Spectrum of epilepsy - prevalence, impact, and treatment gap: an epidemiological study from Al-Quseir, Egypt.

BACKGROUND: Epidemiology continues to be an important research tool in the study of epilepsy and related disorders, providing a better understanding of the frequency, causes, and natural history of the disorder. OBJECTIVE: To estimate the prevalence of epilepsy in Al-Quseir, Red Sea Governorate, Egypt, and its magnitude of treatment gap. METHODS: The study was part of a door-to-door study, including every door, to screen all inhabitants in Al-Quseir (33,818 inhabitants) by three specialists of neurology and 15 female social workers (for demographic data collection) using a standardized screening questionnaire. All suspected cases were subjected to detailed history, clinical examination, and electroencephalogram. Neuroimaging studies and estimation of serum drug level were done in select cases if needed. RESULTS: The study revealed that the lifetime prevalence rate of epilepsy in Al-Quseir is 5.5/1,000, with the highest peak during early childhood, while that of active epilepsy is 3.3/1,000 population. The annual incidence rate is 48/100,000, and the age-specific incidence rate has a U-shaped pattern with two peaks of incidence in early infancy and elderly life. Localization-related epilepsy is the most frequently encountered type (58.8%). The treatment gap of epilepsy in Al-Quseir is 83.8%. CONCLUSION: The lifetime prevalence of epilepsy in Al-Quseir city, Red Sea Governorate, was 5.5/1000.

Prevalence of multiple sclerosis in Al Quseir city, Red Sea Governorate, Egypt.

BACKGROUND: Multiple sclerosis (MS) is a chronic and disabling disorder with considerable social effects and economic sequelae. It is one of the major causes of disability in young adults. OBJECTIVES: This study aimed at detecting the prevalence of MS among the population of Al Quseir city. METHODS: This study is a part of door-to-door survey of major neurological disorders that was conducted in Al Quseir city, Red Sea Governorate, Egypt. The sample size was 33,285 persons. The youngest patient was 17 years old. The number of people at and above 17 years of age was 21,827. They were screened by three neurologists. Then, the positive cases were subjected to meticulous clinical evaluation by three staff members of Department of Neurology, Assiut University Hospital, Egypt. Essential investigations were done. RESULTS: A total of three cases of MS were diagnosed with an age-specific prevalence ≥17 years of 13.7/100,000.

Cerebral palsy in Al-Quseir City, Egypt: prevalence, subtypes, and risk factors.

Cerebral palsy (CP) is the most frequent cause of motor handicap. The present door-to-door survey was conducted in Al-Quseir City, Egypt, to investigate the epidemiology of CP. All inhabitants were screened by three neurologists. Medical and neurological examinations were performed for all residents and suspected cases of CP were confirmed by meticulous neurological assessment, brain magnetic resonance imaging, electroencephalography, and testing with the Stanford-Binet Intelligence Scale. Forty-six of 12,788 children aged ≤18 years were found to have CP, yielding a childhood prevalence of 3.6 (95% confidence interval 1.48-2.59) per 1,000 live births. Five adults (aged 19-40 years) among 13,056 inhabitants had CP, giving an adult prevalence of 0.4 (95% confidence interval 0.04-0.72) per 1,000. The risk factors for CP identified in this study were premature birth, low birth weight, neonatal jaundice, neonatal seizures, and recurrent abortion in mothers of children with CP.

Prevalence of dementia in Al-Quseir city, Red Sea Governorate, Egypt.

Dementia is one of the most important public health problems as a result of the rapid increase in the number of elderly persons worldwide. Improvement of prevention strategies and caring for people with dementia should be undertaken. We performed a door-to-door study to screen all subjects aged 50 years and older (n=4,329 of 33,285 inhabitants) in Al-Quseir city. The screening was performed by 3 neuropsychiatrists, using a modified form of the Mini-Mental State Examination. Suspected cases were subjected to case ascertainment according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnostic criteria for dementia; full clinical assessment; psychometric assessment using Cognitive Abilities Screening Instruments, Hachinski Ischaemic Score, Instrumental Activities of Daily Living Scale and the Geriatric Depression Scale; neuroimaging (computed tomography and/or magnetic resonance imaging); and laboratory investigations for selected patients when indicated. The prevalence of dementia was 2.01% for participants aged 50 years or older and 3.83% for those aged 60 years or older. It increased steeply with increasing age to a maximum of 13.5% for those aged 80 years or older. Alzheimer's dementia (48.3%) was the most common subtype, followed by vascular dementia (36.8%), dementia resulting from general medical conditions (11.5%), and last, dementia resulting from multiple etiologies (3.4%).

Epidemiology of non-fatal cerebrovascular stroke and transient ischemic attacks in Al Quseir, Egypt.

BACKGROUND AND PURPOSE: Stroke is a medical emergency that can cause permanent neurological damage, complications, and disability. We aim to determine the epidemiology of non-fatal cerebrovascular stroke (CVS) and transient ischemic attacks (TIAs) in Al Quseir City, Red Sea, Egypt. METHODS: The total population (n=33,285) was screened through a door to door study by three specialists of neurology and 15 female social workers (for demographic data collection). All suspected stroke patients were subjected to a full clinical examination, computerized tomography (CT) and/or magnetic resonance imaging (MRI) of their brain, blood sugar, lipogram, serum uric acid, complete blood cells, blood urea, and serum creatinine, as well as evaluated by Barthel Index and Scandinavian Stroke Scale. Carotid doppler, echocardiography, and thyroid functions were done for selected cases. RESULTS: CVS was recorded among 130 patients out of 19,848 subjects aged 20 years and more, yielding a total prevalence of 6.55/1,000 population. From June 1, 2010 to May 31, 2011, 36 patients were recorded to have stroke within 1-year, yielding an incidence rate of 1.81/1,000. Prevalence and incidence rates were higher among males than females, and both indices increased steadily with advancing age to reach the highest prevalence (37.02/1,000) and incidence rate (9.5/1,000) among aged persons 60 years and more. CONCLUSION: The prevalence of non-fatal stroke in Al Quseir city (6.55/1,000) was at the lower range of that recorded in developing countries (5-10/1,000) and slightly higher than that recorded in industrialized countries (5/1,000 population). Ischemic stroke is the most common type of stroke. The prevalence of TIAs was 0.15/1,000.

Prevalence of trigeminal neuralgia in Al-Quseir city (Red sea Governorate), Egypt.

BACKGROUND: Trigeminal neuralgia or tic douloureux is sometimes described as the most excruciating pain known to humanity. OBJECTIVES: To estimate the prevalence of trigeminal neuralgia among the population of Al-Quseir city. METHODS: This study forms a part of door to door survey of major neurological disorders in Al-Quseir city, Red sea governorate, Egypt. The total population (33,285 persons) were screened through door to door (every door) by three specialists of Neurology and fifteen female social workers. Then, positive cases were subjected to clinical and neurological examination by other three staff members of neurology. Cases were identified as suffering from trigeminal neuralgia according to the diagnostic criteria of the International headache society (IHS). RESULTS: We identified 4 female patients out of 13,541 persons (aged 30 years and more) suffering from trigeminal neuralgia with age specific prevalence rate of 29.5/100,000. Co-morbid depression and hypertension were observed among the affected persons.

Prevalence of spinal cord disorders in Al-Quseir City, Red Sea Governorate, Egypt.

The knowledge of the prevalence of spinal cord disorders (SCD) is important to understand specific causes in each part of the worldand to allow to potentially adapt health care and public policy including law enforcement to the main causes. SCD have important personal, biopsychological, socio-economic, short-term and long-term consequences. An SCD is the underlying cause for 1 of every 40 patients admitted to a major trauma centre. The affected population consists primarily of young male adults. The aim of the present study was to determine the prevalence and cause of SCD in Al-Quseir City, using a door-to-door method. The total of inhabitants was 33,285 in Al-Quseir City screened by 3 specialists of neurology. Suspected cases were subjected to full clinical assessment and MRI or CT of the spine. The prevalence rate of SCD was 63/100,000 for the total population. Traumatic spinal cord injury had a prevalence of 18/100,000, while non-traumatic SCD was found in 45/100,000. Degenerative cervical disc prolapse was the most common aetiology of SCD with a prevalence rate of 27/100,000.

Epidemiological study and risk factors of stroke in Assiut Governorate, Egypt: community-based study.

BACKGROUND: Because there have been no epidemiological studies of stroke in Egypt, a community-based survey was conducted in the Assiut Governorate to estimate the prevalence and risk factors of stroke in our community. METHODS: A three-phase door-to-door study was performed in which 6,498 participants were chosen by random sampling from 7 districts in Assiut (first phase). Out of this sample, 578 dropped out leaving 3,066 males (51.8%) and 2,854 females (48.2%). There were 3,660 (61.8%) urban residents and 2,260 (38.2%) from the rural community. In the second phase participants were screened using the questionnaire for stroke, while the third phase involved medical evaluation of all suspected cases, with diagnosis of stroke confirmed by evaluation of CT scans. The Mini Mental State Examination and Hamilton Depression Scale were evaluated for each patient. RESULTS: 65 participants were identified as positive on the survey questionnaire, but only 57 patients were found to have stroke, giving a crude prevalence rate of 963/100,000 inhabitants with an age-adjusted local prevalence rate of 699.2/100,000 and an age-adjusted prevalence relative to the standard world population of 980.9/100,000. The prevalence among males was higher than females (1174/100,000 vs. 736/100,000) with a ratio 1.7:1. There was a significantly higher prevalence of ischemic (895/100,000) than hemorrhagic (68/100,000) stroke. Stroke prevalence was the same in rural and urban areas and in males and females. There was, however, a significantly higher prevalence in illiterate (2413/100,000) than literate participants (357/100,000). Forty-two patients (73.7%) had one or more risk factors for stroke, hypertension being the commonest (66%) and diabetes mellitus second (38.6%). Nine cases had poststroke dementia (15.8%) and 14 cases (24.6%) had mild depression. CONCLUSIONS: The overall prevalence rate of stroke is high, especially in older adults, men and illiterate individuals. A higher prevalence of ischemic than hemorrhagic stroke was recorded, with hypertension and diabetes mellitus being the commonest risk factors in our community.

A community based epidemiological study of epilepsy in Assiut Governorate/Egypt.

BACKGROUND: The aim of the study was to estimate the prevalence of different types of epilepsy and their possible risk factors in the region of the Assiut Governorate/Egypt. MATERIAL AND METHODS: A community based study with random sampling of 7 districts, involving 6498 inhabitants. Out of this sample, 578 dropped out leaving 3066 males (51.8%) and 2854 females (48.2%). There were 3660 (61.8%) urban residents and 2260 (38.2%) from the rural community. Patients were evaluated using a screening questionnaire for epilepsy, and then referred to the hospital to be re-evaluated by a qualified neurologist and with electroencephalography (EEG) and computed tomography of the brain (CT). RESULTS: Seventy-five cases were diagnosed with epilepsy giving an overall the crude lifetime prevalence rate (CPR) for epilepsy of 12.67/1000 (95% CI: 9.8-15.54). The active prevalence rate was 9.3/1000 and the incidence rate was 1.5/1000 (95% confidence interval: 0.53-2.51). Fifty-six cases (75%) had idiopathic epilepsy (CPR 9.5/1000). Symptomatic epilepsy was recorded in 19 (25%) cases (CPR 3.2/1000). Generalized seizures were more common (CPR 6.75/1000) than partial seizures (CPR 2.5/1000). The prevalence rate of partial seizures evolving to secondary generalization was 0.84/1000 while simple partial and complex partial seizures had CPR 1.4/1000 and 0.34/1000, respectively. The CPR of mixed seizures was 0.17/1000. Epilepsy was slightly but not significantly more common among males than females (CPR of 14.4 and 10.9 per 1000 population, respectively). The CPR was higher in rural than urban populations (17.7/1000, with 95% CI 12.2-23.18 and 9.56/1000, with 95% CI: 6.39-12.7, respectively) and in the illiterate group than the literate population (12.02/1000 and 9.94/1000, respectively). The highest prevalence rate was recorded in the early and late childhood period (69.78/100,000 and 43.78/100,000, respectively). Prenatal insults and infection represented major causes of symptomatic epilepsy. CONCLUSIONS: We found a high prevalence rate of epilepsy (comparable with that in other Arabic and European countries) in our community particularly among children and teenagers. Overall the prevalence was higher in the rural than in the urban population. A family history of epilepsy, prenatal insults, and infection represented major risk factors of symptomatic epilepsy.

A community-based epidemiological study of peripheral neuropathies in Assiut, Egypt.

BACKGROUND: There is very little published information about the prevalence, patterns, and predictors of peripheral neuropathies. The current study is a community-based survey was conducted in the Assiut Governorate to estimate their prevalence and clinical profile. MATERIAL AND METHODS: A door-to-door study was carried out on 42,223 persons from rural and urban communities in the Assiut Governorate, Egypt. There were 13,288 (31.5%) subjects from the urban and 28,935 (68·5%) from the rural area. All subjects filled in a questionnaire designed specifically for diagnosis of peripheral neuropathy. Positive cases were then given a complete medical and neurological examination, routine laboratory tests, neurophysiology, and neuroimaging (magnetic resonance). RESULTS: The crude prevalence rate (CPR) of peripheral neuropathy was 3181/100,000 inhabitants. There was a significantly higher prevalence in the rural compared with the urban population (3795 versus 1844/100,000) and in females than males (4473 versus 1943/100,000; P<0.001 for both). The most common type reported was entrapment neuropathy (736 cases with CPR of 1743/100,000), particularly carpal tunnel syndrome (1686/100,000). Diabetic neuropathy was the most common non-compressive neuropathy with a CPR of 649/100,000. Type II diabetes was recorded in 241 patients with a CPR of 571/100,000. Compressive radiculopathy had a crude prevalence of 358/100,000; traumatic and iatrogenic radiculopathy had a prevalence rate of 149/100,000. Less common conditions were: uremic neuropathy (21/100,000) hepatic neuropathy (14/100,000), Bell's palsy (28/100,000), Guillian-Barre' syndrome (12/100,000), chronic inflammatory demyelinating polyneuropathy (12/100,000), hereditary sensory motor neuropathy (12/100,000), and idiopathic neuropathy (92/100,000). CONCLUSION: The overall prevalence of peripheral neuropathies was high in comparison to other studies. Entrapment neuropathy, diabetic neuropathy, and spondylotic radiculopathy were the most common. Overall, the prevalence of peripheral neuropathy was higher in the rural than in the urban population.

Epidemiological study and clinical profile of Parkinson's disease in the Assiut Governorate, Egypt: a community-based study.

BACKGROUND: Few comprehensive epidemiological studies of the prevalence of Parkinson's disease (PD) have been undertaken in Arab countries, and none has been carried out in Egypt. A community-based survey was conducted in the Assiut Governorate to estimate the prevalence and clinical profile of PD. METHODS: A community-based study was carried out, with random sampling of 7 districts, involving 6,498 inhabitants. Out of this sample, 578 subjects dropped out, leaving 3,066 males (51.8%) and 2,854 females (48.2%). There were 3,660 urban residents (61.8%) and 2,260 (38.2%) from the rural community. Patients were evaluated using a screening questionnaire, the Unified Parkinson Disease Rating Scale and the Non-Motor Symptoms Scale for PD. RESULTS: Thirty-nine subjects were found to have parkinsonism, giving a crude prevalence rate of 659/100,000 inhabitants. Of these subjects, 33 were diagnosed with PD (21 males), with a mean age of 66.9 ± 8.4 years, a crude prevalence rate of 557/100,000 and an age-specific prevalence rate (≥50 years old) of 2,748/100,000. There were more males than females (3,395 vs. 1,989/100,000), but the difference was not significant. The highest age-specific prevalence rate was recorded among subjects 70-79 years old (7,263/100,000). There was a significantly higher prevalence among rural than urban inhabitants (973 vs. 301/100,000) and among illiterate than literate persons (1,103 vs. 280/100,000). The clinical profile of our patients was similar to that of other populations but was characterized by a high prevalence of mood/cognition dysfunction and gastrointestinal symptoms; there were few reported perceptual problems. CONCLUSION: The overall prevalence of PD was high, especially in older adults.

The effects of glucocorticoid therapy on the inflammatory and dendritic cells in muscular dystrophies.

Various clinical trials have documented the therapeutic benefit of glucocorticoids (GCs) in enhancing muscle strength and slowing disease progression of Duchenne and Becker muscular dystrophies (DMD/BMD). We hypothesized that GCs may have relevance to the differential anti-inflammatory effect on mononuclear inflammatory cells (MICs) and Dendritic cells (DCs) infiltrating the dystrophic muscles. In this prospective study, two muscle biopsies were obtained (before and after 6-month prednisone therapy) from 30 patients with dystrophies (DMD = 18; BMD = 6; and limb girdle muscular dystrophies (LGMD) = 6). MICs and DCs infiltrating the muscles were examined using mouse monoclonal antibodies and immunoperoxidase staining methods. Muscle strength was evaluated monthly by manual testing, motor ability and timed tests. Prednisone therapy was associated with: (i) functional improvement of overall motor disability, in upper limbs of DMD (P < 0.001) and BMD (P < 0.01) and lower limbs of DMD (P < 0.001) and BMD (P < 0.05); (ii) histological improvement such as fibre size variation (DMD, P < 0.01; BMD, P < 0.05), internalization of nuclei (DMD, P < 0.05), degeneration and necrosis (DMD and BMD, P < 0.01), regeneration (DMD, P < 0.001; BMD, P < 0.01) and endomysial connective tissue proliferation (DMD, P < 0.01; BMD, P < 0.05) and (iii) reduction of total MICs (P < 0.01) and DCs (P < 0.01). There was a positive correlation between the degree of improvement in overall motor disability and reduction of DCs numbers (In upper limbs; r = 0.638, P < 0.01 for DMD and r = 0.725, P < 0.01 for BMD, in Lower limbs; r = 0.547, P < 0.05 for DMD and r = 0.576, P < 0.05 for BMD). Such improvements and changes of MICs/DCs were absent in LGMD. In DMD/BMD, prednisone therapeutic effect was associated with reduced MICs and DCs numbers. Whether this therapeutic effect reflects targeting of the deleterious immune response produced by these cells mandates further investigations.

Serum thyroid hormone balance and lipid profile in patients with epilepsy.

PURPOSE: Patients with epilepsy may exhibit changes in thyroid hormone balance, lipids and lipoproteins concentrations. The suggestion that lipid abnormalities are associated with subclinical thyroid dysfunction remains controversial. The aim of this study was to analyze whether thyroid dysfunction encountered in patients with epilepsy would also be associated with abnormal lipid profile. METHODS: Eighty-eight patients with epilepsy and 30 control subjects were included in the study. A fasting blood sample for thyroid hormones, lipid profile and GGT determination was obtained. RESULTS: The serum levels of FT3 was elevated in 10.2% of patients, FT4 was low in 28.4%, TSH was high in 4.6% and low in 2.3%. 13.6% of patients had high TC, 17.1% had high LDL-c, 60.2% had marked reduction of HDL-c levels (P<0.0001) and only 2.3% had high TG levels. Abnormalities were predominated in CBZ-treated patients. 27.3% patients with abnormal hormones had abnormal lipid profile. Significant association was identified between the serum TC, LDL-c, TG, GGT and EIAEDs and between the duration of illness and TG (r=-0.411; P=0.017), and FT4 (r=-0.412; P=0.018). HDL was higher in women than men (r=0.416; P<0.002). However, changes in HDL-c levels associated neither with duration of illness, type or serum levels of AEDs nor with age or degree of control on AEDs. CONCLUSIONS: Our results support that (1) altered lipid metabolism might be associated but not solely influenced by thyroid hormones and (2) enzyme induction is not the main or only reason for altered thyroid function or HDL-c among patients with epilepsy. Hypothalamic/pituitary dysregulation by precisely mechanism caused by epilepsy itself or AEDs seems possible and (3) it is important to recognize that patients with epilepsy are at great risk for atherosclerosis, hence monitoring and correction of the culprit risks are mandatory.

Bayesian estimation of six different sets of carbamazepine pharmacokinetic parameters in Egyptian adult epileptic patients.

The individualization of carbamazepine (CBZ) dosage regimen based on estimation of pharmacokinetic (PK) parameters and measurement of serum drug concentration in epileptic patients can help to control epilepsy. In a retrospective study, the predictive performance of six different sets of CBZ PK parameters selected according to the literature was evaluated in 60 adult epileptic patients. Patients were administered controlled release CBZ (dose range: 200-1200 mg day(-1)) as monotherapy and one steady state serum concentration of the drug was available for each patient. The Bayesian Program of Abbott (PKS system; Abbott Laboratories, Wiesbaden, Germany) was used in the prediction process. Predictive measures included estimation of mean prediction error (mpe) for bias, mean squared prediction error (mspe) and root mean squared prediction error (rmspe) for precision. The analysis showed that three of the investigated six sets achieved the best predictive performance in Egyptian patients and consequently, the PK parameters of any of these three sets can be used by the Bayesian approach as prior information for CBZ dose optimization among the Egyptian adult population.