Phenotype and molecular characterization of Wilson's disease in Morocco.

BACKGROUND AND STUDY AIMS: In Morocco the prevalence of Wilson disease (WD) and the spectrum of mutations are not known. The aim of the present study was to estimate the prevalence of WD in Morocco, to evaluate the phenotype among a large cohort of WD patients, and to characterize ATP7B variants in a subgroup of WD patients. PATIENTS AND METHODS: We collected data from 226 patients admitted to five university hospital centers in Morocco between 2008 and 2020. The diagnosis was based on clinical manifestations, function tests and biochemical parameters. The genotype was characterized in 18 families diagnosed at the University Hospital Center of Marrakesh, by next generation sequencing. RESULTS: The mean annual prevalence in Morocco was 3.88 per 100,000 and the allele frequency was 0.15 %. Among the 226 patients included (121 males and 105 females), 196 were referred for a hepatic or neurological involvement and 30 were asymptomatic. The mean age at diagnosis was 13 ± 5.1 years (range: 5 - 42 years). Consanguinity was found in 63.3 % of patients. The mean duration of illness was 2.8 ± 1.9 years. Kayser-Fleischer rings were found in 131 (67.9 %) of 193 patients. Among the 196 symptomatic patients, 141/159 (88.7 %) had low serum ceruloplasmin (<0.2 g/L) and a high 24-hours urinary copper (>100 µg/day) was found in 173/182 (95.1 %) patients. The initial treatment was D-penicillamine in 207 patients, zinc acetate in five, zinc sulfate in five, and nine patients were not treated; 60/207 (29 %) patients have stopped treatment. A total of 72 patients died; the mortality rate was 31.9 %. Eight different ATP7B variants were identified among the 18 patients studied, of which two were novel (p.Cys1104Arg and p.Gln1277Hisfs*52), and six previously published (p.Gln289Ter, p.Cys305Ter, p.Thr1232Pro, p.Lys1020Arg, p.Glu583ArgfsTer25 and c.51+4A>T). All informative patients were homozygous for the disease-causing mutation. CONCLUSION: In Morocco, a high prevalence due to consanguinity and a high mortality rate due to the difficulty of diagnosis and lack of treatment were observed in WD patients. NGS sequencing identified new ATP7B variants in WD patients from Morocco.

The prevalence of headache in the adult population of Morocco: a cross-sectional population-based study.

BACKGROUND: The series of population-based studies conducted by the Global Campaign against Headache has, so far, included Pakistan and Saudi Arabia from the Eastern Mediterranean Region. The Maghreb countries of North Africa, also part of this Region, are geographically apart and culturally very different from these countries. Here we report a study in Morocco. METHODS: We applied the standardised methodology of Global Campaign studies, with cluster-randomized sampling in regions of Morocco selected to be representative of its diversities. In three of these regions, in accordance with this methodology, we made unannounced visits to randomly selected households and, from each, interviewed one randomly selected adult member (aged 18-65 years) using the HARDSHIP structured questionnaire translated into Moroccan Arabic and French. In a fourth region (Fès), because permission for such sampling was not given by the administrative authority, people were randomly stopped in streets and markets and, when willing, interviewed using the same questionnaire. This was a major protocol violation. RESULTS: We included 3,474 participants, 1,074 (41.7%) from Agadir, 1,079 (41.9%) from Marrakech, 422 (16.4%) from Tétouan and 899 from Fès. In a second protocol violation, interviewers failed to record the non-participating proportion. In the main analysis, excluding Fès, observed 1-year prevalence of any headache was 80.1% among females, 68.2% among males. Observed 1-day prevalence (headache yesterday) was 17.8%. After adjustment for age and gender, migraine prevalence was 30.8% (higher among females [aOR = 1.6]) and TTH prevalence 32.1% (lower among females [aOR = 0.8]). Headache on ≥ 15 days/month (H15+) was very common (10.5%), and in more than half of cases (5.9%) associated with acute medication overuse (on ≥ 15 days/month) and accordingly diagnosed as probable medication-overuse headache (pMOH). Both pMOH (aOR = 2.6) and other H15+ (aOR = 1.9) were more common among females. In the Fès sample, adjusted prevalences were similar, numerically but not significantly higher except for other H15+. CONCLUSIONS: While the 1-year prevalence of headache among adults in Morocco is similar to that of many other countries, migraine on the evidence here is at the upper end of the global range, but not outside it. H15 + and pMOH are very prevalent, contributing to the high one-day prevalence of headache.

Chronic Cephalalgia-Parkinsonism Complex Revealing a Meningioma in a Young Patient: A Case Report.

The emergence of parkinsonism in a patient with an intracranial meningioma is indeed an uncommon occurrence. Here, we detail the case of a patient experiencing parkinsonian syndrome for four years without any observable clinical improvement following medical treatment. A magnetic resonance imaging (MRI) of the brain revealed a left intracranial meningioma. The successful complete surgical removal of the tumor led to the resolution of parkinsonian syndrome. The extent of the neoplasm and the surrounding peritumoral edema could potentially exert significant pressure, thereby compromising perfusion in the basal ganglia region. This clinical case serves as an exemplar, emphasizing the criticality of identifying specific red flags that necessitate further clinical investigations in the context of parkinsonian syndrome.

Ameliorative effect of Ononis natrix against chronic lead poisoning in mice: neurobehavioral, biochemical, and histological study.

Lead (Pb) is one of the most common heavy metals with toxicological effects on many tissues in humans as well as animals. In order to counteract the toxic effects of this metal, the administration of synthetic or natural antioxidants is thus required. The aim of this study was to examine the beneficial effect of the aqueous extract of Ononis natrix (AEON) against lead acetate-induced damage from a behavioral, biochemical, and histological point of view. Forty-eight male mice were divided into four equal groups: Ctr (control); Pb (lead acetate 1g/l); Pb + On 100 mg/kg (lead acetate 1 g/l + AEON 100 mg/kg); Pb + On 500 mg/kg (lead acetate 1 g/l + AEON 500 mg/kg). AEON was administered orally from day 21 after the start of lead exposure up to the end of the experiment. The results revealed that lead induced behavioral disorders, increased serum levels of liver markers (AST, ALT, and bilirubin), as well as kidney markers (urea and creatinine). At the same time, levels of thiobarbituric acid reactive substances (TBARS) and glutathione peroxidase (GPx) increased significantly. Moreover, Pb caused structural changes in the liver and kidneys of Pb-exposed mice. However, AEON administration significantly improved all lead-induced brain, liver, and kidney dysfunctions. Our results suggest that AEON could be a source of molecules with therapeutic potential against brain, liver, and kidney abnormalities caused by lead exposure.

Artificial Intelligence and Multiple Sclerosis: Up-to-Date Review.

Multiple sclerosis (MS) remains a challenging neurological disorder for the clinician in terms of diagnosis and management. The growing integration of AI-based algorithms in healthcare offers a golden opportunity for clinicians and patients with MS. AI models are based on statistical analyses of large quantities of data from patients including "demographics, genetics, clinical and radiological presentation." These approaches are promising in the quest for greater diagnostic accuracy, tailored management plans, and better prognostication of disease. The use of AI in multiple sclerosis represents a paradigm shift in disease management. With ongoing advancements in AI technologies and the increasing availability of large-scale datasets, the potential for further innovation is immense. As AI continues to evolve, its integration into clinical practice will play a vital role in improving diagnostics, optimizing treatment strategies, and enhancing patient outcomes for MS. This review is about conducting a literature review to identify relevant studies on AI applications in MS. Only peer-reviewed studies published in the last four years have been selected. Data related to AI techniques, advancements, and implications are extracted. Through data analysis, key themes and tendencies are identified. The review presents a cohesive synthesis of the current state of AI and MS, highlighting potential implications and new advancements.

Prevalence of epilepsy in Morocco: A population-based study.

OBJECTIVE: In Morocco, there was a lack of data related to the epidemiology of epilepsy. This data serves as a useful basis for the development of any national intervention or action program against epilepsy in Morocco. Through this study, we aimed to estimate the active and lifetime prevalence of epilepsy in Morocco. METHODS: We collected data from eight out of 12 Moroccan regions in two steps: In the screening step, we first used a nationwide telephone diagnosis questionnaire and in the second stage, a team of physicians under the direction of an epileptologist conducted a confirmative survey for suspected cases. We fixed the confidence interval at α = 5% and the precision at 0.02. RESULTS: Up to 3184 responded positively to our invitation to participate in this study and were able to answer the questions of the first diagnostic questionnaire. In the diagnostic phase, physicians in neurology reinterviewed all 86 suspected cases using a confirmative diagnosis questionnaire, and 63 persons were confirmed as having lifetime epilepsy and 56 with active epilepsy. The mean age (Mean ± SD) of persons with epilepsy was 35.53 years (±21.36). The prevalence of lifetime and active epilepsy were 19.8 (19.6-20.0) and 17.6 (17.5-17.8) per 1000 (95% confidence interval), respectively. SIGNIFICANCE: This is the first study to estimate the active and lifetime prevalence of epilepsy in Morocco according to the international recommendations of the ILAE. The prevalence of lifetime and active epilepsy were 19.8 (15-24.6) and 17.6 (13.3-22.8) per 1000, respectively. We included both children and elderly subjects. The rates of active and lifetime population epilepsy prevalence in Morocco ranged between Asian and sub-Saharan Africa low- and middle-income countries.

Epilepsy awareness days, weeks, and months: Their roles in the fight against epilepsy and the intersectoral global action plan on epilepsy and other neurological disorders.

OBJECTIVES: This research sought to find out the epilepsy awareness days around the world and understand the nature and role of the days in the fight against epilepsy in relation to the Intersectoral Global Action Plan (IGAP) on epilepsy and other neurological disorders (2022-2031). METHODS: We conducted a review of journal articles. The databases that we searched were ProQuest Central, EBSCOhost Academic Search Complete, EBSCO Medline, PubMed Central, Wiley Online, Directory of Open Access Journals (DOAJ), African Journals Online (AJOL), and Google Scholar. We limited our search to papers of relevance to our subject published between January 2000 and January 2023. We searched 'epilepsy awareness day, week, or month'. From the databases, 13 articles met our inclusion criteria. We augmented our results with a search on Google of articles about epilepsy awareness day, week, or month. We also searched directly on the websites of epilepsy organizations. RESULTS: We found that epilepsy awareness days fall into these categories: global awareness days (n = 2), awareness months (n = 4), regional awareness weeks (n = 5), and regional awareness days (n = 1). Our search for national awareness days (n = 7) was not comprehensive, and this could be an area for future research. The literature shows that epilepsy awareness days could play a role in (1) reducing knowledge and treatment gaps, (2) increasing participation, (3) unlocking resources, and (4) necessitating policy change and increasing networking. The major role of these dedicated days in the IGAP is to accelerate awareness and advocacy for policy change and improved interventions. CONCLUSIONS: Epilepsy awareness days are bringing stakeholders together already, and IGAP initiatives could tap into this achievement to accelerate awareness in a cost effective, contextual and collaborative manner. This could be achieved by adopting themes that relate more directly to the IGAP goals. Another important strategy is to motivate countries that do not have national epilepsy days or regions that do not have a regional awareness days, to consider doing one within the confines of resources.

Secondary headache disorders in Turkey, the Middle East, Asia, and Africa: A cross-sectional, multicenter study.

BACKGROUND: This multicenter cross-sectional study aimed to determine the frequency and characteristics of secondary headaches in different geographic regions, including Turkey, the Middle East, Asia, and Africa. METHODS: Patients were admitted to the study on a particular day each week for five consecutive weeks between 1 April and 16 May 2022. Before the study, all researchers underwent a constructed briefing about the use and code of the ICHD-3 criteria. The study was conducted in two stages. In the first stage, data on secondary headaches were compared between the regions. In the second stage, the sub-diagnoses of secondary headaches were analyzed only in Turkey. RESULTS: A total of 4144 (30.0%) of the 13,794 patients reported headaches as the main symptoms at admission. A total of 422 patients were excluded from the study. In total, 1249 (33.4%) of 3722 patients were diagnosed as having secondary headaches (Turkey [n = 1039], Middle East [n = 80], Asia [n = 51], Africa [n = 79]). The frequency of secondary headaches (Turkey 33.6%, Africa 30.1%, Middle East 35.5%, Asia 35.4%) did not differ significantly between the regions (p > 0.05). The most common subtype of secondary headaches was headache attributed to substances or their withdrawal in all the studied regions. There was a female predominance in all regions, but it was lower in Africa than in Turkey. The severity and density of headaches differed significantly between the regions, with patients from Africa reporting milder pain than patients from other regions. In Turkey, the most common sub-diagnoses of secondary headaches were medication overuse headache, idiopathic intracranial hypertension, and cervicogenic headache. CONCLUSION: In the present study, one in three patients with a headache had a secondary headache. Headache attributed to substances or their withdrawal was the most common subtype of secondary headaches in all the studied regions. The female predominance of secondary headaches was lower in Africa than in Turkey. The severity and density of headaches differed significantly between regions, with patients from Africa reporting milder pain.

Morocco's Healthcare System: Achievements, Challenges, and Perspectives.

Despite progress in recent years, access to quality medical care remains a significant issue, particularly in rural areas. The unequal distribution of resources, inadequate funding, healthcare worker shortages, and the rise of non-communicable diseases pose substantial challenges. However, implementing universal health coverage and improving key health indicators demonstrate notable achievements. To further enhance the healthcare system, perspectives such as addressing resource disparities, increasing funding and the healthcare workforce, managing non-communicable diseases, embracing digital technologies, strengthening public healthcare, and focusing on prevention and health education are proposed. These perspectives offer a global vision for improving Morocco's healthcare system's efficiency, inclusiveness, and quality, ultimately ensuring equitable access to healthcare services for all citizens.

Severe acute polyradiculoneuritis revealing systemic lupus erythematosus: a case report.

Systemic Lupus Erythematosus (SLE) is a common disease with extremely heterogeneous neurological manifestations in its clinical expression. However, few cases have been reported in the last 50 years when the initial manifestation of SLE is Guillain-Barré syndrome (GBS). Our work highlights the importance of evoking SLE as a potential etiology in a patient presenting with acute polyradiculoneuritis. We report the case of a 41-year-old woman who presented with dyspnoea with a purely proxo-distal motor deficit in all four limbs with dermatological lesions such as generalized myxedema and alopecia. The clinical electrical and biological presentation confirms acute polyradiculoneuritis revealing systemic lupus erythematosus. The outcome was marked by clinical improvement, despite the severity of the clinical picture, after treatment with corticosteroid and cyclophosphamide boluses. In conclusion, neurological manifestations in lupus disease are common, whereas the form of acute polyradiculoneuropathy is very rare with a committed vital prognosis. Early diagnosis and management are essential.

International Delphi Consensus on the Management of AQP4-IgG+ NMOSD: Recommendations for Eculizumab, Inebilizumab, and Satralizumab.

BACKGROUND AND OBJECTIVES: Neuromyelitis optica spectrum disorder (NMOSD) is a rare debilitating autoimmune disease of the CNS. Three monoclonal antibodies were recently approved as maintenance therapies for aquaporin-4 immunoglobulin G (AQP4-IgG)-seropositive NMOSD (eculizumab, inebilizumab, and satralizumab), prompting the need to consider best practice therapeutic decision-making for this indication. Our objective was to develop validated statements for the management of AQP4-IgG-seropositive NMOSD, through an evidence-based Delphi consensus process, with a focus on recommendations for eculizumab, inebilizumab, and satralizumab. METHODS: We recruited an international panel of clinical experts in NMOSD and asked them to complete a questionnaire on NMOSD management. Panel members received a summary of evidence identified through a targeted literature review and provided free-text responses to the questionnaire based on both the data provided and their clinical experience. Responses were used to generate draft statements on NMOSD-related themes. Statements were voted on over a maximum of 3 rounds; participation in at least 1 of the first 2 rounds was mandatory. Panel members anonymously provided their level of agreement (6-point Likert scale) on each statement. Statements that failed to reach a predefined consensus threshold (≥67%) were revised based on feedback and then voted on in the next round. Final statements were those that met the consensus threshold (≥67%). RESULTS: The Delphi panel comprised 24 experts, who completed the Delphi process in November 2021 after 2 voting rounds. In round 1, 23/25 statements reached consensus and were accepted as final. The 2 statements that failed to reach consensus were revised. In round 2, both revised statements reached consensus. Twenty-five statements were agreed in total: 11 on initiation of or switching between eculizumab, inebilizumab, and satralizumab; 3 on monotherapy/combination therapy; 7 on safety and patient population considerations; 3 on biomarkers/patient-reported outcomes; and 1 on research gaps. DISCUSSION: An established consensus method was used to develop statements relevant to the management of AQP4-IgG-seropositive NMOSD. These international statements will be valuable for informing individualized therapeutic decision-making and could form the basis for standardized practice guidelines.

Epilepsy and stigma in Africa: Viewpoint of healthcare professionals and combat strategies.

Epilepsy is a major public health problem in developing countries where eighty percent (80%) of people with epilepsy (PWE) live. Stigma has psychological consequences as well as serious repercussions on patients' quality of life. This study assesses the perception of health professionals in Africa regarding the stigmatization of PWE. METHODOLOGY: This is a multicenter descriptive, cross-sectional study, from 1st August 2020 to 1st September 2021. Medical practitioners from African countries involved in the management of epilepsy and who agreed to fill out forms were included in the study. Sampling was nonrandom and based on respondent choice. The data were analyzed using the EPI INFO 7 software. RESULTS: A total of two hundred and twenty-nine (229) health workers from twenty-six (26) African countries participated in this survey. 24.89% of the respondents were specialists and 46.72% were neurologists. Ninety-one percent (91%) of practitioners felt that PWE were stigmatised. The main forms of stigma were isolation (68.56%), celibacy (60.70%), unemployment (53.28%), divorce (44.54%) and exclusion (37.99%)%). Community, school and family were recognized as the main places of stigmatization. The fight against this stigma was carried out mainly in hospitals and in isolation in 58.4% and 55.8% of cases, respectively. Only 0.4% of practitioners opted for mass awareness. CONCLUSION: PWE are victims of various forms of stigmatization, particularly in community settings. Measures aimed at raising awareness of the public are essential to reduce this stigma and improve patients' quality of life.

Telemedicine for Individuals with epilepsy: Recommendations from the International League Against Epilepsy Telemedicine Task Force.

Worldwide, People with Epilepsy (PWE) are confronted with several barriers to face-to-face consultations. These obstacles hamper appropriate clinical follow-up and also increase the treatment gap for Epilepsy. Telemedicine holds the potential to enhance management as follow-up visits for PWE are focused on more on clinical history and counselling rather than physical examination. Besides consultation, telemedicine can also be used for remote EEG diagnostics and tele-neuropsychology assessments. In this article, the Telemedicine Task Force of the International League Against Epilepsy (ILAE) outlines recommendations regarding optimal practice in utilizing in the management of individuals with epilepsy. We formulated recommendations for minimum technical requirements, preparing for the first tele-consultation and the specificities for follow-up consultations. Special considerations are necessary for specific populations, including paediatric patients, patients who are not conversant with tele-medicine and those with intellectual disability. Telemedicine for individuals with epilepsy should be vigorously promoted with the aim of improving the quality of care and ultimately reduce the wide clinician access related treatment gap across several regions of the globe.

Anti-MDA5 antibody-positive dermatomyositis with mild encephalopathy with reversible splenial lesion: a possible rare association?

Central nervous system (CNS) involvement in dermatomyositis (DM) is seldom observed. However, there are very rare case reports of CNS involvement with juvenile dermatomyositis. Encephalopathy in DM may occur for a number of reasons, such as cerebral vasculitis and hypoperfusion/hypertensive encephalopathy, but mostly as a consequence of immunosuppressant treatment. We report here for the first time the case of a patient with two rare diseases, namely anti-MDA5 antibody-positive dermatomyositis and mild encephalopathy with reversible splenial lesion (MERS).

Etiological profile of peripheral neuropathies in an academic hospital in southern Morocco.

Background: Peripheral neuropathies constitute a common complaint in general and neurology practice, and are a source of handicap to patients. Epidemiological data in the Middle East and North Africa region as well as in the African continent are sparse. Nevertheless, regional etiological profiles are crucial in navigating the diagnostic maze of neuropathies. This study outlines the etiological profile of peripheral neuropathies in an academic hospital in southern Morocco. Results: A total of 180 cases were recorded in a span of 8 years (22.5 cases per year). The mean age of patients was 42.35 years. Male gender was predominant (68.88%), with a sex ratio of 2.2. Motor symptoms were the most frequently reported (86.6%). The axonal form (40.56%) was the most frequently encountered electrophysiologic form. The most frequent etiologies in the study were diabetes (26.7%), acute polyradiculoneuropathy (26.1%) and amyotrophic lateral sclerosis (16.1%). Alcohol neuropathy was found in 2.2% of the cohort. No cause was found in 5% of cases. Outcome was mostly favorable under treatment, although 10 deaths due to acute polyradiculoneuropathy were recorded (mortality = 21.3%). Conclusions: Knowledge of the etiological profile of peripheral neuropathies should guide clinicians to an early diagnosis and aid in an adapted management of patients. Supplementary Information: The online version contains supplementary material available at 10.1186/s41983-022-00531-4.

The adaptation of the Object and Action Naming Battery into Moroccan Arabic: Norms for name agreement, frequency, imageability, visual complexity, and age of acquisition.

INTRODUCTION: The ability to name pictures has been investigated widely in healthy people and clinical populations. The Object and Action Naming Battery (OANB) is widely used for psycholinguistic research, aphasia research, and clinical practice. Normative databases for pictorial stimuli have been conducted in language processing studies to control for various psycholinguistic variables known to affect the availability of picture names. The present study provides Moroccan Arabic norms for name agreement, familiarity, imageability, visual complexity, and age of acquisition for 100 line drawings of actions and 162 line drawings of objects taken from Druks and Masterson. METHODS AND PROCEDURES: 160 healthy Moroccan Arabic-speaking individuals participated in this study. Name agreement values for the OANB items were collected from forty subjects, followed by collecting data for the psycholinguistic variables: spoken-word frequency, imageability, visual complexity, and age of acquisition from 120 participants. RESULTS: The Moroccan Arabic OANB (MA-OANB) comprises 70 objects and 60 action pictures. 77% of the nouns and 68% of the verbs obtained 100% target responses. A minimum of 93 percent name agreement was reached for the remaining items. Norms were also collected for the following psycholinguistic variables: spoken-word frequency, imageability, age of acquisition, and visual complexity. CONCLUSION: The stimuli can be used for various psycholinguistic investigations and also for assessment and therapeutic purposes in Morocco.

Cross-cultural adaptation of the Moroccan version of the Mini-Mental State Examination: A preliminary study.

INTRODUCTION: The Mini-Mental State Examination (MMSE) is widely used for dementia screening. The purpose of this study was twofold. First, to cross-culturally adapt the Moroccan Arabic version of MMSE (MA-MMSE) to screen dementia among literate and illiterate elderly Moroccans, and second to analyze its psychometric properties. METHODS: The MA-MMSE was administered to 80 elderly patients, 28 were females and 52 were males. Among all the participants, 22 showed evidence of dementia. Receiver Operator Characteristic (ROC), internal consistency, and test-retest reliability were investigated. The test-retest reliability was assessed by Spearman correlation analysis. Cronbach's α coefficients for internal consistency between total scores and subscores of the test were calculated. RESULTS: Areas under the ROC curve in literate and illiterate elderly Moroccans participants corresponded to 0.932 and 0.936, respectively. The cutoff point of 21/22 on the MA-MMSE in literate elderly had the highest sensitivity (85.7%), specificity (94.7%), and a positive likelihood ratio of (16.29%), whereas the cutoff point of 18/19 of the screening test in illiterate elderly yielded the highest sensitivity (92.9%), specificity (95.0%), and a positive likelihood ratio of (18.57%). The Cronbach's α values of the MA-MMSE for literate and illiterate elderly Moroccans were higher than 0.7. Thirty subjects were randomly selected for participation in the test-retest protocol. Participants were retested after an interval of 4-6 weeks. The test-retest reliability for total scores was significant 0.78 (p < 0.01). CONCLUSION: The findings provide preliminary evidence that the MA-MMSE is a feasible instrument for dementia screening.

Why does Africa have the lowest number of Neurologists and how to cover the Gap?

PURPOSE: Neurology is one of Africa's central and noble specialties due to the frequency of its related diseases. Through this study we: -1-described the status of neurologists in Africa in terms of numbers,-2-listed the reasons and discussed how to increase their number, and how to get the most benefit of them in healthcare coverage. METHODS: The distribution and number of neurologists in the African continent was acquired from many participants in different African countries using a survey sent between March 2020 and August 2020 by email. Further, data from the World health organization on the number of neurologists was added for the countries, from which we didn't receive answers by the survey. RESULTS: Surveys' answers were received from representatives of 50 (92%) of the 54 African nations. Authors suggest a ranking into four levels according to the number of neurologists per nation. Level A [more than 201 neurologists per country] included 2 nations. Level B [31 to 200 neurologists per country] included six nations. Level C [1 to 30 neurologists per country] including the majority of African countries (36 nations). Level D includes 10 nations without any neurologists. CONCLUSION: The need for reliable and competent neurologists with a sufficient number is considered as a crucial element to enhance the care of neurological diseases in Africa. For this, all African countries should establish new centers of excellence in neurology, by developing good south-south collaboration with supports from governmental and non-governmental institutions.