevalence varie entre 18 et 61 p. 100. Ceci peut s’expliquer par les methodes et echelles utilisees qui different d’une etude a une autre. Conclusion Ces resultats suggerent l’existence d’un lien important entre l’AVC et la depression et incitent a prendre en compte la depression dans le traitement de tout sujet presentant un AVC.

A - 4 Suivi clinique et thérapeutique des personnes souffrant d’épilepsie en milieu rural au Bénin

Introduction La non-disponibilite des medicaments antiepileptiques, leur cout et le manque de suivi des personnes souffrant d’epilepsie (PSE) limitent l’acces au traitement dans les pays en developpement. Objectifs Cette etude avait pour objectif de faire un suivi clinique et therapeutique des PSE dans l’arrondissement de Djidja au Benin. Methodes L’arrondissement de Djidja Centre dans le departement du Zou a servi de cadre a la presente etude. Il s’agissait d’une etude a la fois transversale et longitudinale qui a ete menee du 11 janvier 2005 au 27 juin 2006. Elle a porte sur 172 epileptiques et sur 11 496 sujets non epileptiques. Les donnees ont ete collectees a l’aide de 3 fiches et analysees grâce au logiciel Epi Info 6.04 d fr. Resultats La prevalence de l’epilepsie etait de 14,7 ‰, l’incidence de 87,0 pour 100 000 et le taux de mortalite de 17,4 ‰. L’âge moyen des PSE etait de 25,2 ans. Sur le plan clinique, 54 % des PSE avaient des antecedents familiaux d’epilepsie, 65,3 % des crises generalisees et 30,7 % des crises partielles secondairement generalisees. L’âge moyen de debut des crises etait de 13,7 ans. Sur le plan therapeutique, l’evolution avait ete jugee favorable pour 80 % des PSE. Discussion Ces resultats suggerent que dans cette localite comme dans la plupart des pays africains, l’epilepsie est un probleme majeur de sante publique. La prise en charge des PSE necessite un effort visant a assurer un suivi continu pour une amelioration de leur etat de sante et de leur qualite de vie. Conclusion La morbidite et la mortalite sont assez elevees dans cette population de PSE. Malgre cela, les chances de remission sont elles aussi elevees chez les PSE qui sont traitees.