M. Ndiaye

Prise en charge de l’état de mal épileptique dans les conditions de pays en développement

Status epilepticus (SE) is a condition requiring emergency care, which is often poorly managed in developing countries due to the lack of personnel, drugs, and insufficient technical and medical means. This study aims at determining the epidemiologic and etiologic characteristics and the difficulty in treating SE under the existing medical practice conditions in a developing country such as Senegal. A retrospective study was therefore carried out based on SE medical files at the University Hospital of Dakar over the period January 1988 to December 1998, and included several hospital departments, i.e., paediatrics, infectious diseases and neurology. Over an 11-year period 697 cases were recorded; of these, 48.2% of patients were under 5 years of age. The seizures were generalized in 58.2% of cases, partial in 21.2%, partial secondarily generalized, or with an association of both clinical presentations in 20.6% of cases. The etiology was as follows: mainly infectious (67%), followed by resistant and/or unbalanced epilepsy (9.9%), epilepsy of vascular origin (8%), and various other causes. The overall mortality rate was 24.8%. A long period between the onset of clinical symptoms and hospital treatment was noted, with an average time lapse of 16.6 h before treatment. The drugs utilized were diazepam and phenobarbitol, administered by injection. The overall outcome could be improved by better management, i.e., better prevention and an efficient treatment of infectious diseases, a reduction in the time before treatment, and improved means of intensive care.

Enquête sur l’épilepsie chez des enseignants d’un pays en développement : exemple du Sénégal

Resume Il s’agit d’une etude transversale effectuee sur la base d’un questionnaire elabore par nos soins et portant sur les connaissances de la maladie et les attitudes et pratiques des enseignants face a l’epileptique. Cette enquete a eu lieu au niveau de l’Academie Scolaire de Dakar et a porte sur 400 enseignants. Trois cent soixante-treize enseignants (93 p. 100) ont repondu au questionnaire. Leur âge moyen etait de 40 ans. La duree d’exercice dans l’enseignement variait de 10 a 30 ans. Pour 28,7 p. 100 des enseignants, l’epilepsie etait consideree comme due a des phenomenes surnaturels. Pour 69 p. 100 des enseignants, le cerveau etait l’organe dont le dereglement pouvait etre a l’origine des crises epileptiques, tandis que 31 p. 100 incriminaient d’autres organes. Parmi les causes de l’epilepsie, les enseignants citaient les traumatismes crâniens, les malformations et les infections du systeme nerveux central et l’heredite. Les manifestations et les facteurs declenchants etaient relativement bien connus. Vingt-quatre pour cent des enseignants pensaient que l’epilepsie etait contagieuse et que la salive etait la principale voie de transmission incriminee. Pour 73 p. 100 des enseignants, l’epilepsie etait curable ; ils faisaient confiance a la medecine moderne mais une proportion non negligeable (34,9 p. 100) d’entre eux estimait necessaire d’y associer la medecine traditionnelle. Pour 73 p. 100 des enseignants, l’epilepsie etait grave en raison des risques d’accidents mortels et du handicap social et cognitif. La prise en charge de l’epilepsie devrait mobiliser outre les enseignants, les medecins et les familles pour 25,7 p. 100 des enseignants. Soixante-trois pour cent des enseignants estimaient que les epileptiques pouvaient etre scolarises dans les ecoles traditionnelles ; 31,1 p. 100 proposaient une scolarisation specialisee. Quatre-vingt-quatre pour cent des enseignants estimaient leurs connaissances sur l’epilepsie insuffisante et 99 p. 100 souhaitaient l’organisation de seminaires de formation sur l’epilepsie.

Managing neurocysticercosis: challenges and solutions

Taenia solium neurocysticercosis (NCC) is a major cause of neurological morbidity in the world. Variability in the neuropathology and clinical presentation of NCC often make it difficult to diagnose and manage. Diagnosis of NCC can be challenging especially in endemic and resource-limited countries where laboratory and imaging techniques are often lacking. NCC management can also be challenging as current treatment options are limited and involve symptomatic agents, antiparasitic agents, or surgery. Although antiparasitic treatment probably reduces the number of active lesions and long-term seizure frequency, its efficacy is limited and strategies to improve treatment regimens are warranted. Treatment decisions should be individualized in relation to the type of NCC. Initial measures should focus on symptomatic management, with antiparasitic therapy only to be considered later on, when appropriate. Symptomatic treatment remains the cornerstone in NCC management which should not only focuses on epilepsy, but also on other manifestations that cause considerable burden (recurrent headaches, cognitive decline). Accurate patients’ categorization, better antiparasitic regimens, and definition of new clinical outcomes for trials on NCC could improve management quality and prognosis of NCC. Prevention strategies targeting tapeworm carriers and infected pigs are yielding good results in local models. If local elimination of transmission is confirmed and replicated, this will open the door to cysticercosis eradication efforts worldwide.

Prise en charge des accidents vasculaires cérébraux au Sénégal

Resume Objectif La gravite et l’evolution rapide vers des lesions irreversibles font des accidents vasculaires cerebraux une extreme urgence. L’objectif de cette etude prospective etait de determiner le delai moyen de prise en charge des accidents vasculaires cerebraux et les attitudes et moyens therapeutiques qui leur sont appliques au centre hospitalier national de la capitale senegalaise suppose etre le dernier maillon dans l’organisation sanitaire du pays. Patients et Methodes Nous avons collige 170 dossiers de patients âges de 25 a 90 ans avec une moyenne d’âge de 61 ± 13 ans. Le sex-ratio etait de 0,68. Soixante-dix pour cent des patients etaient originaires de Dakar. Resultats Le recours a une structure medicale etait dans la plupart des cas tardif. Aucun patient n’a ete recu avant la 3 e heure, un seul a ete recu avant la 6 e heure. L’eloignement des structures joue un role dans ce retard de prise en charge car 36 p. 100 des patients originaires de Dakar ont consulte entre 6 et 24 heures contre 7,8 p. 100 des patients venant de l’interieur du pays. Ni le niveau d’instruction, ni le niveau socio-economique ne joue un role majeur dans la prise en charge tardive. Aucun patient n’a beneficie d’un transport medicalise ni de soins prehospitaliers. Le traitement etait essentiellement symptomatique dans les accidents vasculaires hemorragiques. Il reposait sur les anticoagulants ou les antiagregants plaquettaires dans les accidents vasculaires ischemiques. La reeducation motrice en milieu specialise n’a ete suivie que par 29,4 p. 100 des patients. Le taux de mortalite etait de 50,6 p. 100 a un an et le taux de dependance de 41,7 p. 100. Conclusion La prise en charge des accidents vasculaires cerebraux au Senegal est souvent tardive du fait de l’insuffisance des ressources humaines et materielles et de l’inaccessibilite aux soins.

Investigation of Death Cases by Pesticides Poisonning in a Rural Community, Bignona, Senegal

This study gives the report of an epidemiological investigation of twenty nine deaths among fifty cases (global lethality rate was 58%).in a rural community which use widely pesticides and insecticides for agricultural purposed. A case control study with an environmental description has been realized. Serologic tests were performed to eliminate arboviruses aetiology. A qualitative investigation was undertaken, to evaluate the perception, the beliefs, and the population attitudes toward the infection and the inventory of the different pesticides used in the sites of study. In Africa, there are many incidents of domestic or professional poisoning with a fatal ending for which, few data are available, toxicological analysis are still a challenge.

Hemorrhagic Stroke: Clinical, Etiologic and Evolutive Aspects inSenegalese Children

Introduction: Hemorrhagic Stroke (HS) are uncommon among children. They have an etiological specificity and different risk factors that are different from those of adults. Prognosis depends on the etiology. Our objective was to study the characteristics of childrens HS in Senegal. Methodology: Descriptive retrospective study from July 2003 to February 2014. Results: 13 patients were collected, including 9 boys. The mean age was 9.85 years. The antecedents were: rheumatic heart disease (2 patients); congenital heart disease (1 patient); arterial hypertension systolic-diastolic untreated (1 patient); heterozygous sickle cell anemia (1 patient). No history for (8 patients - 61.53%). The beginning was sudden or rapidly progressive in all patients. Clinical manifestations were hemiplegia (53.84%), headache and vomiting (46.15%), consciousness disorders (30.76%), partial motor seizures (7.69%). The topography was supratentorial (84.61%). The causes were: arteriovenous malformations (3 patients); severe thrombocytopenia (1 patient); systolic-diastolic arterial hypertension (1 patient); myeloblastic leukemia (1 patient). No etiology (7 patients). 4 patients died during the acute phase. 1 patient was transferred to pediatric oncology. 1 patient was transferred abroad for embolization. The mean follow-up was 11.8 months. Outcome was favorable in patients with ad integrum restitution. 7 patients had hemiparesis type of neurological sequelae (4 patients), motor partial epilepsy (4 patients) and aphasia (1 patient). 1 patient developed hydrocephalus. No recurrence was noted. Conclusion: This study provides a better diagnostic and etiological approach for better management.

Épilepsie dans le contexte neuropédiatrique sénégalais

Epilepsy is a significant health public problem in Senegal with an estimated prevalence of 8 to 14%. The aim of this study was to determine the clinical and electroencephalographic features of epilepsy in a cohort of Senegalese infants, search for etiological factors and determine the impact of disease on school life. This retrospective study concerned 459 children who attended the neurological outpatients clinic at the Fann hospital, Dakar, Senegal, between July 2003 and December 2006. All were aged under 19 years. Among the 135 children with idiopathic epilepsy, 23.7% had parental consanguinity and 37.77 % familial epilepsy. Rolandic epilepsy and epilepsy with absences were more frequent but several infants with idiopathic epilepsy were not classified. Non-idiopathic epilepsy was noted in 312 children. In this group, estimates of parental consanguinity and familial epilepsy were of 21.79 and 17.94%, respectively. Etiological factors were predominantly pregnancy and birth abnormalities (28.84%) and central nervous system infection (20.19%). Twelve children had febrile seizures. Of patients with idiopathic epilepsy, 65.18% were attending school versus only 9.29 with non-idiopathic epilepsy.

Comorbidity of Cerebral Palsy, the Cyst of the Corpus Callosum, Parenchymal Cyst, Epilepsy and Cardiac Disease: About an Observation

Motor impairment of cerebral origin is a syndrome that induces a reduction in activity, the origin of which is brain injury or a non-progressive and definitive abnormality occurring in a developing immature brain. Motor disability, spastic, dyskinetic or ataxic, is often associated with sensory, cognitive, sensory and behavioral disorders with or without epileptic disease. View of accidental discoveries of corpus callosum abnormalities, most often asymptomatic or associated with psychomotor retardation, epilepsy, neurological disorders or cardiomyopathy, a high technical platform must be available for its diagnosis. We report in this article the case of a 7-year-old boy followed at the neuropsychiatric center Joseph Guislain of the Brothers of Charity of Lubumbashi in Congo (DRC) since 2016 for generalized tonic-clonic seizures, in whom the diagnosis of cerebral palsy on cyst of corpus callosum and in the right parietal lobe, as well as cardiopathy was posed during its consultation in September 2017. This case was published with parental consent.

Spinal Abscess Revealed by Spastic Paraplegia in a 15-Month-Old Infant: About an Observation

Submit Manuscript | http://medcraveonline.com particularly MRI, has greatly facilitated the diagnosis. The wellconducted treatment associating surgical drainage and antibiotic therapy adapted to the germ involved are the best guarantors of functional prognosis [2-4]. The interest of this observation lies in the neurological consequences of the infectious complications due to the neglected dermal sinuses making the prophylactic neurosurgical treatment urgent [5]. The other interest is to present the very specialized management of the consequences of the paraplegia of the infant. We report an observation of a 15-month-old infant admitted for motor deficiency of the lower limbs of progressive installation evolving in a febrile context and in which the clinical examination revealed a spastic paraplegia. Spinal MRI shows a pseudo-tumor process. Neurosurgical surgery was performed and an intramedullary abscess was found and a dermal sinus was present. Pus culture isolated Staphylococcus aureus. Adequate antibiotics were administered and the progression was satisfactory with partial recovery of muscle strength.

Ischemic stroke in childhood: A Senegalese cohort

Ischemic stroke is infrequent in childhood. Etiological factors depend on epidemiological context. The purpose of this study is to determine risk factors, clinical and radiological features and outcome of arterial ischemic stroke in a cohort of Sen- egalese infants. We carried out a retrospective study of medical data of children hospitalized with arterial ischemic stroke in the neurological department of Fann teaching hospital and at Childrens Hospital Albert Royer, from July 2003 to July 2011. Forty- eight cases were included in this study with ages ranging from 2 months to 18 yr, with a female/male ratio of 0.71. Mean age at the time of occurrence stroke was 89.37 mo. The most common symptoms were hemiparesis (93.75%), motor partial seizures (24.44%), and Brocas aphasia (33.3%). The middle cerebral artery was mostly affected (87.5%). Risk factors were predomi- nantly sickle cell disease, anemia, embolic heart disease, meningoencephalitis and head trauma. 8.33% of patients died. After discharge, 16.66% of patients were lost follow-up and 62.5% of the total cohort had neurological impairments. Treatment was essentially symptomatic and secondary prevention was provided by treatment with anticoagulants or anti-platelets agents de- pending on the etiology of ischemic stroke.