Profil epidemiologique de l’epilepsie chez des patients atteints de troubles du spectre de l’autisme: Etude de 45 cas a Dakar (Senegal)

Description: Troubles du spectre de l’autisme (TSA) et épilepsie peuvent coexister chez une même personne constituant des facteurs de mauvais pronostic bilatéraux. Objectif:  Décrire les éléments sociodémographiques de patients atteints de TSA et étudier les aspects clinico-paracliniques et évolutifs des épilepsies chez ces patients. Patients et Méthodes:  Etude transversale et descriptive au service pédopsychiatrique du CHNU Fann, avec analyse des dossiers, via un questionnaire standardisé, de tous les patients suivis entre Janvier 2004 et Septembre 2018 pour TSA avec ou sans épilepsie. Résultats:  Quarante-cinq patients avec TSA colligés, avec une fréquence de l’épilepsie de 37,8%. L’épilepsie avait débuté avant l’âge de 5 ans dans 94% des cas. Les crises étaient généralisées (58,8%), essentiellement motrices tonico-cloniques (80%), ou focales (35,3%), avec une fréquence de 2 crises/jour à 1 crise/semaine. L’EEG de veille et sommeil montrait des anomalies majoritairement frontales dans 60%, et centro-pariétales dans 26,6% des cas. L’imagerie cérébrale était normale dans 93,9% des cas, et les potentiels évoqués auditifs (PEA) normaux dans 87,2% des cas. La prise en charge était multidisciplinaire pour les TSA (neuropsychologique, psychomotrice, orthophonique) et médicale, essentiellement (82,4%) en monothérapie pour l’épilepsie. Les médicaments antiépileptiques utilisés étaient le valproate de sodium (58,8%) et le phénobarbital (17,6). Le niveau d’instruction était bas avec 40% de non-scolarisés et 55,6% au primaire. Seuls 6,7% étaient autonomes et 20 patients nécessitaient une aide quasi-constante. Conclusion: La prévalence de l’épilepsie chez les patients atteints de TSA varie suivant les études. Une prise en charge globale et multidisciplinaire de l’épilepsie et des TSA améliore les troubles de comportement.   English Title: Epidemiologic profile of epilepsy in patients with autism spectrum disorders: study of 45 cases in Dakar (Senegal) Description: Autism spectrum disorders (ASD) and epilepsy can coexist in the same person, which are factors of bilateral poor prognosis. Purpose: To describe the socio-demographic profile of ASD patients and to study the clinical, paraclinical and evolutive aspects of epilepsy among them. Patients and methods: We did a cross-sectional and descriptive study in the department of child psychiatry of Fann university hospital in Dakar. We analyzed patients’ files followed between January 2004 and September 2018 for autism’s spectrum disorders with or without epilepsy. We used a standardized survey with several items. Results: Forty-five patients with ASD were collected, with an epileptic frequency of 37.8%. Epilepsy had started before the age of 5 years in 94% of cases. Seizures were generalized (58.8%), mainly tonico-clonic (80%), or focal (35.3%), with a frequency of 2 seizures per day to 1 seizure per week. The awake and sleep EEG showed abnormalities mostly in frontal area in 60%, and centro-parietal in 26.6%. Brain imaging was normal in 93.9%, and auditory evoked potential (AEP) normal in 87.2%. Management was multidisciplinary for ASD (neuropsychological, psychomotor, speech therapy) and medical, mainly (82.4%) monotherapy for epilepsy. The main molecules were: sodium valproate (58.8%) and phenobarbital (17.6). The level of education was low with 40% of students out of school and 55.6% in primary school. Only 6.7% were self-reliant and 20 patients needed almost constant assistance. Conclusion: The prevalence of epilepsy in patients with ASD varies according to the studies. The global and multidisciplinary management of epilepsy and ASD improves behavioral disorders

Ischemic Stroke and Ruptured Mycotic Aneurysm, Two Complications of Infective Endocarditis in One Patient

The incidence of infective endocarditis is estimated to be around 30 cases per million inhabitants/year. It can be responsible for various neurological complications such as cerebral infarction, meningitis, cerebral abscesses, and cerebral hemorrhage due to ruptured mycotic aneurysms. Several germs have been incriminated in this condition including Staphylococcus, Streptococcus, and Enterococcus. We report the case of a 64-year-old patient who presented with an acute motor deficit of the left upper limb associated with dysarthria. MRI showed infarcts in both cerebral hemispheres, and the TOF sequence showed an amputation of M2. On transesophageal ultrasound, there was evidence of vegetations at the mitral valve. Blood culture isolated Streptococcus oralis. With antibiotic treatment, the evolution was marked by a stable apyrexia with regression of the dysarthria. Before her surgery, she suddenly developed aphasia with worsening of the motor deficit. CT scan showed a right fronto-parietal hematoma which was related to a ruptured cerebral aneurysm. She underwent endovascular embolisation and subsequent cardiac surgery