[Neurological manifestations of Gougerot and Sjögren disease: a Black African case]. / Les manifestations neurologiques du syndrome de Gougerot et Sjögren: à propos d'un cas en Afrique noire.

Primitive Gougerot-Sjögren syndrome (PGSS) is a systemic autoimmune exocrinopathy in which twenty percent of affected patients develop neurological manifestations. It has been little described in the Black African literature. We report a case of PGSS in a 64-year-old Black woman as revealed by neurological manifestations in an inflammatory context. Central neuropathy was present and the patient fulfilled at least four of the six Vitali American-European diagnostic criteria. There were abnormal aspects on the sylvian artery and hyperintense lesions of periventricular predominance. PGSS is a serious disease which we must consider when we encounter any unexplained neurological manifestations especially those associated with vasculitic lesions.

[Amyotrophic Lateral Sclerosis (ALS) in the 10 last years in CHU Campus of Lomé (TOGO)]. / Sclerose Laterale Amyotrophique (SLA): Rapport de 10 ans d'activites en service de neurologie du CHU Campus de Lome (TOGO).

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that causes damage of upper motor neuron and lower motor neuron. Our objective was to describe the incidence and demographic characteristics of ALS and to analyze its diagnosis and management in Togo. MATERIALS AND METHODS: A retrospective and descriptive study of patient's observations was conducted in the department of neurology of the teaching hospital in Lomé during a 10 years period (2000 to 2009). The diagnosis of ALS was made according to the clinical classification of El Escorial. RESULTS: 5 cases of ALS were diagnosed, representing 0.049% of the hospitalizations in the department of neurology. The average age of patients was 49 years [range: 24 - 67 years] and the average evolution of the disease was 17.6 months [range: 6 - 36 months]. All the patients were men. The treatment was symptomatic in every case. Treatment with Riluzole was not delivered. During the follow-up, one patient died from respiratory complications. CONCLUSION: The El Escorial criteria should be made more accessible for a larger audience, as the availability and classification of care management relies heavily on diagnosed cases, namely early diagnosis.

La sclérose latérale amyotrophique (SLA) est une maladie dégénérative du motoneurone qui atteint les deux neurones de la voie motrice volontaire et qui est cliniquement définie. BUT: Avoir des données préliminaires au Togo concernant la SLA. MATÉRIEL ET MÉTHODES: Il s'agit d'une étude rétrospective et descriptive sur les observations de patients en service de neurologie du CHU campus de Lomé sur une durée de 2000 à 2009. Sont inclus, les patients répondant aux critères de SLA certaine selon les critères d'El Escorial. RÉSULTATS: Cinq (5) cas de SLA ont été diagnostiqués, représentant 0,049% des hospitalisations du service. L'âge moyen était de 49 ans [24; 67 ans] avec une durée moyenne d'évolution de 17,6 mois [6; 36 mois]. Tous les patients étaient de sexe masculin. Le traitement a été symptomatique dans tous les cas. Le traitement au Riluzole n'a pas pu être institué. Un patient était décédé plus tard de complications respiratoires. CONCLUSION: Les critères d'El Escorial doivent être vulgarisés, car la disponibilité et la codification de la prise en charge dépendent du nombre des cas diagnostiqués et surtout de la précocité du diagnostic.

Management of epilepsy patients in Batamariba district, Togo.

OBJECTIVE: To describe the feasibility of managing epilepsy in a rural setting in a developing country. METHODS: The project comprised four phases. After a study of the perception of epilepsy, we conducted a sensitization campaign in November 2001. The third phase was a survey, to detect epilepsy patients, in which 6249 persons were asked to complete a questionnaire. Persons with epilepsy were then examined, treated, mainly with phenobarbital, and followed up. RESULTS: The prevalence of epilepsy was estimated to be 15.7 per thousand. Ninety-two patients took antiepileptic drugs from 1 February 2002. By November 2005, 92.7% of all treated patients had achieved complete suppression of seizures, and 7.3% had reduced seizure frequency. CONCLUSIONS: Despite the stigma attached to epilepsy in many developing countries, it can be controlled by relatively simple measures. At present, 601 epilepsy patients are being followed up at the Nadoba health centre, where epilepsy is now the second commonest disease.

[Epilepsy and personality study among the Tamberma of Togo based on a general population survey using the Cloninger's Temperament and Character Inventory]. / Epilepsie et étude de la personnalité chez les Tambermas du Togo: à partir d'une enquête en population générale à l'aide de l'inventaire de tempérament et de caractère de Cloninger.

INTRODUCTION: There are many studies focusing on personality disorders of the patients with epilepsy in developed countries, using different methods. Such investigations with standardised tools like personality questionnaires lack in African populations in general and among the number of epileptic patients who have important psychosocial problems. In Togo, epilepsy still remains a shameful and contagious disease that leads often unfortunately to a "social death". The number of epileptic patients in this country is estimated around 45,000 and 90,000 and the situation is worst in some areas of the country like in Nadoba, chef-lieu of the Tamberma region where lives an homogenous and stable population that has kept its tradition. DESIGN OF THE STUDY: This study was aimed to show the probable existence of specific personality disorder among the epileptics in Nadoba; 34 epileptics and 34 controls chosen among the closest relatives (parents or co-tenants) matched by age (more or less than ten years old) and sex have been interviewed using the Temperament and Character Inventory (TCI) of Cloninger et al., in its French version validated by Pélissolo and Lépine. The TCI is a self addressed questionnaire that has 226 items with dichotomous and forced answer (true or false) that explores 7 dimensions of personality, 4 concerning temperament and 3 concerning character. Regarding psychometric aspects, the TCI has the particularity to gather together, in a unique tool, the exploration of two complementary dimensions: temperament rather conditional and character that has been acquired. The scores of character allow to differentiate the subjects having a good level of adaptation (high scores, about 100%), from those who, because of an individual fragility, adapt themselves less well (low scores). The temperament profile is used on a second approach to locate the personality disorders, taking into account probable deviations. People participating in this study were also interviewed with the Goldberg anxiety and depression scale. For the statistical analysis, the comparison of means was achieved through bilateral Student't-test. A significance threshold of 0.05 has been used for the analysis. RESULTS: Concerning the results, 67 questionnaires have been selected from 33 epileptics (3 men and 30 women), mean age 29.3 years+/-8.1 and 34 controls (4 men and 30 women), mean age 30.6 years+/-5.6. The average scores obtained from the different items of the TCI scale are summarised in chart 1. The comparison of average scores obtained at each item, sub-dimension and dimension of the TCI, did not show any significant difference between cases and controls. However cases were significantly different from controls (P<0.001) on average Goldberg's anxiety scores (4.6+/-1.5 and 2.6+/-1.3) and depression (4.4+/-2.2 and 0.8+/-0.8). DISCUSSION: The average scores obtained in France in the course of the normative study in general population were rather different. The validation study of the French version of TCI showed differences with the population of North America, suggesting inter cultural differences while evaluating the personality and the necessity of using specific norms during each new translation of the instrument. However, the valued in the French-speaking populations (Belgium, Swiss, Lebanon) are in general very close to the French values. The character and behavioural disorders among are of interest and the difficulty in evaluating the part of hysteria in the manifestation of exhibiting pseudo-seizure of epilepsy is also underlined. This question is raised in Nadoba in women, called "Odueri" or "the women that fall", a particular form of tonico-clonic fits observed in that cultural setting. Is it a question of real epileptic seizure or are these phenomena a kind of trance? This investigation of the Tamberma in Togo urges to set up psychometric studies to define local norms. It also suggests the possible existence of personality traits specific to the "women that fall" but these aspects require further developments.

[Epidemiologic, clinical, and etiologic features of acute delirious episodes (ADE) in Togo: findings of a hospital survey]. / Epidémiologie, clinique et facteurs etiologiques des bouffées délirantes aiguës (BDA) au Togo--à partir d'une enquête hospitalière.

This transverse descriptive epidemiologic study carried out in a hospital setting in Togo over a period of 80 days included a total of 63 patients presenting acute delirious episodes. There were 25 women and 38 men ranging in age from 18 to 45 were included. Most patients were young (20 to 34 years) and presented symptoms comparable to those described elsewhere in France and Africa. However several particularites were noted in this fairly protected traditional rural setting in which delirious episodes are uncommon as compared to urban settings in which such cases are more common due to sociocultural stress, drug addiction, and HIV infection.

Psychosocial issues in people with epilepsy in Togo and Benin (West Africa) I. Anxiety and depression measured using Goldberg's scale.

PURPOSE: This study in Togo and Benin, West Africa, was aimed at measuring depression and anxiety among people with epilepsy (PWE). METHODS: This cross-sectional study of 281 adult PWE in Togo and 215 in Benin matched with the same number of controls without epilepsy used Goldberg's anxiety and depression scale. The statistical tests used for comparisons were chi(2) tests, Fisher's exact test, analysis of variance, and Fisher's PLSD test when necessary. RESULTS: PWE in Togo and Benin had significantly higher (P<0.0001) average depression scores (4.4+/-2.1, 4.7+/-2.7) than controls (0.5+/-0.9, 1.4+/-2.4). They also had significantly higher (P<0.0001) average anxiety scores (5.3+/-2.0, 6.2+/-2.1) than controls (2.5+/-1.6, 1.6+/-2.0). In consideration of the thresholds of the scale, the prevalence of possible major anxiety and depression among PWE was also very high compared with controls (P<0.0001). High anxiety and depression scores were, in general, positively correlated with a higher frequency of seizures and lack of treatment. CONCLUSION: Results confirmed the existence of anxiety and depression among PWE in Togo and Benin.

Psychosocial issues in people with epilepsy in Togo and Benin (West Africa) II: quality of life measured using the QOLIE-31 scale.

PURPOSE: This study in Togo and Benin, West Africa, was aimed at measuring health-related quality of life (HRQOL) of people with epilepsy (PWE). METHODS: It was a cross-sectional study among 281 adult PWE in Togo and 215 in Benin matched with the same number of controls without epilepsy, using the Quality Of Life in Epilepsy Scale-31 (QOLIE-31). RESULTS: In Togo and Benin, controls had significantly better HRQOL (80.3+/-7.4, 72.2+/-12.7) than PWE (49.5+/-14.4, 52.1+/-33.4) according to the QOLIE-31 Overall score (P<0.0001). HRQOL was, in general, negatively correlated with a higher frequency of seizures and lack of treatment. CONCLUSION: Results call for specific management of epilepsy in PWE in Togo and Benin to improve their HRQOL.

[Comparison of sociocultural attitudes towards epilepsy in Limousin (France), in Togo and in Benin (Africa)]. / Comparaison des représentations socioculturelles des épilepsies en Limousin (France), au Togo et au Bénin (Afrique).

Sociocultural attitudes continue to have a negative impact on management of epilepsy in many African countries and in a few advanced countries. The purpose of this study was to compare attitudes toward epilepsy in France and two African nations: Togo and Benin. A total of 305 epileptic patients over 18 years of age were interviewed using the same quantitative questionnaire about their beliefs, knowledge attitudes and practices regarding their disease. There were 77 patients from the Limousin region in France, 129 from the rural canton of Nadoba in Togo and 99 from the coastal province in Benin. The frequency of epileptic seizure during the last two years prior to the study was lower in France than in Togo and Benin. The number of people who believed in supernatural causes of epilepsy was higher in Togo and Benin whereas the number of people attributing the disease to social causes (e.g. death and stress) was higher in France. Few epileptic patients in France thought that the disease was contagious whereas many patients in both Togo and Benin still believed that the disease was contagious and that some foods were forbidden. More patients in France than in Togo and Benin were aware of the relationship of epilepsy with alcohol, drug abuse and cerebral injury. Epileptic patients in France were more likely to consult a physician and use medical drugs for the treatment of epilepsy than their counterparts in Togo and Benin. Epileptic patients in Togo often complained of social exclusion. Although sometimes contradictory, these findings support the idea that sociocultural attitudes should be taken into account in the management of the disease.

[Prevalence of HTLV-1 virus infection in Togo (Kozah prefecture and the University Hospital Center of Lomé]. / Prévalence de l'infection par le virus HTLV-1 au Togo (préfecture de la Kozah et CHU de Lomé).

The aim of this study was to determine the prevalence of Human T cell Leukaemia Virus Type 1 (HTLV1) in a representative population sample, in neurological and non-neurological patients hospitalised in the Lomé teaching hospital in order to study the clinical manifestations of this retrovirus. There was no statistical difference among the three groups concerning the prevalence of HTLV1 respectively (1.2%: 21/1717, 1.8%: 15/828 and 1.6%: 4/244). Spastic paraparesis was the only disease significantly linked to HTLV1 (15.5%: 9/58).

[Traditional tattoos with neurological diseases in Togo]. / Les scarifications traditionnelles chez les malades neurologiques au Togo.

In Africa, there are two types of health systems: the modern system and the traditional one. Traditional medicine attracts more patients, because it is more financially accessible and corresponds to cultural representations of disease in society. Traditional therapeutic tattoos are not well known by the conventional health system in West Africa, although they are commonly used by traditional healers. We report here our experience of these tattoos. We examined the skin of 36,000 patients in the neurological department of the teaching hospital of Lome from 1985 to 1995. We found three types of tattoos amongst patients. The first are tribal or social tattoos: they are large, homogeneous, located on exposed parts of the body and can be seen easily by others (fig 1: g, h, i), whilst therapeutic tattoos are slight and hidden under clothes and can also be repeated (heterogeneous). The second type of tattoo is one that reveals the patient's pathological history. The third is linked to the motive of consultation. Seventy-five per cent (75%) of patients had traditional therapeutic tattoos. Epilepsy tattoos are slim, located on the forehead (fig 1a); peripheral facial paralysis tattoos are found on the facial nerve (fig 1 b). In cases of peripheral neuropathy, tattoos are symmetrically distributed on hands and legs (fig 1 f). As for medullar compression, the highest tattoos correspond to the level of compression. Studying the localisation, age, and aim of tattoos brings to light their diagnostic, prognostic, and epidemiological interests. Skin can thus reveal itself to medical staff as an open, though coded, medical file. They need only to learn how to read it.

[Clinical and epidemiological aspects of traditional therapeutic scarification in epilepsy in Togo]. / Intérêts cliniques et épidémiologiques des scarifications thérapeutiques traditionnelles chez l'épileptique au Togo.

One of the major problems of epilepsy in Africa are its social implications. Prejudice against the disease is common and epileptics are marginalised. Epilepsy is concealed from all non-family members. The very pronunciation of the word "falling disease" (as epilepsy is called) is taboo, the disease being regarded as supernatural. This unfavourable context introduces considerable bias in hospital and population-based studies. Traditional doctors are consulted by patients especially when they have such a "supernatural" disease. Traditional scarifications are used for the treatment of epileptics in Togo. We examined the skin of 36,000 patients in the neurological department of Lomé's teaching hospital between 1985 and 1995 and conducted a similar, population-based study on about 20,000 inhabitants in the Kloto district of south-western Togo and on 10,000 inhabitants in the Tone district of northern Togo. Interviews with 40,000 traditional doctors revealed that forehead scarifications are characteristic of epilepsy treatment. More than 80% of epileptics have forehead scarifications. When the seizures are rare, scarifications are slim, short (1-3 mm), near the roots of hair on the forehead and concealed; but when they are frequent, known by many people, scarifications are large, long, visible on forehead, the patient showing the sign of his social sentence.. On the skin of epileptics in Togo, is written the diagnosis of his affection. It only needs to look at it.

[Sexual behavior, knowledge and attitudes to AIDS and sexually transmitted diseases of students at the University of Benin (Togo)]. / Comportements sexuels, connaissances et attitudes des étudiants de l'Université du Bénin (Togo) face au sida et aux maladies sexuellement transmissibles.

Many studies have shown that in Africa, particularly in Togo, the 20- to 29-year-old age group is the age group most frequently affected by AIDS. This age group accounts for 84% of the students of the University of Benin. We studied students, most of the age group thought to be most at risk, investigating sexual behavior, knowledge and attitudes to AIDS and sexually transmitted diseases (STDs). The level of knowledge about the problems of AIDS and STDs was similar for both sexes and for all ages and levels of education of the students. Students had a reasonable knowledge of AIDS, particularly concerning the transmission of HIV (88.6% of students aware), risk behavior (80.8%), AIDS treatment (57.0%) and more general information about HIV (49.4%). They were poorly informed about the transmission (42.9%) and complications (0.69%) of other STDs. Most students had positive attitudes towards HIV issues, particularly the use of preventive measures (3.41 in 5) and the acceptance of infected individuals (3.98 in 5). However, few had seriously considered that AIDS and STDs might impact on their own sex lives (1. 84 in 5) and some were even fatalistic concerning HIV infection. The students were highly sexually active, having intercourse a mean of 31 times per year. Their sexual behavior depended on age and sex. The 15- to 19-year-olds preferred occasional partners. They had sexual intercourse 1 to 3 times per month and used condoms 10 to 20% of the time. The 20- to 29-year-olds had multiple partners. They had sexual intercourse 3 to 5 times per month and used condoms more than 30% of the time. Students over the age of 30 had many partners in addition to their regular partner. They had sexual intercourse 5 to 10 times per month and used condoms 0 to 20% of the time. Significantly more women than men had high-risk sexual behavior (40. 5% of men claimed to regularly use condoms, versus only 22.7% of the women and 11.9% of the women accepted anal penetration versus only 8. 4% of men). The general assumption is that students, who have a high level of education, should be well informed concerning AIDS and STDs and should therefore have positive attitudes and responsible sexual behavior. This study demonstrates that the assumption bears no resemblance to reality. The students were aware of the way in which HIV is transmitted and of what construes risky behavior, but there was nonetheless a high frequency of high-risk behavior (e.g. multiple sexual partners, anal and oral sex, homosexuality, intravenous drug use). The behavior of the students was not significantly different from that of young people living on the streets of Lomé. There were significant relationships between knowledge and attitudes and between some types of sexual behavior and knowledge. However, there was no correlation between attitudes and behavior. The education of young people should focus on both the prevention of AIDS and STDs and on facing up to these diseases.

Peripheral facial paralysis (PFP) and HIV infection in Togo.

OBJECTIVES: The purpose of this study was to determine the seroprevalence of HIV in a group of 150 patients with PFP and to study the semiological and evolutive aspect of PFP in patients with or without HIV. MATERIAL AND METHODS: This semilongitudinal study was conducted during 6 years (1990-1995) at the Lomé teaching hospital. Patients consulting for PFP had the HIV test and regular controls. RESULTS: The HIV seroprevalence was 52%. The average age was 31.4+/-8.81 years There was no difference on clinical features between patients with or without HIV infection. Cerebrospinal fluid was normal in patients without HIV infection, but it showed pleiocytosis in patients with HIV infection (87.88%). Of the HIV carriers 14% presented a recurrence. A total of 26.32% of the patients screened in 1990 developed AIDS when followed up. CONCLUSION: Peripheral facial paralysis is frequently associated to HIV infection. An HIV test must be proposed to all patients with PFP in Africa.

[Huntington disease in a large family in southern Togo]. / La maladie de Huntington dans une vaste famille au sud du Togo.

We report the clinical manifestations and the family in a large family in Southern Togo in which Huntington's disease is known to exist for the past 6 generations. At present there are 8 patients in this family, 67 members descending from patients. This family study adds further information to our knowledge of Huntington's disease among black Africans.

[Cerebral toxoplasmosis in a hospital environment in Lomé (Togo)]. / Toxoplasmose cérébrale en milieu hospitalier a Lomé (Togo).

The authors report the clinical, serological and neuroradiological results of a study about 23 cases of cerebral toxoplasmosis in the Teaching Hospital of Lome. Response to antitoxoplasmic treatment was rapidly favourable with all patients. Cerebral toxoplasmosis was the inaugural manifestation of AIDS in 20 of the 23 patients.

Lack of association between peripheral neuropathy and HTLV-I infection in west Africa. Epidemiological, serological and nerve biopsy study.

Patients (n = 1166) with various neurological disorders hospitalized in Dakar, Abidjan, Lomé and Ouagadougou were examined prospectively over a 42-month period. Seropositivity for HTLV-I alone was found to be 1.8%, which is comparable to that estimated for the general population in Africa. Eighteen of the patients with TSP and only 5 with PN were HTLV-I positive, but co-infections were found in 30-40% of cases. Discrete and unspecific lesions were observed on light and electron microscopic examination of peripheral nerve biopsies from 11 patients. Since spastic paraparesis emerges as the disorder containing the largest number of HTLV-I-positive individuals, it may be premature to conclude that HTLV-I is a causal agent in PN. Nevertheless, their rarity and the frequency of retroviral co-infections distinguish these cases of African HTLV-I-associated myelopathy from comparable cases observed in other parts of the world.

[Pituitary abscess, treated by medication]. / Abcès hypophysaire traité médicalement.

Pituitary abscesses are rare. The case reported here concerns a 28-year old African. Gradual development of diplopia over 6 months was the first clinical manifestation. Three months later this development had reached a more severe and infectious context, with complete right ophthalmoplegia, meningitis and coma (GCS = 9). CT scan showed an image in favour of a pituitary abscess with suprasellar extension, associated with thrombophlebitis of the cavernous sinus. An antibiotic therapy consisting of cefotaxime and metronidazole administered for 1 month, and netilmicin for 15 days succeeded in controlling the infectious syndrome. This resulted in cure of visual disorders, reduction in size of the CT scan image and reconstruction of the pituitary sella which had been destroyed. The diagnosis of pituitary abscess should be made when confronted with an infectious syndrome (unexplained fever, repeated meningitis). CT does not recognize the nature of the hypophyseal mass it shows: necrosis of a pituitary adenoma, giant aneurysm or craniopharyngioma may mimic local infection. Surgery confirms the diagnosis and is regarded as the best treatment. The patient's life is threatened when meningitis is present, and the functional prognosis is poor when recovery from visual disorders is compromised due to late diagnosis. In this paper a comparative analysis of the clinical course of the disease and therapeutic data in our patient is presented and compared with other reported cases.