M. Kchaou

Les critères prédictifs d’une épilepsie pharmacorésistante chez l’enfant

The aim of this study is to identify early predictors of refractory epilepsy. From 600 epileptic children followed for at least 2 years in the department of neurology of Charles Nicolle hospital of Tunis, were identified children with refractory epilepsy. Controls were children who responded well to antiepileptic drugs and who were seizure free for at least 2years. We collected anamnestic, clinical, neuropsychological and radiological data for all children. We identified 67 children with refractory epilepsy, representing 11.6% of the initial population. At diagnosis, the average age was 9.16 years. Some factors have been identified as predictors of drug resistance epilepsy: age of onset less than one year, partial and atonic seizure, combination of several types of attacks, presence of mental retardation and pyramidal syndrome, abnormal electroencephalogram especially focal abnormalities, spike, amplitude abnormalities, interhemispheric asymmetry; and resistance to first antiepileptic drug. Symptomatic epilepsy, especially if associated with radiological lesions such as hippocampal sclerosis and structural brain malformations, was highly correlated with drug resistance. Our study suggests that the initial presentation of epilepsy could predict long-term outcome to drug resistance epilepsy if a detailed analysis of anamnestic, clinical and complementary data is established.

Extensive myelitis revealing common variable immunodeficiency

We report here on the case of a 16-year-old male teenager who was followed for 1 year because of recurrent respiratory infections and bronchiectasis. Within 4 days, the patient developed motor weakness of the lower limbs and urinary retention. Neurological examination revealed a pyramidal syndrome without encephalitis. His routine blood tests were normal, his brain magnetic resonance imaging (MRI) was normal, but spinal MRI showed extensive cervical and dorsal hyperintensities with contrast enhancement (Fig. 1). Cerebrospinal fluid showed 40 cells/mm and mildly elevated protein at 0.56 g/L, with negative culture. Serum protein electrophoresis showed hypogammaglobulinemia at 0.5 g/L. Immunological assessments, including determination of