The primary prevention of epilepsy: A report of the Prevention Task Force of the International League Against Epilepsy.

Among the causes of epilepsy are several that are currently preventable. In this review, we summarize the public health burden of epilepsy arising from such causes and suggest priorities for primary epilepsy prevention. We conducted a systematic review of published epidemiologic studies of epilepsy of 4 preventable etiologic categories-perinatal insults, traumatic brain injury (TBI), central nervous system (CNS) infection, and stroke. Applying consistent criteria, we assessed the quality of each study and extracted data on measures of risk from those with adequate quality ratings, summarizing findings across studies as medians and interquartile ranges. Among higher-quality population-based studies, the median prevalence of active epilepsy across all ages was 11.1 per 1000 population in lower- and middle-income countries (LMIC) and 7.0 per 1000 in high-income countries (HIC). Perinatal brain insults were the largest attributable fraction of preventable etiologies in children, with median estimated fractions of 17% in LMIC and 15% in HIC. Stroke was the most common preventable etiology among older adults with epilepsy, both in LMIC and in HIC, accounting for half or more of all new onset cases. TBI was the attributed cause in nearly 5% of epilepsy cases in HIC and LMIC. CNS infections were a more common attributed cause in LMIC, accounting for about 5% of all epilepsy cases. Among some rural LMIC communities, the median proportion of epilepsy cases attributable to endemic neurocysticercosis was 34%. A large proportion of the overall public health burden of epilepsy is attributable to preventable causes. The attributable fraction for perinatal causes, infections, TBI, and stroke in sum reaches nearly 25% in both LMIC and HIC. Public health interventions addressing maternal and child health care, immunizations, public sanitation, brain injury prevention, and stroke prevention have the potential to significantly reduce the burden of epilepsy.

[Epidemiological and socio-economic support patients living with epilepsy in Dakar, Senegal]. / Profil épidémiologique et prise en charge socioéconomique des patients vivant avec l'épilepsie à Dakar, Senegal.

BACKGROUND: Epilepsy remains a major public health problem especially in developing countries where access to new therapies remains limited. OBJECTIVE: The aim of this work was to study the socio-demographic profile of patients living with epilepsy in Dakar and supported. METHODS: We conducted a cross-sectional study over a period of eight months from November 2009 to June 2010 at Fann University Hospital and Health Center Pikine through research on adherence. RESULTS: The study involved patients living with epilepsy aged over 15 years, diagnosed clinically with epilepsy and/or confirmed by an electroencephalogram and put under antiepileptic drug for more than 3 months. We recruited 411 patients aged 15-74 years with a mean age of 28.93 years. The age range was 15-24 years with 44.6 % majority. The male sex predominated with 52.3 % and the sex ratio was 1.09. Singles outnumbered with 64.7 %. The level of education was the most representative secondary with 29.4 % and patients without profession were 35.5 %. Most of the patients was from semi-urban areas with 47.7 %. Generalized seizures were more frequent with about 70 %. Most of the patients was supported either by their family or by themselves. CONCLUSION: The management should be multisectoral for epilepsy out of darkness.

[Geriatrics and gerontology in Senegal]. / Gériatrie et gérontologie au Sénégal.

Senegal is dealing positively with its demographic transition. On September 1st 2006, the Senegalese government introduced the "Plan Sesame", a national free health care program for elderly people aged 60 years and over. The University of Dakar academic authorities support the Sesame plan through an innovative training program in geriatrics and gerontology. Such programs aim to address the challenge of ageing in a developing country.

Pre-hospital delay in patients with ischemic stroke in the Fann Teaching Hospital, Dakar, Senegal in 2020.

Introduction: stroke is a cerebrovascular disease. Early reperfusion in neurovascular units can reduce its morbidity and mortality. Even when neurovascular units exist, patients usually arrive late in the emergency department. to the purpose of this study was to determine prehospital delay in patients with acute ischemic stroke and associated factors. Methods: we conducted a retrospective cross-sectional study in the neurology department of the Fann University Hospital in Dakar from January 1s t to June 30th, 2020. We included patients younger than 80 years seen in the emergency unit for ischemic stroke. The median time to presentation was calculated based on the time of stroke onset and that of arrival at the hospital. Multivariate analysis was used to determine factors associated with prehospital delay. Results: a total of 56 patients were enrolled, among whom 58.6% arrived at the hospital in less than 3 hours. Of them, 37.5% presented to a level 3 or 4 hospital first. Less than 34% of our patient presented to a level 2-3 hospital in less than 3 hours. Based on bi- and multivariate analysis, being married (OR = 7.2 [CI à 95%: 1.5 - 35.8]), being a female (OR = 5.5 [CI à 95%: 1.5 - 19.8]) and having stroke during week days (OR = 4.3 [CI à 95%: 1.3-13.9]) were associated with prehospital delay. Conclusion: most of our patients arrived late at a level 2 or 3 hospital. Being a married woman increased the risk of late arrival. This study highlights the importance of improving awareness in order to increase the proportion of patients potentially eligible for revascularization.

Neuromyelitis optica spectrum disorders (NMO-SD) in a Sub-Saharan Africa country: A preliminary study of sixteen Senegalese cases.

BACKGROUND: Neuromyelitis optica (NMO) is an autoimmune disease of the central nervous system. In Sub-Saharan Africa, publications are rare and deal with isolated cases. Our goal was to analyze the characteristics of NMO spectrum disorders in a Senegalese cohort compiled in Dakar. PATIENTS AND METHOD: This was a retrospective descriptive study conducted at the Neurology Department of Fann Teaching Hospital. We included all patients with NMO-SD according to the 2014 diagnostic criteria. RESULTS: Sixteen patients were enrolled, 4 men and 12 women with an average age of 30 years. Ten patients (62.5%) presented an acute myelopathy associated with retrobulbar optic neuritis and 5 (31.25%) had isolated spinal cord injury. Spinal MRI showed abnormal cervical (6 patients), dorsal (4 patients), bulbar-cervical (3 patients) or cervico-dorsal (2 patients) signal extended (≥3 vertebral segments) of the spinal cord. Visual evoked potentials (VEP) showed demyelinating optic nerve involvement in 8 patients. Ten patients were positive to AQP-4 IgG. Systemic corticosteroid therapy was the rule in all patients, associated with azathioprine in 10 of them. The clinical course at 3 months was predominantly favourable (10 patients). CONCLUSION: This cohort is the first one compiled in Dakar. African multicentric epidemiological studies are needed.

Metastatic Spinal Cord Compression Secondary to Liver Cancer.

Metastatic spinal cord compression (MSCC) is a medical emergency that requires rapid diagnosis and treatment to reduce pain, to preserve neurological functioning, and to prolong survival. The diagnosis of liver cancer is often neglected in the differential diagnosis of MSCC. Treatment is usually palliative and evolution is often fatal. This is a case report of a 28-year-old patient living in Mauritania hospitalized in November 2014 at the neurology department of Fann national teaching hospital in Dakar, for the management of a chronic dorsal spinal cord compression. The radiological and laboratory investigations done revealed the metastatic compression originating from a liver cancer with elevated alpha-fetoprotein and aspartate transaminase, positive hepatitis B surface antigen, and multiple metastasis in the lungs, mediastinum, ribs, iliac, and peritoneum. The hip joint X-ray showed a spontaneous fracture of the right femoral neck. The multidisciplinary treatment was palliative and the evolution was fatal within the month of hospitalization. Earlier diagnosis and treatment of MSCC may not have saved the life of the patient but may have prevented much suffering and would likely have prolonged the life of a young man.

Late onset epilepsy associated with marijuana abuse: a case report with MRI findings.

Marijuana is the most widely used illicit substance in the world. The relation between marijuana use and epileptic seizures is still controversial. We report a case of late onset epilepsy associated with marijuana abuse, with brain magnetic resonance imaging (MRI) findings. A 44-year-old patient was admitted for 03 isolated episodes of secondary generalized tonic-clonic seizures. He had a history of 26 years regular marijuana smoking. On admission, we found a tachycardia, psychomotor slowing, asymmetric hyperreflexia, bilateral Babinski sign without weakness. Laboratory work-up showed a high level of urine of Δ-9-tétrahydroxycannabinol. Electroencephalogram was normal. Brain MRI revealed abnormal signal intensities in the right frontal lobe and basal ganglia. Seizures cessation was obtained with anti-epileptic treatment. We suggest that marijuana abuse through vascular and toxic mechanisms could explain seizures in this case.

Echocardiographic screening for rheumatic heart disease: age matters.

BACKGROUND: Echocardiography is emerging as a screening tool for rheumatic heart disease (RHD) in endemic regions. The vast majority of surveys have been limited to children. We ought to appreciate the interest of including adolescents in their late teens in such school screening programmes. METHODS: School-based echocardiography cross-sectional survey conducted in Dakar, Senegal (March 2010). A total of 2004 school attendees were randomly selected and enrolled in the study, among which 1116 were aged 5-15 years old (group 1), and 888 were 16-18 years old (group 2). Case detection rates and phenotype of RHD were compared according to age groups. RESULTS: A total of 22 youngsters were suspected by on-site echocardiography, 12 in group 1 and 10 in group 2. Among the 12 RHD cases suspected on-site in group 1, 6 (50%) were eventually considered as confirmed RHD, compared to 9 out of 10 (90%) in group 2, giving prevalence rates of 5.4 (CI 95% 2.0-11.7) and 10.1 (CI 95% 4.6-19.2) per 1000 in group 1 and group 2, respectively. The proportion of marked/advanced lesions was 33% in group 1, and 89% in group 2 (p=0.08). Mean concordance rates between the 3 reviewers were 40% for group 1, compared to 93% in group 2 (p=0.05). CONCLUSIONS: Extension of screening to adolescents in their late teens should be considered with interest in the light of the higher prevalence of the disease and relative clarity of subclinical cardiac lesions that could be more easily detected in the field.

[Estimate of the prevalence of cognitive impairment in an elderly population of the health center of Senegalese national retirement institution]. / Estimation de la prévalence du déficit cognitif dans une population de personnes âgées sénégalaises du Centre médico-social et universitaire de l'Institution de prévoyance retraite du Sénégal.

OBJECTIVE: To assess the prevalence of cognitive impairment in a Senegalese elderly population, of the Sociohealth and university center of Senegalese national retirement institution, Dakar, Senegal. METHODOLOGY: A cross sectional study was conducted in 872 Senegalese elderly population aged 55 years and over utilizing the Sociohealth and university center of IPRES, Dakar, Senegal for health care. Sociodemographic, lifestyles, physical activity, medical history, familial history of dementia data were collected with a structured questionnaire completed with a clinical exam and neuropsychological testing. Cognitive impairment was defined as a score of 28 or less with the test of Senegal. RESULTS: Ninety four subjects (10.8%; 95% CI 8,7-12,9) had cognitive impairment. Mean age was 67.2 years (±7.5 years), 63% were men, 79% were married, and half of them knew how to read and write. Hypertension, arthritis and gastro-intestinal diseases were the main health conditions reported. Prevalence of cognitive impairment varied with age and education. CONCLUSION: Prevalence of cognitive decline in the Sociohealth and university center of IPRES, Dakar, Senegal, is higher and varied with age and education.

Facteurs de risque de démence dans une population de personnes âgées sénégalaise

Description La démence est devenue un problème de santé publique. Dans le but d'une prévention, il est important de connaitre son épidémiologie au Sénégal. L'objectif de cette étude était d'identifier les facteurs de risque de démence dans une population de personnes âgées sénégalaises. Méthodes Une étude transversale a été réalisée du 01 Mars 2004 au 31 Décembre 2005 auprès d'une population de 872 personnes âgées de 55ans et plus utilisant le Centre Médicosocial et Universitaire de l'Institut de Prévoyance Retraite du Sénégal pour des soins. Par une étude en deux phases, des données sociodémographiques, sur le mode de vie, le réseau social, les antécédents ont été collectées à l'aide d'un questionnaire structuré complété par un examen clinique et une évaluation neuropsychologique. Le diagnostic de démence reposait sur des critères DSM IV-R

Prevalence de la demence dans une population de personnes agees senegalaises

Description Avec le vieillissement de la population, survient la démence dans la population de personnes âgées. Objectif. L'objectif de cette étude était d'estimer la prévalence de cette affection dans une population de personnes âgées sénégalaises. Méthodes Par une étude transversale qui s'est déroulée du 01 mars 2004 au 31 décembre 2005, des personnes âgées de 55 ans et plus venant consulter pour un problème de santé au Centre Médico-Social et Universitaire de l'IPRES (Sénégal) ont été évaluées sur le plan clinique et neuropsychologique. Des données sur les caractéristiques sociodémographiques, les antécédents médico-chirurgicaux et familiaux, le mode de vie, le réseau social ont été collectées à l'aide d'un questionnaire structuré avec des réponses fermées. Résultat La population à l'étude était composée de 872 personnes. Elles avaient un âge moyen de 67,2 ans ± 7,5. Elles étaient de sexe masculin (62,6%), mariées (79%), non instruites (50,7%). Dans les antécédents, l'HTA, le diabète, les affections respiratoires, les affections rhumatismales, la cataracte et les troubles digestifs étaient les plus fréquents. Le tabagisme et l'alcoolisme était faible alors que la marche constituait la principale activité physique. Les personnes âgées vivaient en famille avec un bon réseau social.Cinquante huit (58) personnes ont présenté une démence (6,6%). La prévalence de la maladie variait de manière significative avec l'âge et l'instruction. Conclusion Ce résultat confirme que la prévalence de la démence varie en fonction de l'âge et de l'instruction de la personne âgée