E. E. Philip-Ephraim

The Role of Radiotherapy and Chemotherapy in the Treatment of Primary Adult High Grade Gliomas: Assessment of Patients for These Treatment Approaches and the Common Immediate Side Effects

Gliomas are the commonest primary brain tumours in adults. They are usually classified and graded according to the criteria by the World Health Organisation. High-grade gliomas are the most malignant primary brain tumours. Conventional therapies include surgery, radiotherapy, and chemotherapy. The tumours often demonstrate high levels of resistance to these conventional therapies, and in spite of treatment advances the prognosis remains poor.

Factors associated with prehospital delay among stroke patients in a developing African country.

In Nigeria, stroke has remained the most frequent cause of neurological admissions (1) and a significant cause of mortality. Successful acute stroke treatment and improved outcomes critically depend on early hospital presentation. Several studies in developed countries have evaluated the factors causing prehospital delays (2). In this study we investigated delays in presentation of stroke patients and explored factors associated with such delays in a tertiary health center of Nigeria. To this end, we designed a prospective study of consecutive stroke admissions at the Emergency Department of the University of Calabar Teaching Hospital, Nigeria, over a six-month period (August 2012– January 2013). The time of stroke onset was defined as the time when the first symptom was noticed by the patient or a carer. Delay was defined as greater than three-hours from time of symptoms onset to presentation. Univariable and multivariable logistic regression analyses were used to explore factors associated with prehospital delay. Eighty-one consecutive patients (47 males, 58%; mean age, SD: 57·6 ± 12·1 years) were recruited.Only 17 (21%) of the patients arrived at the hospital within three-hours of stroke onset, while 53 (65·4%) patients arrived >24 h after symptom onset. None of the patients were brought by ambulance service. More than half of the patients (55·6%) had no knowledge of stroke symptoms. In univariable analysis lack of awareness of symptoms of stroke and referral from other facilities were associated with late presentation (Table 1). In multivariable logistic regression, only lack of awareness of the symptoms of stroke was associated with delayed presentation (OR: 7·43; 95% CI: 1·47– 37·4; P = 0·015) (Table 1). Our study in a developing country reports considerable prehospital delays in patients with acute stroke symptoms presenting at the emergency department, in line with other recent studies in developing and emerging economies (3–5). Our data highlight the need for educational programs in order to increase awareness of stroke in Nigeria, including stroke symptoms/warning signs and the limited time window for effective interventions.

Stroke-Like Presentation of Cerebral Toxoplasmosis: Two HIV-Infected Cases

Toxoplasmosis is the most common opportunistic infection of the central nervous system in patients with acquired immunodeficiency syndrome (AIDS). Clinical presentation of cerebral toxoplasmosis in these patients includes headache, focal neurological deficits and seizures. Prompt diagnosis and appropriate therapy results in rapid clinical and radiological improvement as well as good outcome for patients. In this article, we report two cases with stroke-like presentation of cerebral toxoplasmosis in the setting of HIV infection.

Multidisciplinary Interventions in Motor Neuron Disease

Motor neuron disease is a neurodegenerative disease characterized by loss of upper motor neuron in the motor cortex and lower motor neurons in the brain stem and spinal cord. Death occurs 2–4 years after the onset of the disease. A complex interplay of cellular processes such as mitochondrial dysfunction, oxidative stress, excitotoxicity, and impaired axonal transport are proposed pathogenetic processes underlying neuronal cell loss. Currently evidence exists for the use of riluzole as a disease modifying drug; multidisciplinary team care approach to patient management; noninvasive ventilation for respiratory management; botulinum toxin B for sialorrhoea treatment; palliative care throughout the course of the disease; and Modafinil use for fatigue treatment. Further research is needed in management of dysphagia, bronchial secretion, pseudobulbar affect, spasticity, cramps, insomnia, cognitive impairment, and communication in motor neuron disease.

Disease Modifying Therapy in Multiple Sclerosis

Multiple sclerosis is an autoimmune disease of the central nervous system characterized by inflammatory demyelination and axonal degeneration. It is the commonest cause of permanent disability in young adults. Environmental and genetic factors have been suggested in its etiology. Currently available disease modifying drugs are only effective in controlling inflammation but not prevention of neurodegeneration or accumulation of disability. Search for an effective neuroprotective therapy is at the forefront of multiple sclerosis research.

Cranial nerve palsies in Nigerian children

Background : Cranial nerve palsies are common clinical problem routinely encountered in neurological practice; the dysfunction can occur at any point in the course of the nerve and may point to serious pathology. The aim of this study was to determine the pattern and underlying aetiology of cranial nerve palsies in Nigerian children. Method: Children in the Children’s Emergency Unit and the Children’s Ward of the University of Calabar Teaching Hospital, Calabar, Nigeria, with neurological problems over a 12-month period (January through December 2012), were recruited into the study. Each child was admitted and evaluated by the Paediatric Neurology Unit. Those with cranial nerve palsies were selected for detailed analysis. The biodata, clinical features and relevant laboratory results were documented. Results: Of the 285 with neurological problems 23 (8.1%) had cranial nerve palsies. Fifteen (65.2%) of the children had single cranial nerve palsies while eight (34.8%) had multiple cranial nerves involvement. Of the 43 nerves involved, the facial nerve was the commonest (38.3%) followed by the oculomotor (23.5%) and abducens (20.6%). Intracranial infections such as meningitis, viral encephalitis and brain abscess were incriminated in 60.8% of the patients and 70.6% of the nerves involved. Conclusion : Cranial nerve palsies cause handicap and cosmetic problems. It is recommended that every child with cranial neuropathy should be evaluated for intracranial infections among other differentials. Prompt diagnosis, treatment and immunisation against related infections is paramount.