Deep brain stimulation for movement disorders treatment in Africa: The current status, outcomes, and challenges.

Movement disorders (MDs), a diverse group of neurological conditions characterized by abnormal and involuntary movements, have a profound impact on individuals, families, and healthcare systems. Deep Brain Stimulation (DBS) has emerged as a promising therapeutic intervention, offering relief from symptoms and improved quality of life. By implanting electrodes in specific brain regions and connecting them to a pulse generator, DBS modulates aberrant neural activity underlying these disorders. While DBS has gained recognition globally, its utilization in African countries remains limited. This comprehensive article presents the results of a literature review on the status of DBS therapy for MDs in Africa. The review assesses treatment outcomes, patient demographics, and challenges tied to implementing DBS in the African context. The findings reveal promising developments in DBS therapy across several African countries, particularly in treating Parkinson's disease and dystonia. However, challenges related to awareness, access to specialized care, and a scarcity of expertise still impede broader adoption. The article underscores the urgent need for collaborative efforts, policy changes, and increased training to expand the reach of DBS therapy, thus mitigating the burden of MDs on the African continent.

Deep Brain Stimulation for Dystonia: Experience of a Moroccan University Hospital.

BACKGROUND: Deep brain stimulation (DBS) is a well-established procedure that provides long-term symptom control of the third most common movement disorder: dystonia. In this study, we aim to report the experience of Ibn Rochd University Hospital in the treatment of dystonia using DBS of the globus pallidus internus, which represents an exceptional challenge for a developing country such as Morocco. METHODS: Since 2013, we selected five eligible candidates for DBS surgery at the university hospital Ibn Rochd. A genetic assessment had been performed in four cases. Their motor and mental states were prospectively monitored using several validated scales, including Burke-Fahn-Marsden Dystonia Rating Scale, Mini Mental State Examination, 36-Item Short Form Survey, and Zarit scale. RESULTS: Our sample had two clinical phenotypes of dystonia: isolated dystonia (in two patients) and combined dystonia (in three patients). Patients were aged 14 to 32 years, and their mean onset age ranged from 7 to 13 years with a mean progression duration of 9 years. Our results indicate successful treatment of patients with dystonia using DBS. Scores from the Burke-Fahn-Marsden Dystonia Rating Scale confirm improvements ranging from 40% to 95%. However, some potentially surgery-related complications could occur such as lead infection, which, in our experience, was reported in one case. CONCLUSION: The experience of the university hospital Ibn Rochd regarding the use of DBS in treating dystonia was largely positive. However, the procedure faces challenges due to its complexity, specifically concerning its multidisciplinary nature, its genetic test costs, and the reluctance of pediatricians to get involved.

RBD and hyposmia in Moroccan patients with a synucleinopathy: prevalence and the timing of occurrence in a large cohort.

INTRODUCTION: Rapid Eye Movement Sleep Behavior Disorder (RBD) and hyposmia are common in synucleinopathies and they tend to occur in connection to the prodromal development of these disorders. In this study, we sought to determine the prevalence of RBD and hyposmia and the timeline of their occurrence in a large cohort of Moroccan patients. METHODS: We recruited 774 consecutive patients with synucleinopathy and tauopathy at Ibn Rochd University Hospital of Casablanca. A group of 100 healthy controls was also recruited. We relied on a questionnaire to collect general characteristics and clinical data filled by the patient and his companion under the supervision of a qualified health professional. RESULTS: The study included 697 patients with PD, 37 with DLB and 40 had a tauopathy disorder (PSP or CBD). The proportion of patients who have RBD was 52% in PD, 100% in DLB, 0% in tauopathies and 12% among healthy controls. Hyposmia symptom was found in 47% of patients with PD, 68% in patients with DLB, 0% in tauopathy patients and in 10% of healthy controls. Moreover, 46% of PD patients and 75% of DLB patients developed RBD during the prodromal phase. Meanwhile, hyposmia occurred in association with the prodromal phase among 67% of PD cases and 85% of DLB patients. CONCLUSION: RBD and hyposmia are both prevalent among Moroccan patients with synucleinopathy and they occur frequently during the prodromal phase. Identifying these premotor signs will improve early and differential diagnosis and enhance our understanding of how a specific synucleinopathy progresses.

Parkinson's disease research in Morocco: a review.

Aim: To quantify and provide an overview on the scientific productivity made by Moroccan academics in the research on Parkinson's disease (PD) and parkinsonism. Materials & methods: Scientific articles, in either English or French, were gathered from published literature in three recognized databases: PubMed, ScienceDirect and Scopus. Results: We identified 95 published papers from which 39 articles have been extracted after removing inadequate publications and duplications between databases. All articles were published between 2006 and 2021. The selected articles were subdivided into five categories. Conclusion: The Moroccan academia is presently facing a low productivity issues and a lack of research laboratories focusing on PD research. We anticipate that providing more budgetary funds will significantly improve the productivity of PD research.

This work aims to quantify the studies conducted by Moroccan academics on Parkinson's disease (PD), which is a neurological condition that causes shaking, muscle stiffness and slows movement. As well, this review aims to provide an overview of the available Moroccan research papers on PD and Parkinsonism. For this purpose, we have gathered scientific articles, drafted in English or French, from three recognized scientific databases: Scopus, ScienceDirect and PubMed. We identified 95 published studies on PD and Parkinsonism from which 39 articles, published between 2006 and 2021, have been extracted after removing the inadequate publications and the duplication between databases. Subsequently, the selected articles were subdivided into five categories: diagnosis (n = 6), motor and non-motor symptoms (n = 13), etiology and pathophysiology (n = 9), genetic (n = 4), treatment and prevention (n = 7). From this review, we conclude that we are presently facing, in addition to low productivity, a serious lack of research laboratories focusing on PD research. We anticipate that providing more budgetary funds will significantly improve the scientific productivity related to PD.

An overview of the worldwide distribution of LRRK2 mutations in Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative disorder with significant genetic influence. The LRRK2 gene is a major genetic contributor, particularly the Gly2019Ser mutation. This focused review investigates the global distribution of LRRK2 mutations, with emphasis on Gly2019Ser and other pathogenic variants. Prevalence rates of Gly2019Ser are highest in North Africa and the Ashkenazi-Jewish population, indicating a potential common ancestor and founder effect. Other LRRK2 mutations, including Asn1437His, Arg1441Gly/Cys/His, Tyr1699Cys and Ile2020Thr, exhibit varying global prevalences. Understanding these distributions enhances our knowledge of PD genetics and aids personalized medicine. Further research is crucial to unravel clinical implications and develop targeted therapies for LRRK2 mutation carriers.

Prevalence, characteristics and risk factors in a Moroccan cohort of Long-Covid-19.

INTRODUCTION: Covid-19 can involve persistence of nonspecific symptoms and sequelae that last weeks to months after initial recovery, but the definition of this situation is lacking. Thus, the aim of our study is to estimate the prevalence, symptoms, and signs extending beyond the acute phase of Covid-19 compared to the general population not infected with the virus and to assess the factors influencing the occurrence of these symptoms in developing countries like Morocco. PATIENTS AND METHODS: This study recruited 118 healthcare workers who endured the Covid-19 infection and 118 matched controls that had never experienced it. We have defined Long-Covid-19 according to guidance for NICE, and we used a survey made of direct questions and short answers sent to the recruiters via mail to evaluate the demographic parameters, severity and duration of the Covid-19 symptoms, vaccination against SARS CoV-2, and pulmonary involvement, and a series of general symptoms were looked for. FINDINGS: Our study found that the prevalence of Long-Covid-19 was 47.4%. Compared to the general population, the symptoms with statistical significative results were predominated by asthenia, myalgia, and brain fog. The severity of the pulmonary involvement on chest CT scan was the only risk factor to their occurrence, whereas no effect of the vaccination anti-SARS-CoV-2 was found. CONCLUSION: Comparing to the literature, this study showed that nearly half of the patients who have been infected with SARS-CoV-2 will experience a variety of symptoms after the acute phase of this infection, and that it would be a real burden even in the youngest. We also found that vaccination against SARS-Cov-2 has no impact on this prevalence, which is to the best of our knowledge has never been previously studied.

Isolated generalized myoclonus immune-mediated by SARS-CoV-2: an illustrative videotaped case.

Myoclonus in the context of COVID-19 is an increasingly recognized condition. The occurrence in an ICU context in hypoxic patients, with metabolic disorders, taking several types of medication, makes difficult to establish a precise cause. Also, the implication of SARS-CoV-2 by direct invasion of the CNS or by immune-mediated phenomena is not yet clear. Currently, a dozen of cases of myoclonus as a predominant clinical manifestation, immune-mediated by SARS-Cov-2 are published. In all these cases, myoclonus was preceded by respiratory or other suggestive symptoms (e.g., anosmia) for this infection making straightforward the causal link. We describe a case of an isolated generalized myoclonus without other clinical complaints nor chest CT scan abnormalities nor SARS-CoV-2 RNA detection on nasopharyngeal swabs and on the CSF, as a para-infectious phenomenon of COVID-19 infection with excellent response to steroids perfusion. This challenging diagnosis was made upon confirmation of seroconversion (serology was negative at admission, then positive for IgM at day 6, then for both IgM and IgG at day 10) underlying that repeating serology is a diagnostic key to capture a similar findings.

Screening for SGCE mutations in Moroccan sporadic patients with Myoclonus-Dystonia syndrome.

Myoclonus-Dystonia (M-D) is a rare autosomal-dominant movement disorder characterized by myoclonic jerks in combination with dystonia and psychiatric features. Mutations in the Epsilon-sarcoglycan (SGCE, DYT11) gene have been found to cause M-D in 30%-50% of familial M-D. Sporadic cases have also been reported. The aim of study was to investigate whether the M-D phenotype is associated with the existence of SGCE mutations in Moroccan sporadic patients with M-D syndrome. The study included 12 M-D patients. We sequenced the entire coding region of the SGCE gene. We identified two different heterozygous SGCE mutations (c.769A > C ; c.391-3T > C). Our finding confirm that SGCE mutations can occur in sporadic patients when the phenotype is consistent with M-D. Further functional studies are needed to show how changes in SGCE protein function lead to the M-D phenotype.

Clinical course of neuromyelitis optica spectrum disorder in a moroccan cohort.

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) was suggested to be more frequent and have specific features among populations from Africa or North Africa. However, we could not find any large study about NMOSD in an African population in the medical literature. OBJECTIVES: To describe the characteristics of NMOSD in a Moroccan monocenter population. PATIENTS AND METHODS: A retrospective study was conducted. Patients fromJanuary 1999 to December 2015 fulfilling the 2015 International Consensus Criteria for NMOSD were included. RESULTS: Sixty four patients fulfilled the criteria. Mean age at onset was 35.7 ±â€¯10.7 years, and the sex ratio was 1/3.57. First clinical event was represented by optic neuritis (38.1%), followed by myelitis (27.0%) and a Devic's syndrome (17.2%). Mean annualized relapse rate was 1.07 ± 1.23 and mean EDSS at last visit was 5.1 ±â€¯2.8. Aquaporine 4 antibodies were positive in 47.1%. Brain lesions were found in 71.2%. Most patients (76.6%) received disease-modifying therapy, mainly cyclophosphamide (86.0%) and 49% remained relapse-free after treatment initiation CONCLUSION: Data from our study suggest more similarities between North African NMOSD patients and non-Caucasian populations. More studies are needed to assess other pathological patterns and compare disease course to other populations.

Genetic Aspects of Myoclonus-Dystonia Syndrome (MDS).

Myoclonus-dystonia (M-D) is an autosomal-dominant movement disorder with onset in the first two decades of life. Mutations in the epsilon-sarcoglycan gene (SGCE, DYT11) on chromosome 7q21-q31 represent the major genetic cause of M-D in some populations. The syndrome was related with mutations in two other genes (DRD2 and DYT1). A second locus has been reported in one large M-D family (DYT15, 18p11), but no gene has been identified yet. In this review, we discuss genetic aspects of myoclonus-dystonia.