Acute hypersomnia due to valproate based treatment: A case report

The onset of hypersomnia following a valproic acid based treatment is usually suggestive of a valproate-induced hyperammonemic encephalopathy. This condition is a rare complication that presents itself clinically with altered consciousness, lethargy, neurological deficits and cognitive impairment. Its diagnosis is based on the clinical manifestations, screening for high blood ammonia levels, and characterized electroencephalography (EEG) anomalies of encephalopathy. Management consists essentially of withdrawing valproate intake. Here we describe a clinical case of acute hypersomnia due to valproate-induced hyperammonemic encephalopathy

L’épilepsie dans la région de Fès-Boulmane, Suivi prospectif d’une cohorte de 60 patients

Purpose of the study Determine the clinical, therapeutic, paraclinical and progression of the disease in Fes-Boulmane epileptic population and consequently improve the quality of care provided for those patients with epilepsy. Methods Prospective study conducted over 12 months from January to December 2011 in the Department of Neurology, University Hospital of Fez, which involved patients aged over 12 years admitted through the epilepsy consultation. Patient data were collected with a record specially dedicated for epilepsy consultants. Results The average age of our population was 32 years, 56% are under the age of 30 years. The age of the first seizure was less than 20 years at 75% of our patients. Generalized epilepsy was found in 40% of patients and partial epilepsy in 42% and 18% are unclassifiable epilepsy. In 30% of cases, the epilepsy was due to a lesion. Ten percent (10%) of our patients had drug resistant epilepsy. A case of drugresistant epilepsy in relation to hippocampal sclerosis had an epilepsy surgery with good outcome. Conclusion Clinical features, aetiology and progression of the disease in epileptic patients of our region resemble data reported in developing countries. This is a very young population with a delay and a lack of significant support. In this paper we discuss the problems of management of epilepsy and control measures against these problems.Objectif de l’étude Déterminer le profil clinique, thérapeutique, paraclinique et évolutif de la maladie épileptique dans la population de Fès-Boulmane et par conséquent améliorer la qualité de la prise en charge prodiguée aux patients épileptiques. Méthodes Etude prospective menée sur 12 mois allant de Janvier au Décembre 2011 dans le service de neurologie du centre hospitalier universitaire (CHU) Hassan II de Fès, qui a intéressé les patients âgés de plus de 12 ans, admis par le biais de la consultation d’épilepsie. Les données des patients ont été recueillies grâce à une fiche préétablie spécialement dédiée aux consultants épileptiques. Résultats L’âge moyen de notre population était de 32 ans, dont 56% sont âgés de moins de 30 ans. L’âge de la première crise était de moins de 20 ans chez 75% de nos patients. L’épilepsie généralisée est retrouvée chez 40% des patients, et l’épilepsie partielle chez 42%, et 18% sont des épilepsies inclassables. Dans 30% des cas, l’épilepsie était lésionnelle. Dix pour cent (10%) de nos patients présentaient une épilepsie pharmacorésistante. Un cas d’épilepsie pharmaco-résistante en rapport avec une sclérose hippocampique a eu une chirurgie d’épilepsie avec bonne évolution. Conclusion Les caractéristiques cliniques, étiologiques et évolutives de la maladie épileptique dans notre région ressemblent aux données rapportées dans les pays en voie de développement. Il s’agit d’une population très jeune souffrant d’un retard et d’un manque importants de prise en charge. Dans cette étude nous discutons les problèmes de prise en charge de l’épilepsie et les mesures de lutte contre ces difficultés

Accident vasculaire cérébral ischémique révélant une maladie coeliaque

La maladie cœliaque (MC) de l’adulte est une pathologie fréquente dont la présentation clinique est polymorphe. Les manifestations extradigestives sont multiples et rendent le diagnostic difficile lorsqu’elles sont isolées. Nous rapportons le cas d’un patient de 52 ans qui présentait un accident vasculaire cérébral ischémique (AVCI). Le bilan étiologique objectivait une hyperhomocystéinémie avec une carence en vitamine B12. La biopsie duodénale était en faveur d’une maladie coeliaque. Les anticorps antigliadines étaient positifs. Le patient fût mis sous régime sans gluten, antiaggrégant plaquettaire et hydroxocobalamine avec une évolution favorable

Pseudotumoral Demyelinating Lesions: A Presentation of Acute Disseminated Encephalomyelitis

Pseudotumoral forms of demyelination are related to central nervous system demyelinating disorders, usually considered to be an atypical presentation of multiple sclerosis including its different varieties such as Balo’s, Schilder’s, and Marburg diseases. These lesions could also be seen in myelin oligodendrocyte glycoprotein antibody-associated demyelination, acute disseminated encephalomyelitis (ADEM), and neuromyelitis optica spectrum disorder. The pseudotumoral aspect may be mistakenly considered as an abscess or a cancerous tumor, in which case, patients could endure unnecessary possibly harmful brain biopsy and have a delay in their disease diagnostics and management. Once latter differential diagnosis is discarded, pseudotumoral demyelination prompts uncertainties concerning the nature of the underlying demyelinating condition as prognosis and management differ from multiple sclerosis to other syndromes, especially whether a chronic treatment is needed or not. In this case report, we present a 35-year-old male patient hospitalized in the department of neurology for a rapidly progressive onset of encephalopathy and polyfocal neurological deficits, with pseudotumoral lesions shown on brain MRI. On further investigations, ADEM was the more likely diagnosis that could fit the patient’s clinical and radiological presentation. Thence, he was put on high dose of intravenous corticosteroids, with a followed good recovery within the first week of the treatment

Dysplasies corticales focales

Focal cortical dysplasia (FCD) corresponds to developmental brain damage with the common   characteristic of partial epilepsy beginning in childhood. The best known are the FCD type II, described by Taylor et al in 1971. They are a major cause of drug resistant epilepsy. Their diagnosis is based on clinical, EEG and MRI data. The standard treatment is still present surgery.Les dysplasies corticales focales (DCF) correspondent à des lésions cérébrales d’origine développementale ayant comme caractéristique commune une épilepsie partielle débutant dans l’enfance. Les mieux connues sont les DCF de type II, décrites par Taylor et collaborateurs en 1971. Elles représentent une cause majeure de pharmacorésistance. Leur diagnostic se base sur la clinique, l’EEG et l’IRM. Le traitement de référence reste est à l’heure actuelle d’ordre chirurgical

Comparative analysis of VEP signals discrimination methods based on time-frequency transformation and CNN-2D

The Visual Evoked Potential (VEP) examination is used to analyze the appropriate functioning of the optical pathways from the retina to the visual cortex. In hospitals, the diagnosis made by physicians is based mainly on reading the temporal trace and identifying the latency P100. However, after a considerable research effort, it has been confirmed that this method is subjective and relatively less reliable. In our work, we report different approaches to resolve the inadequacy of traditional classification, by studying the efficiency of VEP signal classification in a comparative approach using 3 models: Model A: STFT-CNN, Model B: CWT-CNN, and Model C: Wigner-Ville-CNN, therefore we evaluate in the same context the effectiveness of using a pre-trained 2D CNN structure. The time-frequency transformation allows us to generate two-dimensional data from one-dimensional signals to bring out the integrated features that are not valued in the temporal plot, and then exploit them for good discrimination between the two classes, in order to be able to use a CNN-2D classification architecture, taking into consideration the advantages offered by this architecture in terms of the involvement of the attribute extraction phase and its efficiency in classifying 2D data. The results provided by the different scenarios proved that the Wigner-Ville transformation combined with a pre-trained CNN architecture can be considered a good method in terms of different performance metrics, which demonstrates that it is a successful candidate for providing significant assistance to physicians in their analysis of VEP signals