Tunisian version of the brief international cognitive assessment for multiple sclerosis: Validation and normative values.

BACKGROUND: The Brief International cognitive assessment for Multiple sclerosis (BICAMS) is a specific batterie used to identify cognitive impairment in Multiple Sclerosis (MS) in a reliable and easy way. To date, for the Arabic-speaking Tunisian MS patients, there is no consensus for the use of specific cognitive batteries in MS. OBJECTIVE: The aim of our work was to develop and validate the Tunisian version of the BICAMS (T-BICAMS) and to determine our own normative values. MATERIAL AND METHODS: Patients diagnosed with MS and followed up in the department of Neurology of Razi Hospital were recruited and matched to healthy controls according to age, sex and educational level. T-BICAMS validity was established by comparing MS and healthy controls for symbol digit modalities test (SDMT), brief visual memory test (BVMT-R) and Tunisian verbal learning tests (TVLT) which was used instead of the California verbal learning test (CVLT-II). RESULTS: The 104 MS patients and 104 healthy controls were comparable for age, sex and educational level. The MS group exhibited lower performances in all T-BICAMS domains compared to healthy controls: SDMT (x003Dp<10-3), BVMT-R (p = 0.002) and TVLT (p x003D<10-3). T-BICAMS Cronbach alpha value was 0.741. Normative values were identified for patients with MS: SDMT [39-40], BVMT-R [26-27] and TVLT [43-44]. Cognitive impairment was identified among 76 patients (73.1%). Males, lower educational levels and progressive MS were associated with a more severe cognitive impairment. CONCLUSIONS: The current study has established the BICAMS as a valid and reliable tool for the identification of cognitive impairment in the Tunisian MS population.

Paraneoplastic opsoclonus-myoclonus-ataxia syndrome revealing dual malignancy.

Dual malignancy has been rarely associated to paraneoplastic syndromes. We describe an unusual case of metachronous small cell lung carcinoma revealed by opsoclonus-myoclonus ataxia syndrome in a 69-year-old patient with known prostate adenocarcinoma, with positive anti-Hu and anti-Yo antibodies and good responsiveness to corticosteroids and chemotherapy.