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J Epilepsy Res ; 10(1): 31-39, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32983953


Background and Purpose: The indication and benefit of plasma level of antiepileptic (AEDs) has been debating in the monitoring of people living with epilepsy and the epilepsy treatment gap has largely been documented in developed countries. This study was aimed to highlight the epilepsy treatment gap between rural and urban Mali. Methods: We conducted a pilot study on AEDs treatment from September 2016 to May 2019. For 6 months, 120 children and young adults living with epilepsy (rural site, 90; urban site, 30) received phenobarbital, valproic acid and/or carbamazepine. At our rural study site, we determined the AED plasma levels, monitored the frequency, severity and the duration of seizure, and administered monthly the McGill quality of life questionnaire. At our urban study site, each patient underwent an electroencephalogram and brain computed tomography scan without close monitoring. Results: At the rural study site, patients were mostly on monotherapy; AED levels at 1 month (M1) (n=90) and at 3 months (M3) (n=27) after inclusion were normal in 50% at M1 versus 55.6% at M3, low in 42.2% at M1 versus 33.3% at M3 and high in 7.8% at M1 versus 11.1% at M3. AED levels at M1 and at M3 were significantly different p<0.0001. By M3, seizures (n=90) were <1/month in 26.7%, and lasted less than 1 minute in 16.7%. After a yearlong follow up, all 90 patients reported a good or excellent quality of life. At our urban study site, patients (n=30) were on carbamazepine and valproid acid in 66.67% and monotherapy (carbamazepine) in 33.33%. By November 2018, only six out 30 patients (on bi-therapy) were still taking their medications. Conclusions: Epilepsy diagnostic and treatment are a real concern in Mali. Our data showed appropriate AED treatment with close follow up resulted in a better quality of life of patients in rural Mali. We will promote the approach of personalized medicine in AED treatment in Mali.

Pan Afr Med J ; 35: 117, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32637015


Serum protein electrophoresis is of certain diagnostic interest. We report a case of unusual electrophoresis associated with cholestatic jaundice complicating a cholangiocarcinoma. The study involved a 55-year old patient hospitalized for the exploration of cholestatic jaundice. Capillary electrophoresis showed bisalbuminemia diagnosed based on the thickening of the bottom of the albumin peak and a supernumerary peak X. Second electrophoresis with Hydragel showed the disappearance of the two above abnormalities which was the proof that bisalbuminemia was acquired and of the lipidic nature of the Pic X. In our case, the most likely cause was the presence of interfering substances such as free bilirubin (hyperbilirubinemia), lipids (hyperlipidaemia) and bile acids. Bisalbuminemia in a patient with similar electrophoretic picture should suggest the search for underlying diseases.

Neoplasias dos Ductos Biliares/diagnóstico , Colangiocarcinoma/diagnóstico , Albumina Sérica/análise , Eletroforese Capilar , Humanos , Masculino , Pessoa de Meia-Idade