Construction and validation of an algorithm to separate focal and generalised epilepsy using clinical variables: A comparison of machine learning approaches.

PURPOSE: Epilepsy type, whether focal or generalised, is important in deciding anti-seizure medication (ASM). In resource-limited settings, investigations are usually not available, so a clinical separation is required. We used a naïve Bayes approach to devise an algorithm to do this, and compared its accuracy with algorithms devised by five other machine learning methods. METHODS: We used data on 28 clinical variables from 503 patients attending an epilepsy clinic in India with defined epilepsy type, as determined by an epileptologist with access to clinical, imaging, and EEG data. We adopted a machine learning approach to select the most relevant variables based on mutual information, to train the model on part of the data, and then to evaluate it on the remaining data (testing set). We used a naïve Bayes approach and compared the results in the testing set with those obtained by several other machine learning algorithms by measuring sensitivity, specificity, accuracy, area under the curve, and Cohen's kappa. RESULTS: The six machine learning methods produced broadly similar results. The best naïve Bayes algorithm contained eleven variables, and its accuracy was 92.2% in determining epilepsy type (sensitivity 92.0%, specificity 92.7%). An algorithm incorporating the best eight of these variables was only slightly less accurate - 91.0% (sensitivity 89.6%, and specificity 95.1%) - and easier for clinicians to use. CONCLUSION: A clinical algorithm with eight variables is effective and accurate at separating focal from generalised epilepsy. It should be useful in resource-limited settings, by epilepsy-inexperienced doctors, to help determine epilepsy type and therefore optimal ASMs for individual patients, without the need for EEG or neuroimaging.

The first Helicobacter pylori-induced Guillain-Barré syndrome in Sudan.

Key Clinical Message: This case report highlights the role of Helicobacter pylori infection in the development of GBS. Healthcare providers should consider H. pylori in their differential diagnosis for patients with neurological syndromes. Astract: We report the first known case of Guillain-Barré syndrome (GBS) associated with Helicobacter pylori infection in Sudan. This case highlights the role of H. pylori infection in the development of GBS. It also emphasizes the importance of wide screening of different endemic infections for patients with neurological syndromes for early detection and improves the case management in resource-limited settings like Sudan. Further research is needed to better understand the underlying mechanisms of H. pylori-inducing neurological disorders.

Guillain-Barre syndrome associated with hepatitis E virus infection: A case report.

Key Clinical Message: Hepatitis E virus (HEV) infection can be manifested with several neurological syndromes including GBS. Therefore, healthcare providers should consider HEV in their differential diagnosis for patients with neurological disorders. Abstract: We report a case of Guillain-Barré syndrome associated with hepatitis E virus infection. The current case-report demonstrates diagnostic challenge to identify GBS case in a limited-resources country like Sudan. However, HEV infection should be highly suspected in patients with neurological manifestation with high liver enzymes.

An epilepsy type algorithm developed in India is accurate in Sudan: A prospective validation study.

PURPOSE: The effects of epilepsy are worse in lower- and middle-income countries (LMICs) where most people with epilepsy live, and where most are untreated. Correct treatment depends on determining whether focal or generalised epilepsy is present. EEG and MRI are usually not available to help so an entirely clinical method is required. We applied an eight-variable algorithm, which had been derived from 503 patients from India using naïve-Bayesian methods, to an adult Sudanese cohort with epilepsy. METHODS: There were 150 consecutive adult patients with known epilepsy type as defined by two neurologists who had access to clinical information, EEG and neuroimaging ("the gold standard"). We used seven of the eight variables, together with their likelihood ratios, to calculate the probability of focal as opposed to generalised epilepsy in each patient and compared that to the "gold standard". Sensitivity, specificity, accuracy, and Cohen's kappa statistic were calculated. RESULTS: Mean age was 28 years (range 17-49) and 53% were female. The accuracy of an algorithm comprising seven of the eight variables was 92%, with sensitivity of 99% and specificity of 72% for focal epilepsy. Cohen's kappa was 0.773, indicating substantial agreement. Ninety-four percent of patients had probability scores either less than 0.1 (generalised) or greater than 0.9 (focal). CONCLUSION: The results confirm the high accuracy of this algorithm in determining epilepsy type in Sudan. They suggest that, in a clinical condition like epilepsy, where a history is crucial, results in one continent can be applied to another. This is especially important as untreated epilepsy and the epilepsy treatment gap are so widespread. The algorithm can be applied to patients giving an individual probability score which can help determine the appropriate anti-seizure medication. It should give epilepsy-inexperienced doctors confidence in managing patients with epilepsy.

Guillain-Barre syndrome associated with COVID-19 infection: A case series.

In this communication, we reported a series of six patients presented with Guillain-Barré syndrome that associated with COVID-19 infection, which was confirmed with RT-PCR. Here we discuss the laboratory investigation and case management, as well as clinical presentation and outcome of each case. The current report demonstrated the first case series of COVID-19-associated GBS-cases in Sudan.

Obstacles faced by healthcare providers during COVID-19 pandemic in Sudan.

The impacts of COVID -19 pandemic have been quite significant on healthcare providers. I was particularly challenging for those in Low and Middle-Income Countries including Sudan . Unfortunately, the pandemic has hit Sudan on extremely difficult time for the country and its people. The country was coming out of long-brutal and devastating dictatorship and transitioning to new democracy with civilian leadership. In addition to the pandemic related issues, trying to rebuild the health system during socioeconomic crisis, healthcare providers  in the country were challenged personally and professionally. These challenges include the stress of working in under-resourced settings with limited access to personal-protection equipment and testing kits raised the fear of contracting the virus and spreading it to their families. The professional, social, and personal life of healthcare providers have been dramatically changed by the ongoing pandemic, however, they are heroically accepting this change in a hope that, this will save the life of many more people. Nevertheless, their fights and sacrifices should at least be rewarded by governments and communities altogether strictly enforce the implementation of other preventive measures including vaccination, face masking, and social distancing and get all protected. We should all understand that, unless we are all protected no one is protected, so all must adapt to the new norm of life and collaborate not only on ending this pandemic but to prevent similar ones in the future.

Availability of Therapies and Services for Parkinson's Disease in Africa: A Continent-Wide Survey.

BACKGROUND: The growing burden of Parkinson's disease (PD) in Africa necessitates the identification of available therapies and services to improve patient care. OBJECTIVE: To investigate the availability, affordability, frequency of usage, and insurance coverage of PD therapies (pharmacological, surgical, physical, and speech therapies) and services including specialized clinics, specialists, and nurses across Africa. METHODS: A comprehensive web-based survey was constructed and distributed to neurologists/physicians with a special interest in PD across Africa. The survey instrument includes components that address availability, affordability, frequency of use, and insurance coverage of different therapies and services. RESULTS: Responses were received from 28 (of 43 contacted) countries. Levodopa-based oral preparations were always available in 13 countries (46.4%) with variable affordability and "partial or no" insurance coverage in 60% of countries. Bromocriptine was the most available (50%) and affordable ergot dopamine agonists (DA), whereas non-ergot DA was always available in only six countries (21.4%). Trihexyphenidyl was the most available and affordable anticholinergic drug (46.4%). Tricyclic antidepressants and selective serotonin reuptake inhibitors were available in most countries (89.3% and 85.7% respectively), with variable affordability. Quetiapine and clozapine were less available. Specialized clinics and nurses were available in 25% and 7.1% of countries surveyed, respectively. Other services were largely unavailable in the countries surveyed. CONCLUSION: PD-specific therapies and services are largely unavailable and unaffordable in most African countries. The data provide a platform for organizing strategies to initiate or scale up existing services and drive policies aimed at improving access to care and tailoring education programs in Africa. © 2021 International Parkinson and Movement Disorder Society.

COVID-19 in Sudan.

The steadily growing COVID-19 pandemic is challenging health systems worldwide including Sudan. In Sudan, the first COVID-19 case was reported on 13th March 2020, and up to 11 November 2020 there were 14,401 confirmed cases of which 9,535 cases recovered and the rest 3,750 cases were under treatment. Additionally, 1,116 deaths were reported, indicating a relatively high case fatality rate of 7.7%. Several preventive and control measures were implemented by the government of Sudan and health partners, including the partial lockdown of the country, promoting social distancing, and suspending mass gathering such as festivals and performing religious practices in groups. However, new cases still emerging every day and this could be attributed to the noncompliance of the individuals to the advocated preventive measurements.

Intra-familial phenotypic heterogeneity in a Sudanese family with DARS2-related leukoencephalopathy, brainstem and spinal cord involvement and lactate elevation: a case report.

BACKGROUND: Leukoencephalopathy with brainstem and spinal cord involvement and lactate elevation (LBSL, OMIM #611105) is a genetic disease of the central nervous system characterized by lower limb spasticity, cerebellar ataxia and involvement of the dorsal column. The disease is caused by mutations in the DARS2 gene but has never been reported in sub-Saharan Africa so far. CASE PRESENTATION: Two siblings, aged 18 years and 15 years, from a consanguineous family presented with pyramidal signs and symptoms since infancy and developmental delay. Whole exome sequencing of the proband identified two compound heterozygous variants (NM_018122.4:c.1762C > G and c.563G > A) in DARS2. Sanger sequencing confirmed the presence of the mutations and their segregation in trans in both patients and in their elder sister (aged 20 years), who showed only brisk reflexes and mild lower limb spasticity. Surprisingly, in contrast to her subtle clinical presentation, the elder sister had abnormal MRI features and serum lactate levels comparable to her ill sisters. CONCLUSION: This report illustrates intra-familial phenotypic variation in LBSL and provides an example of a marked dissociation between the clinical and radiological phenotypes of the disease. This may have implications for the detection of mutation carriers in LBSL.