Drug-resistant epilepsy in Morocco: description, prevalence and predictive factors in Casablanca-Settat region

Drug-resistant epilepsy (DRE) affects about one-third of people with epilepsy (PWE). Our study aims to estimate the DRE prevalence and its predictive factors in Morocco. A cross-sectional study was conducted over 18 months. PWE with clinical diagnosis of epilepsy, and with an antiseizure treatment duration >12 months were examined in the neurology, neurosurgery, psychiatry, and pediatrics departments, of different sampled clinical sectors for the Casablanca-Settat region. Sociodemographic and clinical data were collected using a questionnaire during consultations. Antiseizure multi-therapy, a seizure freedom duration <12 months, compliance, and adequate posology were the determining factors for classifying DRE. Data were analyzed using Statistical Package for Social Sciences (SPSS) software, version 21.0. Statistical significance was set at p < 0.05 and logistic regression was performed to determine the predictive factors. In our sample of 446 PWE, the median age is 25 years (IQR: 11.75-44.00). The DRE estimated prevalence was 29.4 %. Pseudo-resistant epilepsy (PRE) was 18.0 %. Multivariate logistic regression analysis reports that single marital status (ORa = 1.94; CI95%: 1.02-3.71), comorbidities and concomitant affections (ORa = 2.14; CI95%: 1.27-3.59), structural etiology (ORa = 1.96; CI95%: 1.16-3.30), pre-ictal aura (ORa = 1.90; CI95%: 1.09-3.29), inter-ictal EEG abnormalities (ORa = 2.45; CI95%: 1.24-4.84) and allopathic treatment use (ORa = 2.10; CI95%: 1.30-3.39) are the predictive factors for DRE. We report an alarming DRE prevalence. Associated factors found may contribute to the prognosis and early management. PWE awareness, facilitating healthcare access and the development of epilepsy surgery are the key points to limit DRE in Morocco and prevent its various complications, especially for the pediatric population.

Scoliosis secondary to neglected Hemivertebra: A case report

INTRODUCTION AND IMPORTANCE

A hemivertebra is a congenital anomaly of the spine characterized by an incomplete vertebra resulting from a failure in the formation of the vertebral body. The significance of this article lies in the fact that early diagnosis of hemivertebra allows for personalized surgical treatment, which can enhance outcomes and prevent the development of spinal deformities and associated complications.

CASE PRESENTATION

We report on the case of a 17-year-old girl with scoliosis secondary to lumbar hemivertebra, where surgical management was very late due to parental negligence, which delayed diagnosis.

DISCUSSION

Multiple surgical procedures are currently used for hemivertebra excision. The approaches available can be globally anteroposterior or posterior alone. Late treatment of this type of deformity requires longer fusion, with a high risk of neurological complications. Early surgical intervention is therefore indicated to correct local deformities. Early correction of primary deformities helps avoid secondary changes.

CONCLUSION

Hemivertebrae represent an interesting group of congenital anomalies. Their presence can potentially disrupt the normal curvature of the spine. Antenatal ultrasound screening enables early diagnosis of congenital malformations. Early diagnosis of a hemivertebra allows early surgical management that is less aggressive than when the diagnosis is made late, during growth.

High expression of BTN3A1 is associated with clinical and immunological characteristics and predicts a poor prognosis in advanced human gliomas

Introduction

Gliomas represent the most prevalent and aggressive tumors within the central nervous system. Despite the current standard treatments, the median survival time for glioblastoma patients remains dismal, hovering around 14 months. While attempts have been made to inhibit the PD-1/PD-L1 and CTLA-4/CD80-CD86 axes through immunotherapy, the outcomes have yet to demonstrate significant efficacy. The immune checkpoint Butyrophilin 3A1 (BTN3A1) can either be involved in advantageous or detrimental function depending on the cancer type.

Methods

In our study, we utilized a Moroccan cohort to delve into the role of BTN3A1 in gliomas. A transcriptomic analysis was conducted on 34 patients, which was then corroborated through a protein analysis in 27 patients and validated using the TCGA database (n = 667).

Results

Our results revealed an elevated expression of BTN3A1 in glioblastoma (grade 4), as evidenced in both the TCGA database and our cohort of Moroccan glioma patients. Within the TCGA cohort, BTN3A1 expression was notably higher in patients with wild-type IDH. We observed a positive correlation between BTN3A1 expression and immune infiltration of B cells, CD8+ T cells, naive CD4+ T cells, and M2 macrophages. Patients exhibiting increased BTN3A1 expression also presented elevated levels of TGF-β, IL-10, and TIM-3 compared to those with reduced BTN3A1 expression. Notably, patients with high BTN3A1 expression were associated with a poorer prognosis than their counterparts with lower expression.

Conclussion

Our findings suggest that BTN3A1 might promote the establishment of an immunosuppressive microenvironment. Consequently, targeting BTN3A1 could offer novel therapeutic avenues for the management of advanced gliomas.

Prevalence and associated factors of psychiatric comorbidities in epilepsy in the Casablanca-Settat region of Morocco: A cross-sectional study

OBJECTIVE

To determine the estimated prevalence of anxiety, depression, and anxiety-depression syndrome (ADS) and to identify the associated factors in Moroccan people with epilepsy (PWE).

METHOD

A cross-sectional study was conducted among adult PWE (June 2021-December 2022) in the Casablanca-Settat region. PWE were interviewed by completing a questionnaire collecting sociodemographic and clinical data. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Out of 21 points, a score ≥8 is in favor of considerable anxiety/depression symptoms and a sum of the two scores ≥15 indicates the presence of ADS. Data were analyzed using Statistical Package for Social Sciences (SPSS) 21.0. p-values ≤0.05 were considered statistically significant and logistic regression was performed to determine the associated factors.

RESULTS

Among 294 PWE, the median age was 39 years (interquartile range [IQR]: 25.75-54.00). The median anxiety, depression, and ADS scores were 8 (IQR: 5.00-10.00), 7 (IQR: 4.00-10.00), and 15 (IQR: 10.00-20.00), respectively. Anxiety, depression, and ADS were revealed in 51.4%, 44.9%, and 51.0% of PWE, respectively. Depression was the only predictor for anxiety (aOR = 24.20; 95%CI: 12.45-47.01). Antiseizure polytherapy (aOR = 3.35; 95%CI: 1.72-6.54) and anxiety (aOR = 24.04; 95%CI: 12.12-47.67) were the factors associated with depression. The risk of ADS was increased by female gender (aOR = 2.83; 95%CI: 1.68-4.78), antiseizure polytherapy (aOR = 2.75; 95%CI: 1.62-4.65), structural epilepsy (aOR = 1.73; 95%CI: 1.01-2.94), and the presence of concomitant conditions with epilepsy (aOR = 1.96; 95%CI: 1.16-3.31).

SIGNIFICANCE

Our study reports high psychiatric comorbidity prevalence in epilepsy, which supports the bidirectional link hypothesis. Associated factors found are important in the prognosis and prevention.

PLAIN LANGUAGE SUMMARY

The neural mechanisms underlying epilepsy tend to expose PWE to psychiatric disorders. Our study aims to quantify the rate of psychiatric comorbidities and their predictive factors in Moroccan PWE. The estimated prevalences of significant symptoms of anxiety, depression, and ADS were 51.4%, 44.9%, and 51.0%, respectively. Depression was the predictor of anxiety. Antiseizure polymedication and anxiety were the associated factors with depression. The risk of SAD was increased by female gender, antiseizure polymedication, structural epilepsy, and concomitant diseases with epilepsy. Our results are important for considering the psychiatric aspect of PWE and improving their care and quality of life.

Antiseizure medication adherence and epilepsy surgery attitude in people with epilepsy in Morocco: A cross-sectional study

We determine the proportion of non-Antiseizure Medication Adherence (non-AMA) and refusal attitude towards Epilepsy Surgery (ES) and their associated factors in Moroccan People With Epilepsy (PWE). A cross-sectional study was conducted (December 2021-December 2022) among adult Moroccan PWE. PWE were interviewed for their reactions to AMA and the ES attitude. Their medical files were processed to complete their sociodemographic and clinical data. Data were analyzed by the Statistical Package for Social Sciences (SPSS) software 21.0. A Chi-square test was performed to compare variables and multivariate logistic regression was used to highlight associations. Statistical tests were considered significant at a p-value ≤ 0.05 for a Confidence Interval (CI) of 95 %. The median age of our sample (n = 294) was 38 years (IQR: 25.00-55.00). Non-AMA was noted in 24.5 % with indifference as the main reason (55.6 %). ES refusal was found in 33.3 %, attributed mostly to apprehension (61.2 %). In the multivariate analysis, male sex (aOR = 1.94; 95 %CI: 1.03-3.64) and the existence of a family history of epilepsy (aOR = 1.96; 95 %CI: 1.02-3.75) were the factors associated with the non-AMA, whereas the use of allopathic treatments (aOR = 2.32; 95 %CI: 1.20-4.51), exclusively focal or generalized (not combined) seizures (aOR = 2.66; 95 %CI: 1.36-5.21) and the combination of a generic with the originator ASM (aOR = 2.64; 95 %CI: 1.12-6.18) were the predictive factors with the ES refusal attitude. The proportions found of non-AMA and ES refusal were relatively low compared to other studies, which may indicate the effort that medical staff have devoted recently to raising awareness of the importance of PWE's therapeutic involvement.

En bloc vertebrectomy: A radical technique for spinal metastases but rarely used

INTRODUCTION AND IMPORTANCE

Total vertebrectomy En bloc by posterior approach is proposed for primary or secondary single-site malignant tumors of the spine to reduce local recurrence and increase patient survival. This type of surgery is gaining increasing recognition. However, it requires a high level of technical skill and knowledge of the anatomy, physiology and biomechanics of the spine.

CASE PRESENTATION

We present here a case of a patient with a single thoracic metastasis with neurological deficit treated by total vertebrectomy via the posterior approach, using a cage and pedicle screws in situ.

DISCUSSION

This surgery is technically demanding, and patient selection therefore requires careful preoperative evaluation.

CONCLUSION

The reproducibility of the En bloc vertebrectomy method documented in the literature is demonstrated and supported by our case.

Deep brain stimulation for movement disorders treatment in Africa: The current status, outcomes, and challenges

Movement disorders (MDs), a diverse group of neurological conditions characterized by abnormal and involuntary movements, have a profound impact on individuals, families, and healthcare systems. Deep Brain Stimulation (DBS) has emerged as a promising therapeutic intervention, offering relief from symptoms and improved quality of life. By implanting electrodes in specific brain regions and connecting them to a pulse generator, DBS modulates aberrant neural activity underlying these disorders. While DBS has gained recognition globally, its utilization in African countries remains limited. This comprehensive article presents the results of a literature review on the status of DBS therapy for MDs in Africa. The review assesses treatment outcomes, patient demographics, and challenges tied to implementing DBS in the African context. The findings reveal promising developments in DBS therapy across several African countries, particularly in treating Parkinson's disease and dystonia. However, challenges related to awareness, access to specialized care, and a scarcity of expertise still impede broader adoption. The article underscores the urgent need for collaborative efforts, policy changes, and increased training to expand the reach of DBS therapy, thus mitigating the burden of MDs on the African continent.

Knowledge, attitudes and practices towards epilepsy in morocco: A cross-sectional study

BACKGROUND

This study aims to assess knowledge, practices and attitudes of the general Moroccan population towards epilepsy and to highlight predictive factors.

METHOD

A cross-sectional study was conducted in the Casablanca-Settat Moroccan region. A questionnaire was used to collect sociodemographic data and item answers from 400 people with epilepsy (PWE) and without epilepsy caregivers on dependent variables: knowledge, attitudes, and practices towards epilepsy. Bivariate and logistic regression analyses were performed using IBM SPSS Statistics 21.0. Statistical significance was set when P value < 0.05.

RESULTS

The rates of poor knowledge, practices, and attitudes toward epilepsy were 11.5 %, 41 %, and 66.6 %, respectively. In the multivariate analysis, the risk of having poor knowledge about epilepsy was favored by lack of education (ORa = 4.31;CI95%:1.83-10.13;p = 0.001) and the absence of familiarity with epilepsy (ORa = 4.05;CI95%:1.92-8.54;p < 0.001). The risk of preferring allopathic practices to treat epilepsy was associated with lack of education (ORa = 2.21;CI95%:1.01-4.82;p = 0.046), residence in a city outside Casablanca (ORa = 2.33;CI95%:1.06-5.15;p = 0.035), age over 59 years (ORa = 2.50;CI95%:1.26-4.95; p = 0.008), residence in a rural areas (ORa = 4.41;CI95%:2.61-7.47;p < 0.001) and absence of familiarity with epilepsy (ORa = 4.08;CI95%:2.33-7.15;p < 0.001). Predictors of stigma towards epilepsy were female sex (ORa = 3.05;CI95%:2.04-4.56;p < 0.001) and the tendency to abandon anti-seizure medication for allopathic alternatives (ORa = 3.98;CI95%:2.21-7.17;p < 0.001), whereas advanced age was a protective factor (ORa = 0.57;CI95%:0.36-0.89;p = 0.014[39-59 years vs 18-29 years];ORa = 0.44;CI95%:0.23-0.82;p = 0.011[>59 years vs 18-29 years]).

CONCLUSIONS

The rate of poor attitudes and treatment-seeking behavior was high. This socio-cultural context certainly impacts the quality of life and care of Moroccan PWE. These results should be considered to raise awareness in the Moroccan population.

Bilateral symmetrical extradural hematoma in an older person: A case report

INTRODUCTION AND IMPORTANCE

The occurrence of bilateral extradural hematomas (EDH) is a rare consequence of craniocerebral trauma, and acute symmetrical bilateral epidural hematomas are extremely rare even more so in elderly subjects.

PRESENTATION OF THE CASE

We report the case of an 82-year-old patient who had fallen down a flight of stairs. Scalp examination was consistent with a bi-parietal subgaleal hematoma. Clinically, he was confused with a glascow score of 13/15. His brain scan showed bilateral and symmetrical parietal EDH with simple fractures of both parietal bones. The patient underwent a two-stage evacuation of the extra-dural hematomas.

CLINICAL DISCUSSION

The management of bilateral EDH cases requires careful planning, adequate exposure, judicious surgical approach and time management for good results.

CONCLUSION

To our knowledge, no case of bilateral hematoma in an elderly subject has been reported in the literature.

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.

Pediatric CHANCE fracture treated by lumbar lacing technique: a case report

This paper presents the case of an 7-year-old girl victim of a road accident. The neurological examination revealed a conscious patient without any sensory or motor deficit and she had intense lumbar pain. The lumbar computed tomography scan found a chance fracture at the level of L3. the patient was operated under general anaesthesia with a sublaminar lacing fixation of L2-L3 similar to the lacing of C1C2 in upper cervical trauma. The follow-up was good The control X-ray was satisfied with a complete reduction and restoration of the lumbar lordosis and the patient was discharged from the hospital on the fifth day following the intervention. this article shows that sublaminar lacing can be as effective as pedicle screw fixation, thus preserving bone growth.

Deep Brain Stimulation for Dystonia: Experience of a Moroccan University Hospital

BACKGROUND

Deep brain stimulation (DBS) is a well-established procedure that provides long-term symptom control of the third most common movement disorder: dystonia. In this study, we aim to report the experience of Ibn Rochd University Hospital in the treatment of dystonia using DBS of the globus pallidus internus, which represents an exceptional challenge for a developing country such as Morocco.

METHODS

Since 2013, we selected five eligible candidates for DBS surgery at the university hospital Ibn Rochd. A genetic assessment had been performed in four cases. Their motor and mental states were prospectively monitored using several validated scales, including Burke-Fahn-Marsden Dystonia Rating Scale, Mini Mental State Examination, 36-Item Short Form Survey, and Zarit scale.

RESULTS

Our sample had two clinical phenotypes of dystonia: isolated dystonia (in two patients) and combined dystonia (in three patients). Patients were aged 14 to 32 years, and their mean onset age ranged from 7 to 13 years with a mean progression duration of 9 years. Our results indicate successful treatment of patients with dystonia using DBS. Scores from the Burke-Fahn-Marsden Dystonia Rating Scale confirm improvements ranging from 40% to 95%. However, some potentially surgery-related complications could occur such as lead infection, which, in our experience, was reported in one case.

CONCLUSION

The experience of the university hospital Ibn Rochd regarding the use of DBS in treating dystonia was largely positive. However, the procedure faces challenges due to its complexity, specifically concerning its multidisciplinary nature, its genetic test costs, and the reluctance of pediatricians to get involved.

The immune checkpoint VISTA is associated with prognosis in patients with malignant uveal melanoma

Introduction

Uveal melanoma (UM) is a rare yet deadly tumor. It is known for its high metastatic potential, which makes it one of the most aggressive and lethal cancers. Recently, immune checkpoints such as Programmed cell Death protein-1 (PD1) and Cytotoxic T-Lymphocyte-Associated significantly increasing patient survival in multiple human cancers, especially cutaneous melanoma. However, patients with UMs were excluded from these studies because of their molecular characteristics, which tend to be widely different from those of cutaneous melanoma. This study aimed to analyze the expression of V domain Ig Suppressor T-cell Activation (VISTA), a novel immune checkpoint, to evaluate its prognosis significance and its correlation with PD1 and CTLA-4.

Methods

Evaluation of VISTA, CTLA-4, and PD1 expression was performed through TCGA database analysis and immunohistochemistry using two independent cohorts with primary malignant UM.

Results and discussion

Our results showed that VISTA expression was associated with tumor aggressiveness, T cell exhaustion, and the shortest median overall survival among patients. Surprisingly, PD1 protein expression was negative in all patients, whereas CTLA-4 expression was high in patients with advanced stages. Our findings suggest that VISTA may be a prognostic marker and an attractive treatment strategy for immunotherapy in patients with UM. Exploring its expression profile may predict response to immunotherapy and may lead to the improvement of precision therapy in malignant uveal melanoma patients.

NR2F6, a new immune checkpoint that acts as a potential biomarker of immunosuppression and contributes to poor clinical outcome in human glioma

Intoroduction

Nuclear receptor subfamily 2 group F member 6 (NR2F6) is a promising checkpoint target for cancer immunotherapy. However, there has been no investigation of NR2F6 in glioma. Our study systematically explored the clinical characteristics and biological functions of NR2F6 in gliomas.

Methods

We extracted RNA sequencing (RNA-seq) data of 663 glioma samples from The Cancer Genome Atlas (TCGA) as the training cohort and 325 samples from the Chinese Glioma Genome Atlas (CGGA) as the validation cohort. We also confirmed the NR2F6 gene expression feature in our own cohort of 60 glioma patients. R language and GraphPad Prism softwares were mainly used for statistical analysis and graphical work.

Results

We found that NR2F6 was significantly related to high tumor aggressiveness and poor outcomes for glioma patients. Functional enrichment analysis demonstrated that NR2F6 was associated with many biological processes that are related to glioma progression, such as angiogenesis, and with multiple immune-related functions. Moreover, NR2F6 was found to be significantly correlated with stromal and immune infiltration in gliomas. Subsequent analysis based on Gliomas single-cell sequencing datasets showed that NR2F6 was expressed in immune cells, tumor cells, and stromal cells. Mechanistically, results suggested that NR2F6 might act as a potential immunosuppression-mediated molecule in the glioma microenvironment through multiple ways, such as the recruitment of immunosuppressive cells, secretion of immunosuppressive cytokines, M2 polarization of macrophages, in addition to combining with other immune checkpoint inhibitors.

Conclusion

Our findings indicated that intracellular targeting of NR2F6 in both immune cells and tumor cells, as well as stromal cells, may represent a promising immunotherapeutic strategy for glioma. Stromal cells, may represent a promising immunotherapeutic strategy for glioma.

Glioblastoma simulating an arteriovenous malformation: a case report

Glioblastoma is the most common primary malignant brain tumor in adults. It is enhanced by the abnormal proliferation of central nervous system cells called astrocytes. Microvascular endothelial proliferation is one of the criteria for a histological diagnosis. Hypervascular glioblastoma simulating an arteriovenous malformation is an involuntary manifestation and constitutes a rare entity.

Case presentation

The authors report a case of a 44-year-old patient with no history followed. Symptoms began 6 months ago with the gradual onset of headaches without vomiting or seizures associated with a drop in normal visual acuity without neurological deficit. Cerebral imaging including cerebral angiography concluding with a right parieto-occipital cerebral process probably associated with an arteriovenous malformation.

Clinical discussion

The management was surgical by biopsy after a right parieto-occipital bone flap concluding in glioblastoma. The patient needs chemotherapy and radiotherapy sessions with good clinical evolution.

Conclusion

The coexistence of an arteriovenous malformation and glioblastoma remains an association whose pathophysiology still remains to be explored.

Vertebromedullary hydatidosis: a case report

The contamination of humans with the larval form of the tapeworm Echinococcus granulosus results in the parasitic disease known as hypatidosis. Even though hydatid disease is widespread in Maghreb nations, bone hydatidosis is still uncommon.

Case presentation

This article presents the case of a 12-year-old child with no particular pathological antecedent, who presents a spinal cord compression syndrome evolving gradually for 2 weeks whose objective clinical examination found a 2/5 paraparesis with a sharp pyramidal syndrome and subxiphoid sensory level. Medullary MRI has objectified an aspect of hydatid cysts at the level of D8 D9 and D10 compressing the spinal cord.

Clinical discussion

Management was surgical by decompression by laminectomy of stage D8, D9, and D10 under general anesthesia and put on albendazole, the diagnosis was confirmed by histopathological examination, the evolution was marked by a partial recovery of deficit.

Conclusions

Clinical symptomatology is vague with a gradually inescapable movement towards spinal or root pressure.

TMIGD2 as a potential therapeutic target in glioma patients

Introduction

Among all types of central nervous system cancers, glioma remains the most frequent primary brain tumor in adults. Despite significant advances in immunomodulatory therapies, notably immune checkpoint inhibitors, their effectiveness remains constrained due to glioma resistance. The discovery of TMIGD2 (Transmembrane and Immunoglobulin Domain Containing 2) as an immuno-stimulatory receptor, constitutively expressed on naive T cells and most natural killer (NK) cells, has emerged as an attractive immunotherapy target in a variety of cancers. The expression profile of TMIGD2 and its significance in the overall survival of glioma patients remains unknown.

Methods

In the present study, we first assessed TMIGD2 mRNA expression using the Cancer Genome Atlas (TCGA) glioma transcriptome dataset (667 patients), followed by validation with the Chinese Glioma Genome Atlas (CGGA) cohort (693 patients). Secondly, we examined TMIGD2 protein staining in a series of 25 paraffin-embedded blocks from Moroccan glioma patients. The statistical analysis was performed using GraphPad Prism 8 software.

Results

TMIGD2 expression was found to be significantly higher in astrocytoma, IDH-1 mutations, low-grade, and young glioma patients. TMIGD2 was expressed on immune cells and, surprisingly, on tumor cells of glioma patients. Interestingly, our study demonstrated that TMIGD2 expression was negatively correlated with angiogenesis, hypoxia, G2/M checkpoint, and epithelial to mesenchymal transition signaling pathways. We also demonstrated that dendritic cells, monocytes, NK cells, gd T cells, and naive CD8 T cell infiltration correlates positively with TMIGD2 expression. On the other hand, Mantel-Cox analysis demonstrated that increased expression of TMIGD2 in human gliomas is associated with good overall survival. Cox multivariable analysis revealed that TMIGD2 is an independent predictor of a good prognosis in glioma patients.

Discussion

Taken together, our results highlight the tight implication of TMIGD2 in glioma progression and show its promising therapeutic potential as a stimulatory target for immunotherapy.

A2AR as a Prognostic Marker and a Potential Immunotherapy Target in Human Glioma

Gliomas are considered one of the most malignant tumors in the body. The immune system has the ability to control the initiation and development of tumors, including gliomas. Thus, immune cells find themselves controlled by various molecular pathways, inhibiting their activation, such as the immunosuppressive adenosine 2A receptor (A2AR). Our objective was to establish the expression profile and role of A2AR at the transcriptomic level, using real-time RT-PCR in Moroccan glioma patients, in addition to TCGA and CGGA cohorts. The real-time RT-PCR results in Moroccan patients showed that high expression of this gene was associated with poor survival in males. Our study on the CGGA cohort corroborated these results. In addition, there was a positive association of A2AR with T-cell exhaustion genes. A2AR also correlated strongly with genes that are primarily enriched in focal adhesion and extracellular matrix interactions, inducing epithelial mesenchymal transition, angiogenesis, and glioma growth. However, in the TCGA cohort, the A2AR showed results that were different from the two previously examined cohorts. In fact, this gene was instead linked to a good prognosis in patients with the astrocytoma histological type. The correlation and enrichment results reinforced the prognostic role of A2AR in this TCGA cohort, in which its high expression was shown to be related to lymphocyte differentiation and a successful cytolytic response, suggesting a more efficient anti-tumor immune response. Correlations and differential analyses based on A2AR gene expression, to understand the cause of the association of this gene with two different prognoses (CGGA males and TCGA Astrocytoma), showed that the overexpression of A2AR in Chinese male patients could be associated with the overexpression of extracellular adenosine, which binds to A2AR to induce immunosuppression and consequently a poor prognosis. However, in the second group (TCGA astrocytomas), the overexpression of the gene could be associated with an adenosine deficiency, and therefore this receptor does not undergo activation. The absence of A2AR activation in these patients may have protected them from immunosuppression, which could reflect the good prognosis. A2AR can be considered a promising therapeutic target in male CGGA and Moroccan patients with gliomas.

Parkinson's disease research in Morocco: a review

Aim: To quantify and provide an overview on the scientific productivity made by Moroccan academics in the research on Parkinson's disease (PD) and parkinsonism. Materials & methods: Scientific articles, in either English or French, were gathered from published literature in three recognized databases: PubMed, ScienceDirect and Scopus. Results: We identified 95 published papers from which 39 articles have been extracted after removing inadequate publications and duplications between databases. All articles were published between 2006 and 2021. The selected articles were subdivided into five categories. Conclusion: The Moroccan academia is presently facing a low productivity issues and a lack of research laboratories focusing on PD research. We anticipate that providing more budgetary funds will significantly improve the productivity of PD research.

Primary dural lymphoma: Case report

Primary Dural lymphoma (PDL) is a rare pathology that occurs in immunocompetent patients. In such cases, these lesions may mimic more common intracranial tumors. We present the case of a patient who presented an intra cranial hypertension syndrome; the brain MRI showed a tissular mass that we took for a meningioma; upon surgical intervention, an occult mass was discovered. Major excision and immunohistochemistry demonstrated PDL. Our case report highlights the rarity of these pathology and the importance of combined surgery and medical treatment, as the latter can be treated with chemoradiation with good clinical outcomes.

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Primary dural lymphoma (PDL) is a rare pathology that occurs in immunocompetent patients.

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We present the case of a patient who presented an intra cranial hypertension syndrome; the brain MRI showed a tissular mass that we took for a meningioma; upon surgical intervention, an occult mass was discovered.

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Our case report highlights the rarity of these pathology and the importance of combined surgery and medical treatment.

Kernohan Woltman notch phenomenon caused by subdural chronic hematoma: Systematic review and an illustrative case

Kernohan Woltman Notch Phenomenon (KWNP) is caused by a supratentorial lesion pressing the contralateral cerebral peduncle against the free edge of the tentorium of the cerebellum. It is manifested by neurological signs of ipsilateral localization; cerebral MRI is the most sensitive examination for KWNP. Our patient is a 50-year-old woman, operated in 2011 for aortic and mitral valve replacement by mechanical prosthesis, under oral anticoagulant, consults for headaches evolving for 20 days without any notion of head trauma with installation of a progressively worsening left hemibody deficit. Glasgow coma scale was 14 (E3 V5 M6) with left anisocoria 4mm left/2mm right with left hemiplegia. CT shows a chronic left hemispheric subdural hematoma 13.5mm thick with subfalcorial and ipsilateral temporal involvement of the deficit. The cardiovascular examination as well as the biological assessment was unremarkable. The patient was operated on with a total recovery in 12 days, the anticoagulant is resumed on day 20 postoperatively, with close monitoring. KWNP may contribute to misdiagnosis in patients with bilateral corticospinal tract lesions, and anticoagulation poses a problem in stopping and restarting treatment due to the risk of bleeding on one side and thrombosis on the other side.

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This article presents a review of literature of Kernohan Woltman Notch Phenomenon due to a subdural chronic hematoma.

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The clinical examination revealed a hemiplegic motor deficit associated with consciousness disorders and the CT scan confirmed the diagnosis.

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The relationship between the hypersignal of the cerebral peduncle on MRI and the severity of the clinical picture as well as the delay in postoperative recovery.

Pediatric brain hydatid cyst about two cases: Case report

Cerebral hydatid cyst is rare (2%), and mainly affects children. We report 2 cases aged 5 years. The clinical symptomatology was dominated by intracranial hypertension syndrome and motor deficit in both cases. One patient presented a generalized tonic-clonic seizure, the second one presented a left central facial palsy. The diagnosis was made in both cases by brain CT scan and one patient underwent brain MRI. A radiological workup to look for extra-cerebral localization was performed for all patients, which was normal. The treatment was surgical for both patients (D'ARANA-INIGUEZ hydro pulsion technique) with simple after-effects. The postoperative CT scan showed a residual cavity. All our patients were put under antiparasitic treatment with Albendazole.

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Two cases of children with motor deficit of progressive onset associated with intracranial hypertension.

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The clinical examination revealed a hemiplegic motor deficit the CT scan as well as the cerebral MRI were carried out which was in favor of the diagnosis.

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Confirmation with intraoperatively with the delivery of this one using technique of ARANA-INIGUEZ, and by the parasitological examination which objectified Echinococcus granulosus.

Glioblastoma Following Treated Medulloblastoma After 29 Years in the Posterior Fossa: Case Report and Review of Literature

Glioblastoma multiforme (GBM) is a high-grade glioma that may be a rare complication of radiotherapy. We report a case of a patient who was treated for medulloblastoma (MB) of the posterior fossa at the age of 27 years. Twenty-nine years later, at the age of 56 years, he presented with a double-location tumor: supratentorial and in the posterior fossa. Imaging features of the supratentorial location were very suggestive of a meningioma. We operated on the posterior fossa location, which revealed a glioblastoma. Histologically, the tumor cells exhibited characteristics of both GBM and rhabdoid tumor cells. Literature reports of cases of GBM following MB at the same place are very rare, and presenting rhabdoid characteristics is even rarer. This is the first case of MB and GBM at ages 27 and 56 years, respectively. The double-location supratentorial probable meningioma and GBM of the posterior fossa 32 years after MB is the only case reported in the literature. What to do in this case remains a topic of debate, and there are no clear recommendations in the literature.

Simultaneous frontal and orbital abscess rare complications of otogenic origin: Case report and literature review

Otogenic frontal abscess is an uncommon location of otogenic abscess of the brain and constitutes less than 5%. And the orbital extension is even more exceptional. An 11-year-old child, presenting with a two-week-long history of an acute otitis badly treated. Admitted for headaches, fever, vomiting and left eyelid swelling. The preoperative CT scan revealed a left frontal epidural abscess associated to a sub-periosteal Abscess. The patient was operated on. A supraorbital incision through the eyebrows allowed the evacuation of the periorbital abscess and the cerebral empyema through a trephine hole. The patient received probabilistic intravenous antibiotic therapy with ceftriaxon, aminoglycoside and metronidazole. Then relay per os. Postoperative recovery was marked by disappearance of headaches at postoperative Day two and the periorbital edema at day six. The patient was discharged home at postoperative week four with oral antibiotic therapy. Three months postoperative months follow-up CT scan revealed a total radiological cleaning. Otogenic frontal abscess associated to orbital Abscess is extremely rare and should be considered in front of ophthalmological signs. The management is multidisciplinary, and the entry point treatment mustn't be forgotten.

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This paper presents an 11-year-old boy complaining presenting with a two-week-long history of an acute otitis badly treated. Admitted for headaches, fever, vomiting and left eyelid swelling. The neurological examination found a conscious child GCS scores were E4V5M6 with no deficit, and palpebral edema.

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The CT scan revealed a left frontal epidural abscess associated to a sub-periosteal Abscess. A supraorbital incision through the eyebrows allowed the evacuation of the periorbital abscess.

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Otogenic frontal abscess associated to orbital Abscess should be considered in front of ophthalmological signs. The management is multidisciplinary, and the entry point treatment mustn't be forgotten.