A Metabolomic Signature of Ischemic Stroke Showing Acute Oxidative and Energetic Stress.

Metabolomics is a powerful data-driven tool for in-depth biological phenotyping that could help identify the specific metabolic profile of cryptogenic strokes, for which no precise cause has been identified. We performed a targeted quantitative metabolomics study in West African patients who had recently suffered an ischemic stroke, which was either cryptogenic (n = 40) or had a clearly identified cause (n = 39), compared to a healthy control group (n = 40). Four hundred fifty-six metabolites were accurately measured. Multivariate analyses failed to reveal any metabolic profile discriminating between cryptogenic ischemic strokes and those with an identified cause but did show superimposable metabolic profiles in both groups, which were clearly distinct from those of healthy controls. The blood concentrations of 234 metabolites were significantly affected in stroke patients compared to controls after the Benjamini-Hochberg correction. Increased methionine sulfoxide and homocysteine concentrations, as well as an overall increase in saturation of fatty acids, were indicative of acute oxidative stress. This signature also showed alterations in energetic metabolism, cell membrane integrity, monocarbon metabolism, and neurotransmission, with reduced concentrations of several metabolites known to be neuroprotective. Overall, our results show that cryptogenic strokes are not pathophysiologically distinct from ischemic strokes of established origin, and that stroke leads to intense metabolic remodeling with marked oxidative and energetic stresses.

Surveillance of Viral Encephalitis in the Context of COVID-19: A One-Year Observational Study among Hospitalized Patients in Dakar, Senegal.

The burden of encephalitis and its associated viral etiology is poorly described in Africa. Moreover, neurological manifestations of COVID-19 are increasingly reported in many countries, but less so in Africa. Our prospective study aimed to characterize the main viral etiologies of patients hospitalized for encephalitis in two hospitals in Dakar. From January to December 2021, all adult patients that met the inclusion criteria for clinical infectious encephalitis were enrolled. Cerebrospinal fluids, blood, and nasopharyngeal swabs were taken and tested for 27 viruses. During the study period, 122 patients were enrolled. Viral etiology was confirmed or probable in 27 patients (22.1%), with SARS-CoV-2 (n = 8), HSV-1 (n = 7), HHV-7 (n = 5), and EBV (n = 4) being the most detected viruses. Age groups 40-49 was more likely to be positive for at least one virus with an odds ratio of 7.7. The mortality was high among infected patients, with 11 (41%) deaths notified during hospitalization. Interestingly, SARS-CoV-2 was the most prevalent virus in hospitalized patients presenting with encephalitis. Our results reveal the crucial need to establish a country-wide surveillance of encephalitis in Senegal to estimate the burden of this disease in our population and implement strategies to improve care and reduce mortality.

Conceptual framework for establishing the African Stroke Organization.

Africa is the world's most genetically diverse, second largest, and second most populous continent, with over one billion people distributed across 54 countries. With a 23% lifetime risk of stroke, Africa has some of the highest rates of stroke worldwide and many occur in the prime of life with huge economic losses and grave implications for the individual, family, and the society in terms of mental capital, productivity, and socioeconomic progress. Tackling the escalating burden of stroke in Africa requires prioritized, multipronged, and inter-sectoral strategies tailored to the unique African epidemiological, cultural, socioeconomic, and lifestyle landscape. The African Stroke Organization (ASO) is a new pan-African coalition that brings together stroke researchers, clinicians, and other health-care professionals with participation of national and regional stroke societies and stroke support organizations. With a vision to reduce the rapidly increasing burden of stroke in Africa, the ASO has a four-pronged focus on (1) research, (2) capacity building, (3) development of stroke services, and (4) collaboration with all stakeholders. This will be delivered through advocacy, awareness, and empowerment initiatives to bring about people-focused changes in policy, clinical practice, and public education. In the spirit of the African philosophy of Ubuntu "I am because we are," the ASO will harness the power of diversity, inclusiveness, togetherness, and team work to build a strong, enduring, and impactful platform for tackling stroke in Africa.

Are Sub-Saharan epileptic people less photosensitive? A Senegalese study of photoparoxysmal response in a reference epilepsy centre.

The photoparoxysmal response (PPR) is defined as the occurrence of generalized spike, spike-wave or polyspike-wave discharges consistently elicited by intermittent photic stimulation (IPS). PPR is not well studied in Sub-Saharan African people. We prospectively studied the epidemiological, clinical, and EEG characteristics of PPR among consecutive patients recorded at the clinical neurophysiology unit of Fann University Hospital (Dakar, Senegal). Among 6,808 EEG recordings including 3,065 pathological EEGs, we collected 56 EEGs with PPR (0.8% of all recorded EEGs and 1.8% of anormal EEGs), from 31 women and 25 men (sex ratio: 0.8). The mean age was 13.3 years (range: 8 months to 59 years). The peak of photosensitivity was found in the range of 6 to 10 years. Of the PPR cases, 12 had clinical manifestations during IPS. Generalized epilepsy was diagnosed in 23 (41%) patients and 18 (32%) had focal epilepsies. The most epileptogenic stimulation frequencies were between 12 and 24 Hz (range: 1-28 Hz). PPR were mainly triggered during eye closure (64%), and 41 patients (73% of PPR cases) were classified as Type 4 (Waltz classification). Our results confirm lower rates of photosensitivity in African Sub-Saharan people compared with others. Although the current data do not support a role of short-term ambient light levels, subject to consistent data from larger cohorts, it may be interesting to study the probable epigenetic-mediated protective role of sunshine against photosensitivity.

Tolosa-Hunt Syndrome: A Painful Ophthalmoplegia.

Tolosa-Hunt syndrome is a painful ophthalmoplegia characterized by recurrent unilateral orbital pain, ipsilateral oculomotor paralysis, and a rapid response to steroids. Our report describes a 37-year-old young woman who presented with right ptosis, ipsilateral ophthalmoplegia, and painful headache with no other neurological deficits in which all biological and neuroimaging investigations were normal. Complete recovery within one week of corticosteroid therapy was observed. This is probably the first case of Tolosa-Hunt syndrome reported in Dakar, Senegal.

Neuromyelitis optica spectrum disorders (NMO-SD) in a Sub-Saharan Africa country: A preliminary study of sixteen Senegalese cases.

BACKGROUND: Neuromyelitis optica (NMO) is an autoimmune disease of the central nervous system. In Sub-Saharan Africa, publications are rare and deal with isolated cases. Our goal was to analyze the characteristics of NMO spectrum disorders in a Senegalese cohort compiled in Dakar. PATIENTS AND METHOD: This was a retrospective descriptive study conducted at the Neurology Department of Fann Teaching Hospital. We included all patients with NMO-SD according to the 2014 diagnostic criteria. RESULTS: Sixteen patients were enrolled, 4 men and 12 women with an average age of 30 years. Ten patients (62.5%) presented an acute myelopathy associated with retrobulbar optic neuritis and 5 (31.25%) had isolated spinal cord injury. Spinal MRI showed abnormal cervical (6 patients), dorsal (4 patients), bulbar-cervical (3 patients) or cervico-dorsal (2 patients) signal extended (≥3 vertebral segments) of the spinal cord. Visual evoked potentials (VEP) showed demyelinating optic nerve involvement in 8 patients. Ten patients were positive to AQP-4 IgG. Systemic corticosteroid therapy was the rule in all patients, associated with azathioprine in 10 of them. The clinical course at 3 months was predominantly favourable (10 patients). CONCLUSION: This cohort is the first one compiled in Dakar. African multicentric epidemiological studies are needed.

Metastatic Spinal Cord Compression Secondary to Liver Cancer.

Metastatic spinal cord compression (MSCC) is a medical emergency that requires rapid diagnosis and treatment to reduce pain, to preserve neurological functioning, and to prolong survival. The diagnosis of liver cancer is often neglected in the differential diagnosis of MSCC. Treatment is usually palliative and evolution is often fatal. This is a case report of a 28-year-old patient living in Mauritania hospitalized in November 2014 at the neurology department of Fann national teaching hospital in Dakar, for the management of a chronic dorsal spinal cord compression. The radiological and laboratory investigations done revealed the metastatic compression originating from a liver cancer with elevated alpha-fetoprotein and aspartate transaminase, positive hepatitis B surface antigen, and multiple metastasis in the lungs, mediastinum, ribs, iliac, and peritoneum. The hip joint X-ray showed a spontaneous fracture of the right femoral neck. The multidisciplinary treatment was palliative and the evolution was fatal within the month of hospitalization. Earlier diagnosis and treatment of MSCC may not have saved the life of the patient but may have prevented much suffering and would likely have prolonged the life of a young man.

Post-ivermectin encephalopathy in Senegal: a case report.

Ivermectin is an ant parasitic drug used for combating onchocerciasis and lymphatic filariasis. It works by inhibiting the function of neurons and muscles, thus causing paralysis of microfilariae. Side effects of this drug have been reported including post-ivermectin encephalopathy requiring emergency care in hospital. We report the case of a 35 years old patient living in rural areas of Senegal who presented two days after a mistake in administration of a second dose of ivermectin, headaches, altered consciousness and bilateral blindness. The workup revealed brain white matter lesions, abnormal liver function tests and biological inflammation without evidence of Loa loa microfilariae in blood and cerebrospinal fluid. Corticosteroid treatment was administered in emergency and patient recovered despite the persistence of bilateral blindness. Inflammatory process seems to have an important role in the pathophysiology of this encephalopathy. We should therefore carefully control the administration of this drugs.

[Epidemiological and socio-economic support patients living with epilepsy in Dakar, Senegal]. / Profil épidémiologique et prise en charge socioéconomique des patients vivant avec l'épilepsie à Dakar, Senegal.

BACKGROUND: Epilepsy remains a major public health problem especially in developing countries where access to new therapies remains limited. OBJECTIVE: The aim of this work was to study the socio-demographic profile of patients living with epilepsy in Dakar and supported. METHODS: We conducted a cross-sectional study over a period of eight months from November 2009 to June 2010 at Fann University Hospital and Health Center Pikine through research on adherence. RESULTS: The study involved patients living with epilepsy aged over 15 years, diagnosed clinically with epilepsy and/or confirmed by an electroencephalogram and put under antiepileptic drug for more than 3 months. We recruited 411 patients aged 15-74 years with a mean age of 28.93 years. The age range was 15-24 years with 44.6 % majority. The male sex predominated with 52.3 % and the sex ratio was 1.09. Singles outnumbered with 64.7 %. The level of education was the most representative secondary with 29.4 % and patients without profession were 35.5 %. Most of the patients was from semi-urban areas with 47.7 %. Generalized seizures were more frequent with about 70 %. Most of the patients was supported either by their family or by themselves. CONCLUSION: The management should be multisectoral for epilepsy out of darkness.

Addressing the treatment gap and societal impact of epilepsy in Rwanda--Results of a survey conducted in 2005 and subsequent actions.

This study, supported by the Rwandan Ministry of Health and the World Health Organization, was conducted in 2005 to determine the prevalence of epilepsy and its sociocultural perception in Rwanda, as well as epilepsy-related knowledge and practices of health-care professionals (HCPs). A cross-sectional, nationally representative survey was conducted throughout Rwanda by trained investigators. Participants were recruited by random cluster sampling based on the organization of administrative units in the country. Overall, 1137 individuals (62% from rural areas) were interviewed. The prevalence of epilepsy was estimated to be 49 per 1000 people or 41 per 1000 for active epilepsy. Onset of epilepsy before the age of 2years was reported in 32% of the cases. Family history of epilepsy, head trauma, and premature delivery were reported in 53%, 50%, and 68% of the cases, respectively. Most (68%) patients did not receive any medical treatment for epilepsy; 21.5% had received some form of traditional treatment. According to responses from the general population, people with epilepsy should not be entitled to schooling (according to 66%), to work (according to 72%), to the use of public places (according to 69%), or to marriage (according to 66%). Furthermore, 50% believed that epilepsy was untreatable, and 40% thought that it was transmissible. Of the 29 HCPs interviewed, the majority knew the definition of epilepsy and status epilepticus, as well as basic treatment options and side effects. However, 90% believed that treatment was only necessary in the first week after a seizure. Living with epilepsy was associated heavily with stigma, and a significant treatment gap (68%) was identified. Following this study, numerous actions have been taken by the Rwandan government, the Rwandan League Against Epilepsy, and several nongovernmental organizations to increase awareness about epilepsy and to close the treatment gap. An overview of these activities is provided.

Prise en charge des douleurs neuropathiques au Sénegal : expérience du centre national d'appareillage orthopédique de Dakar

Introduction : Les douleurs neuropathiques sont graves et de prise en charge difficile. L'efficacité du traitement est jugée sur l'amélioration de la qualité de vie.Objectifs : Déterminer la fréquence des douleurs neuropathiques et apprécier l'efficacité de thérapeutiques utilisées et les difficultés à l'instauration des recommandation dans un centre à Dakar.Méthodologie : Une étude prospective de 4 mois a été menée au Centre National d'Appareillage Orthopédique dont l'objectif a été d'apprécier les obstacles à l'instauration des recommandations internationales sur la prise en charge des douleurs neuropathiques. Les patients reçus pour des douleurs chroniques ont répondu aux questionnaires DN4 et ceux qui ont eu des douleurs neuropathiques inclus. L'intensité de la douleur, le retentissement fonctionnel, et la qualité du sommeil, ont été évalués avant et après traitement. Les effets secondaires des médicaments, les raisons d'une non adhérence au traitement ont été notés et la conformité des examens complémentaires vérifiée.Résultats : 53 patients avec un âge moyen de 50,22 ans ont été inclus. L'EVA moyen a été de 5,75. La marche a été anormale dans 33,96% des cas, impossible (4 cas), la montée et descente des escaliers impossible (18,83%), le périmètre de marche inferieur à 1000m (18,86%) et 13,20% des patients incapables de ramasser un objet à terre. Les activités professionnelles suspendues dans 2 cas et le sommeil perturbé dans 33,96% des cas. Le traitement de première intention a été l'Amitriptyline (54,71%) et a été responsable d'effets secondaires dans 3 cas. Après un recul de 2 mois, la reprise effective des différentes activités a été obtenue dans 94,53%.Discussion et Conclusion : Même si la diminution de l'EVA au cours des douleurs neuropathiques sous traitement est parfois minime, le retentissement sur la qualité de vie doit être apprécié avant de conclure à une inefficacité thérapeutique. Le choix des molécules doit tenir compte de l'accessibilité du médicament. La rééducation doit être effectuée surtout en cas de retentissement fonctionnel et/ ou d'association à d'autres déficiences neurologiques

Epilespie de l'enfant et de l'adolescent au Senegal

Introduction L'epilepsie constitue un probleme de sante publique au Senegal avec une prevalence de 8;3 a 14/1000. Elle concerne principalement les enfants. L'objectif de ce travail est d'etudier les aspects biographiques; phenotypiques et evolutifs de la maladie epileptique dans une cohorte d'enfants au Senegal. Methodologie Il s'agit d'une etude retrospective de dossiers d'enfants epileptiques suivis regulierement au CHU de FANN et a l'Hopital d'Enfants Albert Royer; de Juillet 2003 a decembre 2010. Les criteres d'inclusion etaient: epileptiques ages de moins de 18 ans; regulierement suivis depuis au moins 3 ans; ayant un traitement adapte; a dose efficace; avec une bonne observance therapeutique. Resultats Nous avons collige 522 enfants; ages de 3 mois a 16 ans; avec un sex-ratio de 1;7 en faveur des garcons. L'epilepsie etait idiopathique chez 57% des enfants et non idiopathique chez 43% des patients. Les facteurs etiologiques etaient domines par la consanguinite parentale; les anomalies de la grossesse et de l'accouchement; les infections du systeme nerveux central. Dans le groupe des epilepsies idiopathiques la consanguinite parentale et l'epilepsie familiale etaient retrouvees respectivement chez 64 enfants (21;62%) et 20 enfants (6;75%). Neuf enfants (3%) presentaient un trouble du langage isole; alors qu'un seul enfant (0;33%) avait un deficit cognitif global. Dans le groupe des epilepsies non idiopathiques; les signes associes a l'epilepsie etaient les troubles du langage (15;70%); du comportement (15%) et des deficits moteurs (10;32%). 22;41% des enfants scolarises avaient des difficultes d'apprentissage menant parfois a des redoublements scolaires ou une exclusion. Conclusion La classification syndromique a l'epilepsie est necessaire pour une bonne prevision pronostique et therapeutique. Le caractere idiopathique ou non en est pour une grande place; correle le plus souvent a une epilepsie familial ou une consanguinite ou affection perinatal ou infectieuse du systeme nerveux central

Cerebral neurocysticercosis mimicking or comorbid with episodic migraine?

BACKGROUND: Neurocysticercosis is a major cause of neurological symptoms in developing countries. We report a case of cerebral neurocysticercosis presenting as episodic migraine without aura, with clinico-radiological correlations and discuss the possible causal influence of neurocysticercosis on the pathomechanisms of migraine. CASE PRESENTATION: We report a 24 year-old male consulting for a one year history of recurrent headaches. He described bilateral frontal and/or temporal attacks of throbbing headache, moderate to severe in intensity, worsened by head movements and accompanied by nausea, photophobia and phonophobia. Attacks lasted between 12 and 60 hours if untreated. He never had symptoms suggestive of a migraine aura or an epileptic seizure. Headache attacks progressively increased in frequency to up to 5 to 7 severe attacks per month. On taking history, the patient reported having consumed undercooked porcine meat. Physical examination was unremarkable. A brain CT scan showed two contiguous occipital cystic lesions with ring enhancement and surrounding edema suggestive of cerebral neurocysticercosis. On laboratory work-up, blood serology for cysticercal antibodies was positive. Full blood count, erythrocyte sedimentation rate, c - reactive protein level, human immunodeficiency virus serology, liver and hepatic function were all normal. Albendazole (1000 mg/day) and prednisolone (60 mg/day) were prescribed for seven days. The patient was examined again two and six months after the end of his treatment and there was a significant reduction in headache severity and frequency. CONCLUSION: We propose that in our patient the occipital neurocysticercosis lesions cause migraine without aura-like attacks via inflammation in the surrounding brain parenchyma leading to sensitization of the trigemino-vascular system. We cannot rule out, however, the possibility that our patient has a genetic predisposition for migraine without aura and that the fortuitous association of neurocysticercosis is simply an aggravating factor of his migraine.

NeuroAIDS in Africa.

In July 2009, the Center for Mental Health Research on AIDS at the National Institute of Mental Health organized and supported the meeting "NeuroAIDS in Africa." This meeting was held in Cape Town, South Africa, and was affiliated with the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Presentations began with an overview of the epidemiology of HIV in sub-Saharan Africa, the molecular epidemiology of HIV, HIV-associated neurocognitive disorders (HANDs), and HAND treatment. These introductory talks were followed by presentations on HAND research and clinical care in Botswana, Cameroon, Ethiopia, The Gambia, Kenya, Malawi, Nigeria, Senegal, South Africa, Uganda, and Zambia. Topics discussed included best practices for assessing neurocognitive disorders, patterns of central nervous system (CNS) involvement in the region, subtype-associated risk for HAND, pediatric HIV assessments and neurodevelopment, HIV-associated CNS opportunistic infections and immune reconstitution syndrome, the evolving changes in treatment implementation, and various opportunities and strategies for NeuroAIDS research and capacity building in the region.

Prevalence de la demence dans une population de personnes agees senegalaises

Description Avec le vieillissement de la population, survient la démence dans la population de personnes âgées. Objectif. L'objectif de cette étude était d'estimer la prévalence de cette affection dans une population de personnes âgées sénégalaises. Méthodes Par une étude transversale qui s'est déroulée du 01 mars 2004 au 31 décembre 2005, des personnes âgées de 55 ans et plus venant consulter pour un problème de santé au Centre Médico-Social et Universitaire de l'IPRES (Sénégal) ont été évaluées sur le plan clinique et neuropsychologique. Des données sur les caractéristiques sociodémographiques, les antécédents médico-chirurgicaux et familiaux, le mode de vie, le réseau social ont été collectées à l'aide d'un questionnaire structuré avec des réponses fermées. Résultat La population à l'étude était composée de 872 personnes. Elles avaient un âge moyen de 67,2 ans ± 7,5. Elles étaient de sexe masculin (62,6%), mariées (79%), non instruites (50,7%). Dans les antécédents, l'HTA, le diabète, les affections respiratoires, les affections rhumatismales, la cataracte et les troubles digestifs étaient les plus fréquents. Le tabagisme et l'alcoolisme était faible alors que la marche constituait la principale activité physique. Les personnes âgées vivaient en famille avec un bon réseau social.Cinquante huit (58) personnes ont présenté une démence (6,6%). La prévalence de la maladie variait de manière significative avec l'âge et l'instruction. Conclusion Ce résultat confirme que la prévalence de la démence varie en fonction de l'âge et de l'instruction de la personne âgée

The global campaign against epilepsy in Africa.

One of the leading brain disorders in developing countries is represented by epilepsy. It is estimated that 80% of people suffering from epilepsy around the world, reside in developing world such as Africa. Many perinatal and postnatal causes are brain-stressers in people suffering from malnutrition and low economical conditions. This context is characterised by long delay before modern treatment, reduced number and financial inaccessibility to anti-epileptic drugs (AEDs) and limited human and technical resources for epilepsy. Cultural interpretation also contributes to exclude epileptic patients from the educational and productive fields, aggravating the burden they face and favouring a treatment gap estimated to 80%. To fight against this dramatic reality, a partnership has been built between the International League against Epilepsy, the International Bureau for Epilepsy and the World Health Organisation, named the "Global Campaign Against Epilepsy" "Epilepsy Out of the Shadows" to reduce treatment gap and social and physical burden, educate health personnel, dispel stigma, support prevention.