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.

RBD and hyposmia in Moroccan patients with a synucleinopathy: prevalence and the timing of occurrence in a large cohort

INTRODUCTION

Rapid Eye Movement Sleep Behavior Disorder (RBD) and hyposmia are common in synucleinopathies and they tend to occur in connection to the prodromal development of these disorders. In this study, we sought to determine the prevalence of RBD and hyposmia and the timeline of their occurrence in a large cohort of Moroccan patients.

METHODS

We recruited 774 consecutive patients with synucleinopathy and tauopathy at Ibn Rochd University Hospital of Casablanca. A group of 100 healthy controls was also recruited. We relied on a questionnaire to collect general characteristics and clinical data filled by the patient and his companion under the supervision of a qualified health professional.

RESULTS

The study included 697 patients with PD, 37 with DLB and 40 had a tauopathy disorder (PSP or CBD). The proportion of patients who have RBD was 52% in PD, 100% in DLB, 0% in tauopathies and 12% among healthy controls. Hyposmia symptom was found in 47% of patients with PD, 68% in patients with DLB, 0% in tauopathy patients and in 10% of healthy controls. Moreover, 46% of PD patients and 75% of DLB patients developed RBD during the prodromal phase. Meanwhile, hyposmia occurred in association with the prodromal phase among 67% of PD cases and 85% of DLB patients.

CONCLUSION

RBD and hyposmia are both prevalent among Moroccan patients with synucleinopathy and they occur frequently during the prodromal phase. Identifying these premotor signs will improve early and differential diagnosis and enhance our understanding of how a specific synucleinopathy progresses.

Alerte thrombolyse et la pandémie de la COVID-19 : quel impact ?

Introduction

La pandémie de COVID-19 est un terrible fléau mondial qui sévit depuis mars 2020 au Maroc le poussant à imposer le confinement dont nous évaluerons l’impact sur les alertes thrombolyses (AT).

Objectifs

Comparer le délai d’admission des AT une année avant et pendant la période COVID afin d’établir le rapport des bénéfices et dommages de la pandémie, avec étude de son évolution l’année suivante.

Patients et méthodes

Nous avons recensé toutes les AT lancées aux urgences neurologiques du CHU de Casablanca sur une période de deux années et neuf mois répartis en 3 phases :

– la première allant du mois de mars 2018 au mois de février 2020 ;

– la deuxième allant du mois de mars 2020 au mois de novembre 2021.

Résultats

Au total, 472 AT ont été colligés dont 241 pendant la période précédant la COVID, avec 65 thrombolyses soit 26,97 % contre 131 non thrombolysés (NT) soit 54,35 % et 45 fausses alertes (FA) soit 18,67 %. Pendant la deuxième période, dans les 231 AT recensées, 35 étaient thrombolysés soit 15,15 % contre 123 NT soit 53,24 % et 44 FA soit 19,04 %. Le délai moyen d’admission des patients dans la première phase était de 192 minutes soit 3 h 12 min et 181 minutes dans la seconde phase soit 3 h 1 minute.

Discussion

Le délai d’admission des patients est plus précoce pendant la période COVID. Du fait du confinement, l’absence de l’embouteillage, le regroupement familial expliquerait que les patients soient rapidement acheminés aux urgences avec un gain de 11 minutes en moyenne. Par contre, la diminution du nombre d’alertes s’expliquerait par la crainte de la COVID, le diagnostic à tort de la COVID et le retard occasionné par la désinfection des locaux.

Conclusion

Bien que les patients soient conduits dans les délais, à cette période, l’infection SARS-CoV semblait primer sur les autres pathologies avec un circuit de tri des malades établi qui aurait joué contre le concept Time is brain.

Unilateral pure trigeminal motor neuropathy and neurovascular conflict: More than a coincidence!

Sensory disturbances are usual manifestations of trigeminal neuropathy, but only a few cases of isolated unilateral pure trigeminal motor neuropathy were reported. We describe a rare case of a 65-year-old woman who presented with a 4-year history of progressive facial asymmetry and chewing weakness which was shown on imaging to be caused by unilateral atrophy of masticatory muscles, probably due to a neurovascular conflict between the third trigeminal branch and superior cerebellar vein. To the best of our knowledge, this probable association has never been described. We aimed through this article to describe the clinical presentation of this entity that clinicians might face in their daily practice and radiological aspect of it.

Aspirin withdrawal: A risk factor for ischemic stroke severity

INTRODUCTION

Acetylsalicylic acid (ASA) cessation, is suggestive of a rebound phenomenon laying the ground for ischemic stroke (IS) re-occurrence but nothing is known about its implication for IS severity (ISS). Thus, the aim of our study is to examine whether or not aspirin withdrawal is a risk factor for ISS.

PATIENTS AND METHODS

This study, recruited patients having presented an IS in the following 2 weeks of ASA withdrawal, matched with treatment free cases. ISS was evaluated in all patients at admission using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRS) at 3 months' follow-up.

FINDINGS

Fifty cases were included in this study and fifty, manually matched, controls. ISS analysis found that the case group had a more severe stroke at admission (mean NIHSS: 12.76 (±7.319) in cases vs 10.04 (±5.562) in controls, P=0.039), with ASA discontinuation judged as a risk factor directly related to ISS regardless of the underlying cardiovascular risk factors (using the multivariate analysis).

CONCLUSION

Our study's findings suggest that aspirin interruption over a 15-days period could result in a more severe IS in the acute phase. To our knowledge, no study has ever discussed this outcome, shedding the light on the pressing need for larger studies with various withdrawal periods to support these data.

No impact of confinement during COVID-19 pandemic on anxiety and depression in Parkinsonian patients

BACKGROUND

Governments around the world have imposed varied containment measures to curb the spread of the COVID-19 infection. The psychological impact could be highly negative in patients with neurologic condition like Parkinson's Disease (PD).

METHODS

We prospectively evaluated symptoms of depression and anxiety in 50 (26 females; mean age at 60.4) non demented Moroccan PD patients, using Hospital Anxiety and Depression Scale (HADS), at the beginning and after 6 weeks of a full confinement.

RESULTS

At the first evaluation, 28% of patients had depression while 32% had anxiety. After 6 weeks of confinement, some patients got worse and others got better scores but no significant statistical difference for both troubles was seen.

CONCLUSION

Our results show that there is no significant impact of 6 weeks of confinement on overall anxiety and depression scores. However, confinement could have an unexpected positive psychological impact on a significant number of PD patients.

Othello syndrome in Parkinson's disease: A diagnostic emergency of an underestimated condition

Othello syndrome (OS) is a type of delusional jealousy, characterized by the false absolute certainty of the infidelity of a partner. This syndrome is not uncommon in Parkinson's Disease (PD), appearing as side effect of Dopaminergic Agonists (DA) therapy. We analyze the observations of five patients with OS, diagnosed in a series of 250 consecutive PD patients during two years. All patients are men, with a particularly young age at onset of PD. The mean duration of DA therapy at OS onset was 3 years. One patient had hypersexuality and another had punding. Significant cognitive impairment was present in two patients. All patients were treated with DA: two with Pramipexol and three with Piribedil. At the time of the management of the OS, three patients had already divorced their spouse. It is imperative for clinicians to know this underestimated syndrome in order to identify it early and approach it adequately to avoid irreversible negative prejudice.

Assessment of eligibility for thrombolysis in acute ischaemic stroke patients in Morocco

Introduction

intravenous thrombolysis with recombinant tissue plasminogen activator (rTPA) is an approved treatment for acute ischaemic stroke (AIS). However, its use remains low. We aimed to assess the eligibility of thrombolysis for our patients with AIS before implementing this treatment method in our teaching hospital.

Methods

we conducted a prospective cross-sectional study in the emergency department of Casablanca University Hospital. We included every patient admitted for a stroke-related symptom. Delays between symptom-onset and admission and delays regarding the in-hospital evaluation of patients were recorded. Patients eligible for intravenous thrombolytic therapy were identified according to American Heart Association guidelines.

Results

in all, 463 patients were included. Only 8.42% of patients were eligible for thrombolysis; 74% of patients were ineligible because of an onset-to-thrombolysis delay longer than 4.5 hours. Mean onset-to-thrombolysis time was 27.2 hours. Patients were admitted with a mean delay of 24.9 hours. The in-hospital evaluation, from admission to computerized tomography (CT) interpretation, averaged 2.3 hours in length.

Conclusion

the percentage of patients eligible for thrombolysis remains very low in our structure. The majority would not have benefitted from the therapy because of an extra hospital delay far exceeding the recommended therapeutic window. To shorten our delays and increase the number of patients benefiting from thrombolysis, we must implement strategies aiming to improve the recognition, evaluation and management of patients from the general public to the neurovascular unit.