Knowledge, attitude and traditional practices towards epilepsy among relatives of PWE (patients with epilepsy) in Marrakesh, Morocco.

Epilepsy remains one of the most common neurological diseases in the world but seems to be widely misunderstood, especially in low-income countries. Patients with epilepsy (PWE) can face considerable stigma in society, and there have been various studies that evaluate the knowledge and attitude of the population towards epilepsy. However, there was no study of this kind in Morocco. PURPOSE: Our aim was thus to assess knowledge, attitudes, and traditional practices specifically among relatives and caregivers of PWE in our community, in order to better evaluate their educational needs. METHODS: This cross-sectional and descriptive study was carried out over a year long period in the outpatient neurology clinic of the Mohammed 6 University Hospital, a tertiary referral center in Marrakesh, Morocco. The respondents were relatives of PWE (usually parents and siblings) or spouses who attended the outpatient clinic alongside them. The interviews were carried out by the same investigator at the outpatient clinic during patient's visits, face-to-face using Moroccan Arabic or Darija, with an 18-item questionnaire. RESULTS: Responses of 100 participants were analyzed. The mean age was 40 years old and 5 months. Sixty-six percent of the respondents were women, 50% of rural origin and 76 % lived in an urban area. Forty-one percent were illiterate, and 74% were of low income. Only 65% of the participants knew the Arabic term for epilepsy. For 48%, epilepsy was linked with witchcraft or demonic possession. Seventy-five percent of the respondents had at least one prior consultation to a traditional healer. Only 5% in our study knew the first-aid basics to apply in case of a seizure. CONCLUSION: Despite having a relative with epilepsy, our participants' knowledge was very poor. The level of education and income seem to be the two major contributing factors. Cultural beliefs and superstition are very pervasive, and the majority of our sample had already used traditional healing and alternative medicine. Our study highlights the need for a more global intervention in Morocco encompassing healthcare policies, awareness campaigns, and educational reforms.

Cerebrospinal Fluid Glucose and Lactate Levels After Subarachnoid Hemorrhage: A Multicenter Retrospective Study.

BACKGROUND: In patients with subarachnoid hemorrhage (SAH), abnormalities in glucose and lactate metabolism have been described using cerebral microdialysis. Glucose and lactate concentrations in cerebrospinal fluid (CSF) are more easily accessible, but scarce data are available in this setting. The aim of this study is to assess the relationship of CSF glucose and lactate with blood concentrations and with unfavorable neurological outcome after SAH. METHODS: A retrospective cohort study was conducted in 5 European University intensive care units. Patients aged 18 years and above who were admitted after a nontraumatic SAH over a 4-year period (2011 to 2014) were included if they had an external ventricular drain placed, daily analysis of CSF including glucose (±lactate) concentrations for 1 to 4 consecutive days, and concomitant analysis of glucose and lactate concentrations in the arterial blood. RESULTS: A total of 144 patients were included in the final analysis (median age: 58 [49 to 66] y; male sex: 77/144). Median time from admission to external ventricular drain placement was 1 (0 to 3) day; median Glasgow Coma Scale on admission was 10 (7 to 13), and CT-scan Fisher scale was 4. A total of 81 (56%) patients had unfavorable neurological outcome at 3 months (Glasgow Outcome Scale ≤3). There was a weak correlation between blood and CSF glucose (r=0.07, P=0.007), and between blood and CSF lactate levels (r=0.58, P<0.001) on day 1, which were not influenced by insulin therapy. The presence of shock and low CSF glucose/lactate ratio were the only independent predictors of unfavorable outcome. CONCLUSIONS: CSF glucose and lactate levels poorly correlated with blood concentrations. Low CSF glucose/lactate ratio was associated with poor neurological outcome.