LSN MS guidelines for the management of multiple sclerosis.

OBJECTIVE: The prevalence of multiple sclerosis (MS) in Lebanon is unknown, as there are no available or reliable epidemiological studies to date. The circumstances of Middle East countries are different from those of Europe and North America in terms of differential diagnoses and disease management. The aim of the conference is to establish guidelines for diagnosis, treatment, follow-up and management of patients with MS in Lebanon. Another objective is to discuss and participate in research projects based on epidemiology, clinical trials and more fundamental aspects of the disease in the future. METHODS: Under the authority of the Lebanese Society of Neurology (LSN), a group of neurologists took the initiative to participate in this LSN MS committee with the purpose of establishing a consensus for the management of patients with MS, and under the supervision of a Coordinator (A.T.) designed by the LSN board. RESULTS: Diagnostic and therapeutic, follow-up and research recommendations were proposed with special emphasis on the specific needs and circumstances of Lebanon. The experts highlighted the importance of considering particular needs, the identification of patients at high risk of developing MS in order to maximize therapeutic opportunities, and cost-effective control of treatment efficacy, as well as global assessment of disability. CONCLUSIONS: The experts established guidelines concerning diagnosis, treatment, and follow-up of patients with MS in Lebanon. Furthermore, they recommended some clinical and fundamental research projects.

Ptosis, down-slanting palpebral fissures, hypertelorism, seizures and mental retardation: a possible new MCA/MR syndrome.

We present a family with six children of first cousin parents, in which three present with microcephaly, hypertelorism, down-slanting palpebral fissures, ptosis, a broad nasal tip, a short webbed neck, mental retardation and seizures. Two differential diagnosis, the Noonan and the Baraitser-Winter syndrome are discussed. The possibility of the description of a new MCA/MR syndrome is raised.

[Gadolinium-medium filter-protected percutaneous stended carotid angioplasty]. / Stenting carotidien protégé sous gadolinium.

We report on a patient who underwent a percutaneous carotid angioplasty with stenting. The procedure was protected by a filter and used gadolinium instead of iodine. No neurological or renal complication occurred. This observation represents one of the first publications describing the use of this contrast medium in a complex neuroradiological intervention.

[Neurobrucellosis: clinical features and therapeutic responses in 15 patients]. / Neurobrucellose: études clinique et thérapeutique de 15 patients.

We report a retrospective analysis of 15 cases of neurobrucellosis. Initial clinical manifestations consisted of meningoencephalitis in 5 patients, acute and subacute meningitis in 4, intracranial hypertension in 2, polyradiculoneuritis with albumin-cell dissociation in 2 (one with cerebral and subarachnoid hemorrhage), and transverse myelitis and lumbar epidural abcess with root involvement in 1 each. Cranial nerve involvement was noted in 5 patients. Fever was absent in 3. Transient clinical manifestations mimicking transient ischemic attacks were noted in 3 patients. Unusual central nervous system demyelinating lesions were observed on the MRI in 1 of the patients with meningoencephalitis. Cerebrospinal fluid Wright titers and culture were rarely helpful. Most patients responded favorably with minor neurological sequelae. The most commonly used antibiotics were rifampin, doxycycline, and trimethoprim-sulphamethoxazole, in various combinations for at least 3 months. The differential diagnosis of neurobrucellosis is wide. However, in endemic areas, the disease should be ruled out in all patients who develop unexplained neurological symptoms.

[A rare cause of diplopia: a sinus cavernous dural fistula. A case report]. / Une cause rare de diplopie: la fistule durale du sinus caverneux. A propos d'un cas.

Dural fistulas of the cavernous sinus represent a relatively unknown etiology for diplopia. The authors report on a case where combination of MR and transcranial Doppler (especially transocular) helped in diagnostic and therapeutic approach. They propose a new algorithm for the management of diplopia.

[Progressive myoclonic epilepsy type Lafora]. / Epilepsie myoclonique progressive type Lafora.

Lafora's disease is a form of progressive myoclonic epilepsy characterized by seizures, myoclonus and dementia. We present the case of a 12-year-old girl who is complaining of epilepsy and myoclonic jerks starting a year ago, with deterioration of school performance, and abnormal EEG. The axillary skin biopsy showed PAS-positive inclusions in the cells of sweat glands, typical of Lafora's disease.

[Behçet's disease. Apropos of 32 cases]. / La maladie de Behçet. A propos de 32 cas.

The study of 32 cases of Behçet's disease has enabled the authors to ascertain that the disease presents no particular characteristics in Lebanon, except certain variations in the frequency of the symptoms. Their study includes two familial cases, or approximately 3 p. cent and confirms the severity of these forms. Colchicine proves to be an effective treatment able to cure cutaneous and articular symptoms and perhaps stabilize the ocular lesions. The long-term efficacy of steroid therapy in ocular manifestations is not certain. Chlorambucil caused a stabilization of ocular lesions in four patients.