Drug-resistant epilepsy in Morocco: description, prevalence and predictive factors in Casablanca-Settat region.

Drug-resistant epilepsy (DRE) affects about one-third of people with epilepsy (PWE). Our study aims to estimate the DRE prevalence and its predictive factors in Morocco. A cross-sectional study was conducted over 18 months. PWE with clinical diagnosis of epilepsy, and with an antiseizure treatment duration >12 months were examined in the neurology, neurosurgery, psychiatry, and pediatrics departments, of different sampled clinical sectors for the Casablanca-Settat region. Sociodemographic and clinical data were collected using a questionnaire during consultations. Antiseizure multi-therapy, a seizure freedom duration <12 months, compliance, and adequate posology were the determining factors for classifying DRE. Data were analyzed using Statistical Package for Social Sciences (SPSS) software, version 21.0. Statistical significance was set at p < 0.05 and logistic regression was performed to determine the predictive factors. In our sample of 446 PWE, the median age is 25 years (IQR: 11.75-44.00). The DRE estimated prevalence was 29.4 %. Pseudo-resistant epilepsy (PRE) was 18.0 %. Multivariate logistic regression analysis reports that single marital status (ORa = 1.94; CI95%: 1.02-3.71), comorbidities and concomitant affections (ORa = 2.14; CI95%: 1.27-3.59), structural etiology (ORa = 1.96; CI95%: 1.16-3.30), pre-ictal aura (ORa = 1.90; CI95%: 1.09-3.29), inter-ictal EEG abnormalities (ORa = 2.45; CI95%: 1.24-4.84) and allopathic treatment use (ORa = 2.10; CI95%: 1.30-3.39) are the predictive factors for DRE. We report an alarming DRE prevalence. Associated factors found may contribute to the prognosis and early management. PWE awareness, facilitating healthcare access and the development of epilepsy surgery are the key points to limit DRE in Morocco and prevent its various complications, especially for the pediatric population.

Antiseizure medication adherence and epilepsy surgery attitude in people with epilepsy in Morocco: A cross-sectional study.

We determine the proportion of non-Antiseizure Medication Adherence (non-AMA) and refusal attitude towards Epilepsy Surgery (ES) and their associated factors in Moroccan People With Epilepsy (PWE). A cross-sectional study was conducted (December 2021-December 2022) among adult Moroccan PWE. PWE were interviewed for their reactions to AMA and the ES attitude. Their medical files were processed to complete their sociodemographic and clinical data. Data were analyzed by the Statistical Package for Social Sciences (SPSS) software 21.0. A Chi-square test was performed to compare variables and multivariate logistic regression was used to highlight associations. Statistical tests were considered significant at a p-value ≤ 0.05 for a Confidence Interval (CI) of 95 %. The median age of our sample (n = 294) was 38 years (IQR: 25.00-55.00). Non-AMA was noted in 24.5 % with indifference as the main reason (55.6 %). ES refusal was found in 33.3 %, attributed mostly to apprehension (61.2 %). In the multivariate analysis, male sex (aOR = 1.94; 95 %CI: 1.03-3.64) and the existence of a family history of epilepsy (aOR = 1.96; 95 %CI: 1.02-3.75) were the factors associated with the non-AMA, whereas the use of allopathic treatments (aOR = 2.32; 95 %CI: 1.20-4.51), exclusively focal or generalized (not combined) seizures (aOR = 2.66; 95 %CI: 1.36-5.21) and the combination of a generic with the originator ASM (aOR = 2.64; 95 %CI: 1.12-6.18) were the predictive factors with the ES refusal attitude. The proportions found of non-AMA and ES refusal were relatively low compared to other studies, which may indicate the effort that medical staff have devoted recently to raising awareness of the importance of PWE's therapeutic involvement.

Prevalence and associated factors of psychiatric comorbidities in epilepsy in the Casablanca-Settat region of Morocco: A cross-sectional study.

OBJECTIVE: To determine the estimated prevalence of anxiety, depression, and anxiety-depression syndrome (ADS) and to identify the associated factors in Moroccan people with epilepsy (PWE). METHOD: A cross-sectional study was conducted among adult PWE (June 2021-December 2022) in the Casablanca-Settat region. PWE were interviewed by completing a questionnaire collecting sociodemographic and clinical data. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Out of 21 points, a score ≥8 is in favor of considerable anxiety/depression symptoms and a sum of the two scores ≥15 indicates the presence of ADS. Data were analyzed using Statistical Package for Social Sciences (SPSS) 21.0. p-values ≤0.05 were considered statistically significant and logistic regression was performed to determine the associated factors. RESULTS: Among 294 PWE, the median age was 39 years (interquartile range [IQR]: 25.75-54.00). The median anxiety, depression, and ADS scores were 8 (IQR: 5.00-10.00), 7 (IQR: 4.00-10.00), and 15 (IQR: 10.00-20.00), respectively. Anxiety, depression, and ADS were revealed in 51.4%, 44.9%, and 51.0% of PWE, respectively. Depression was the only predictor for anxiety (aOR = 24.20; 95%CI: 12.45-47.01). Antiseizure polytherapy (aOR = 3.35; 95%CI: 1.72-6.54) and anxiety (aOR = 24.04; 95%CI: 12.12-47.67) were the factors associated with depression. The risk of ADS was increased by female gender (aOR = 2.83; 95%CI: 1.68-4.78), antiseizure polytherapy (aOR = 2.75; 95%CI: 1.62-4.65), structural epilepsy (aOR = 1.73; 95%CI: 1.01-2.94), and the presence of concomitant conditions with epilepsy (aOR = 1.96; 95%CI: 1.16-3.31). SIGNIFICANCE: Our study reports high psychiatric comorbidity prevalence in epilepsy, which supports the bidirectional link hypothesis. Associated factors found are important in the prognosis and prevention. PLAIN LANGUAGE SUMMARY: The neural mechanisms underlying epilepsy tend to expose PWE to psychiatric disorders. Our study aims to quantify the rate of psychiatric comorbidities and their predictive factors in Moroccan PWE. The estimated prevalences of significant symptoms of anxiety, depression, and ADS were 51.4%, 44.9%, and 51.0%, respectively. Depression was the predictor of anxiety. Antiseizure polymedication and anxiety were the associated factors with depression. The risk of SAD was increased by female gender, antiseizure polymedication, structural epilepsy, and concomitant diseases with epilepsy. Our results are important for considering the psychiatric aspect of PWE and improving their care and quality of life.

Knowledge, attitudes and practices towards epilepsy in morocco: A cross-sectional study.

BACKGROUND: This study aims to assess knowledge, practices and attitudes of the general Moroccan population towards epilepsy and to highlight predictive factors. METHOD: A cross-sectional study was conducted in the Casablanca-Settat Moroccan region. A questionnaire was used to collect sociodemographic data and item answers from 400 people with epilepsy (PWE) and without epilepsy caregivers on dependent variables: knowledge, attitudes, and practices towards epilepsy. Bivariate and logistic regression analyses were performed using IBM SPSS Statistics 21.0. Statistical significance was set when P value < 0.05. RESULTS: The rates of poor knowledge, practices, and attitudes toward epilepsy were 11.5 %, 41 %, and 66.6 %, respectively. In the multivariate analysis, the risk of having poor knowledge about epilepsy was favored by lack of education (ORa = 4.31;CI95%:1.83-10.13;p = 0.001) and the absence of familiarity with epilepsy (ORa = 4.05;CI95%:1.92-8.54;p < 0.001). The risk of preferring allopathic practices to treat epilepsy was associated with lack of education (ORa = 2.21;CI95%:1.01-4.82;p = 0.046), residence in a city outside Casablanca (ORa = 2.33;CI95%:1.06-5.15;p = 0.035), age over 59 years (ORa = 2.50;CI95%:1.26-4.95; p = 0.008), residence in a rural areas (ORa = 4.41;CI95%:2.61-7.47;p < 0.001) and absence of familiarity with epilepsy (ORa = 4.08;CI95%:2.33-7.15;p < 0.001). Predictors of stigma towards epilepsy were female sex (ORa = 3.05;CI95%:2.04-4.56;p < 0.001) and the tendency to abandon anti-seizure medication for allopathic alternatives (ORa = 3.98;CI95%:2.21-7.17;p < 0.001), whereas advanced age was a protective factor (ORa = 0.57;CI95%:0.36-0.89;p = 0.014[39-59 years vs 18-29 years];ORa = 0.44;CI95%:0.23-0.82;p = 0.011[>59 years vs 18-29 years]). CONCLUSIONS: The rate of poor attitudes and treatment-seeking behavior was high. This socio-cultural context certainly impacts the quality of life and care of Moroccan PWE. These results should be considered to raise awareness in the Moroccan population.

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.

Unilateral pure trigeminal motor neuropathy and neurovascular conflict: More than a coincidence!

Sensory disturbances are usual manifestations of trigeminal neuropathy, but only a few cases of isolated unilateral pure trigeminal motor neuropathy were reported. We describe a rare case of a 65-year-old woman who presented with a 4-year history of progressive facial asymmetry and chewing weakness which was shown on imaging to be caused by unilateral atrophy of masticatory muscles, probably due to a neurovascular conflict between the third trigeminal branch and superior cerebellar vein. To the best of our knowledge, this probable association has never been described. We aimed through this article to describe the clinical presentation of this entity that clinicians might face in their daily practice and radiological aspect of it.

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.

Assessment of eligibility for thrombolysis in acute ischaemic stroke patients in Morocco.

INTRODUCTION: intravenous thrombolysis with recombinant tissue plasminogen activator (rTPA) is an approved treatment for acute ischaemic stroke (AIS). However, its use remains low. We aimed to assess the eligibility of thrombolysis for our patients with AIS before implementing this treatment method in our teaching hospital. METHODS: we conducted a prospective cross-sectional study in the emergency department of Casablanca University Hospital. We included every patient admitted for a stroke-related symptom. Delays between symptom-onset and admission and delays regarding the in-hospital evaluation of patients were recorded. Patients eligible for intravenous thrombolytic therapy were identified according to American Heart Association guidelines. RESULTS: in all, 463 patients were included. Only 8.42% of patients were eligible for thrombolysis; 74% of patients were ineligible because of an onset-to-thrombolysis delay longer than 4.5 hours. Mean onset-to-thrombolysis time was 27.2 hours. Patients were admitted with a mean delay of 24.9 hours. The in-hospital evaluation, from admission to computerized tomography (CT) interpretation, averaged 2.3 hours in length. CONCLUSION: the percentage of patients eligible for thrombolysis remains very low in our structure. The majority would not have benefitted from the therapy because of an extra hospital delay far exceeding the recommended therapeutic window. To shorten our delays and increase the number of patients benefiting from thrombolysis, we must implement strategies aiming to improve the recognition, evaluation and management of patients from the general public to the neurovascular unit.