An Estimate of the Incidence and Prevalence of Stroke in Africa:A Systematic Review and Meta-Analysis

Background: Stroke is increasingly becoming a challenging public health issue in Africa, and the non-availability of data has limited research output and consequently the response to this burden. This study aimed to estimate the incidence and prevalence of stroke in Africa in 2009 towards improved policy response and management of the disease in the region. Methods: A systematic search of Medline, EMBASE and Global Health for original population-based or hospital-based studies on stroke was conducted. A random effect meta-analysis was conducted on crude stroke incidence and prevalence rates, and a meta-regression-like epidemiological model was applied on all data points. The fitted curve generated from the model was used to estimate incident cases of stroke and number of stroke survivors in Africa at midpoints of the United Nation population 5-year age groups for the year 2009. Results: The literature search yielded a total of 1227 studies. 19 studies from 10 African countries were selected. 483 thousand new stroke cases among people aged 15 years or more were estimated in Africa in 2009, equivalent to 81.2 (13.2– 94.9)/100,000 person years. A total of 1.89 million stroke survivors among people aged 15 years or more were estimated in Africa in 2009, with a prevalence of 317.3 (314.0–748.2)/100000 population. Comparable figures for the year 2013 based on the same rates would amount to 535 thousand (87.0–625.3) new stroke cases and 2.09 million (2.06–4.93) stroke survivors, suggesting an increase of 10.8% and 9.6% of incident stroke cases and stroke survivors respectively, attributable to population growth and ageing between 2009 and 2013. Conclusion: The findings of this review suggest the burden of stroke in Africa is high and still increasing. There is need for more research on stroke and other vascular risk factors towards instituting appropriate policy, and effective preventive and management measures

Epileptic and cognitive changes in children with cerebral palsy: an Egyptian study

Hamdy N El-Tallawy, Wafaa MA Farghaly, Ghaydaa A Shehata, Reda Badry, Tarek A Rageh Department of Neurology, Assiut University Hospitals, Assiut, Egypt Background: Cerebral palsy (CP) is the most frequent cause of motor handicap among children. Aim of the study: We aim to study the relation of epilepsy in children with CP to various risk factors that affect the development of seizures. Patients and methods: In a cross-sectional, descriptive, population-based, case-control study, 98 children with CP (48 children with CP with epilepsy, and 50 children with CP without epilepsy) were compared with 180 children without CP or seizures. The children lived in two regions in Egypt: the Al-Kharga District–New Valley and El-Quseir city–Red Sea. These cases were subjected to meticulous neurological assessment, brain magnetic resonance imaging, electroencephalography, and Stanford-Binet (4th edition) examination. Multinomial logistic regression was used to assess the risk factors. Results: Epilepsy was diagnosed in 48.9% of all cases of CP. Mental subnormality was observed more frequently in children with epilepsy than in those without epilepsy (84.6% versus 66.7%). The frequency of epilepsy was highest in patients with the spastic quadriplegic type of illness (58.3%). Multinomial logistic regression revealed that prematurity (<32 weeks of pregnancy), low birth weight (<2.5 kg at birth), neonatal seizures, jaundice, and cyanosis were significantly associated with CP with epilepsy. Conclusion: CP is associated with a high percentage of seizure disorders. Prematurity, low birth weight, neonatal seizures, cyanosis, and jaundice are significant risk factors among patients with CP with epilepsy compared to patients with CP without epilepsy or a healthy control group. Keywords: cerebral palsy, epilepsy, risk factors, Egyp

Construction of an Arabic computerized battery for cognitive rehabilitation of children with specific learning disabilities

Wafaa MA Farghaly,1 Mohamed A Ahmed,1 Hamdy N El-Tallawy,1 Taha AH Elmestikawy,2 Reda Badry,1 Mohammed Sh Farghaly,3 Montaser S Omar,3 Amr Sayed Ramadan Hussein,4 Mohammed Salamah,5 Adel T Mohammed1 1Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt; 2Department of Psychology, Faculty of Arts, Assiut University, Assiut, Egypt; 3Department of Educational Psychology, Faculty of Education, Assiut University, Assiut, Egypt; 4Department of Hearing Disability, Faculty of Sciences of Special Needs, Beni-Suef University, Beni-Suef, Egypt; 5Department of Phoniatrics, Faculty of Medicine, Assiut University, Assiut, Egypt Purpose: The aim of this study was to design an Arabic computerized battery of cognitive skills for training children with specific learning disabilities (SLD).Subjects and methods: Nineteen students from fourth grade primary schools in Assiut, Egypt, who were previously diagnosed with SLD, agreed to participate in the rehabilitation program. The study passed through four stages: first stage, detailed analysis of the cognitive profile of students with SLD (n=19), using a previously constructed diagnostic cognitive skill battery, to identify deficits in their cognitive skills; second stage, construction of an Arabic computerized battery for cognitive training of students with SLD; third stage, implementation of the constructed training program for the students, each tailored according to his/her previously diagnosed cognitive skill deficit/deficits; and fourth stage, post-training re-evaluation of academic achievement and cognitive skills’ performance.Results: Students with SLD have a wide range of cognitive skill deficits, which are more frequent in auditory cognitive skills (68.4%) than in visual cognitive skills (64.1%), particularly in phonological awareness and auditory sequential memory (78.9%). Following implementation of the training program, there was a statistically significant increase (P<0.001) in the mean scores of total auditory and visual cognitive skills, as well as in academic achievement (P<0.001) of the study group.Conclusion: Remediation-oriented diagnosis of cognitive skills, when tailored according to previously diagnosed cognitive deficits, leads to the improvement in learning abilities and academic achievement of students with SLD. Keywords: cognitive skills, learning disabilities, cognitive rehabilitation, computerized training, dyslexia, dyscalculia, dysgraphi

Construction of standardized Arabic questionnaires for screening neurological disorders (dementia, stroke, epilepsy, movement disorders, muscle and neuromuscular junction disorders)

Hamdy N El Tallawy,1 Wafaa MA Farghaly,1 Tarek A Rageh,1 Ahmed O Saleh,2 Taha AH Mestekawy,3 Manal MM Darwish,4 Mohamed A Abd El Hamed,1 Anwar M Ali,1 Doaa M Mahmoud1 1Department of Neurology and Psychiatry, Faculty of Medicine, 2Psychology Department, Faculty of Education, 3Psychology Department, Faculty of Arts, 4Public Health Department, Faculty of Medicine, Assiut University, Assiut, Egypt Abstract: A screening questionnaire is an important tool for early diagnosis of neurological disorders, and for epidemiological research. This screening instrument must be both feasible and valid. It must be accepted by the community and must be sensitive enough. So, the aim of this study was to prepare different Arabic screening questionnaires for screening different neurological disorders. This study was carried out in three stages. During the first stage, construction of separate questionnaires designed for screening the five major neurological disorders: cerebrovascular stroke, dementias, epilepsy, movement disorders, and muscle and neuromuscular disorders were done. Validation of the screening questionnaires was carried out in the second stage. Finally, questionnaire preparation was done in the third stage. Questions with the accepted sensitivity and specificity in each questionnaire formed the refined separate questionnaires. Keywords: screening questionnaires, neurological disorder

Cerebral palsy in Al-Quseir City, Egypt: prevalence, subtypes, and risk factors

Hamdy N El-Tallawy,1 Wafaa MA Farghaly,1 Ghaydaa A Shehata,1 Tarek A Rageh,1 Nabil A Metwally,2 Reda Badry,1 Mohamed AM Sayed,3 Mohamed Abd El Hamed,1 Ahmed Abd-Elwarth,2 Mahmoud R Kandil1 1Department of Neurology, Assiut University, 2Department of Neurology, El Azhr University, Assiut Branch, Assuit, 3Department of Neurology, Sohag University, Solag, Egypt Abstract: Cerebral palsy (CP) is the most frequent cause of motor handicap. The present ­door-to-door survey was conducted in Al-Quseir City, Egypt, to investigate the epidemiology of CP. All inhabitants were screened by three neurologists. Medical and neurological examinations were performed for all residents and suspected cases of CP were confirmed by meticulous neurological assessment, brain magnetic resonance imaging, electroencephalography, and testing with the Stanford-Binet Intelligence Scale. Forty-six of 12,788 children aged ≤18 years were found to have CP, yielding a childhood prevalence of 3.6 (95% confidence interval 1.48–2.59) per 1,000 live births. Five adults (aged 19–40 years) among 13,056 inhabitants had CP, giving an adult prevalence of 0.4 (95% confidence interval 0.04–0.72) per 1,000. The risk factors for CP identified in this study were premature birth, low birth weight, neonatal jaundice, neonatal seizures, and recurrent abortion in mothers of children with CP. Keywords: cerebral palsy, prevalence, subtypes, risk factors, Egyp