La chirurgie de l’épilepsie au Maroc, étude et suivi à long terme de 51 patients

Introduction: In Morocco, the management of epilepsy has advanced greatly in recent years, and epilepsy surgery was started in 2005 at the university hospital of Rabat. This alternative, considered the prerogative of the rich countries, is starting to grow in emerging countries, but also developing countries such as Morocco. Results: Fifty one patients with intractable lesional temporal partial epilepsy were operated between 2005 and 2011. 48 patients had a anterieur temporal lobectomy, and 3 lesionectomy. In 29 patients (57%) hippocampal sclerosis was found, dysembryoplastic neuroepithlioma in 13 (25%) patients, 4 patients with cortical dysplasia, 2 with ganglioglioma, and one case of cavernoma and astrocytoma. Presurgical evaluation was the same in all cases, based on non invasives methods (detailed History, neurological and psychitrical evaluation, interictal EEG, MRI, Video-EEG with ictal EEG, and neuropsychological tests). After 7 years of follow-up , 40 patients (78,4%) are in class I of Engel’s classification, among them 31 (60,7%) are seizure free (class IA), 5 patients in class II, 6 patients in class III, and no patients in class IV. The outcome is almost identical to the group with hippocampal sclerosis and the other group with other types of lesions for the first four years , after seven years of follow up, 50% of the first group are in class I, and 66,7% for the second group. Conclusion: Our experience demonstrates the feasibility of epilepsy surgery in developing countries particularly in Africa, and appropriateness of non invasives methods evaluation.Introduction: Au Maroc, la prise en charge de l’épilepsie a beaucoup progressé ces dernières années, et la chirurgie de l’épilepsie a pu démarrer en 2005 au centre hospitalier de Rabat. Cette alternative thérapeutique, considérée comme l’apanage des pays riches, commence donc à se développer dans les pays émergents, mais aussi les pays en développement, comme le Maroc. Les auteurs rapportent une série de 51 patients ayant bénéficié de cette chirurgie et discutent les caractéristiques cliniques et surtout les résultats post opératoires avec un recul de sept ans et à travers cette expérience, ils soulignent l’intérêt de démarrer cette chirurgie au moins pour les cas concordants, qui ne nécessitent que des moyens faciles et disponibles dans les pays en développement (EEG, Vidéo- EEG, IRM et neuropsychologie). Résultats : Cinquante et un patients présentant une épilepsie partielle temporale lésionnelle pharmacorésistantes ont été opérés entre 2005 et 2011. 48 patients ont bénéficié d’une lobectomie temporale et 3 patients d’une lésionectomie. Chez 29 patients (57%) une sclérose hippocampique a été trouvée, 13(25%) avaient une tumeur dysembryoplasique, 4 une dysplasie corticale, 2 un gangliogliome, puis un cas de cavernome et astrocytome. L’exploration préchirurgicale a été identique pour tous les patients, basée sur les méthodes non invasives (examen neurologique et psychiatrique, EEG intercritique et critique, vidéo-EEG, IRM et tests neuro-psychologiques). Après un suivi de 7 ans, 40 patients (78,4%) sont au stade I de la classification d’Engel dont 31 (60,7%) sont libres de crises (stade IA),5 patients au stade II , 6 patients au stade III, et aucun patients au stade IV. L’évolution est quasi-identique pour le groupe des patients avec sclérose hippocampique et l’autre groupe avec d’autres type de lésions au cours des quatre premières années, a 7ans de recul 50% des patients du premier groupe sont au stade I , et 66,7% pour le second groupe. Conclusion: Notre expérience démontre la faisabilité de la chirurgie de l’épilepsie dans les pays en développement notamment en Afrique, et la pertinence de l’évaluation prechirurgicale avec les méthodes non invasives

An autosomal recessive leucoencephalopathy with ischemic stroke, dysmorphic syndrome and retinitis pigmentosa maps to chromosome 17q24.2-25.3

Background Single-gene disorders related to ischemic stroke seem to be an important cause of stroke in young patients without known risk factors. To identify new genes responsible of such diseases, we studied a consanguineous Moroccan family with three affected individuals displaying hereditary leucoencephalopathy with ischemic stroke, dysmorphic syndrome and retinitis pigmentosa that appears to segregate in autosomal recessive pattern. Methods All family members underwent neurological and radiological examinations. A genome wide search was conducted in this family using the ABI PRISM linkage mapping set version 2.5 from Applied Biosystems. Six candidate genes within the region linked to the disease were screened for mutations by direct sequencing. Results Evidence of linkage was obtained on chromosome 17q24.2-25.3. Analysis of recombination events and LOD score calculation suggests linkage of the responsible gene in a genetic interval of 11 Mb located between D17S789 and D17S1806 with a maximal multipoint LOD score of 2.90. Sequencing of seven candidate genes in this locus, ATP5H, FDXR, SLC25A19, MCT8, CYGB, KCNJ16 and GRIN2C, identified three missense mutations in the FDXR gene which were also found in a homozygous state in three healthy controls, suggesting that these variants are not disease-causing mutations in the family. Conclusion A novel locus for leucoencephalopathy with ischemic stroke, dysmorphic syndrome and retinitis pigmentosa has been mapped to chromosome 17q24.2-25.3 in a consanguineous Moroccan family

Knowledge, attitudes, and practice of organ donation in Morocco: A cross-sectional survey

In any health system, public awareness of organ donation fundamentally affects the organ transplantation programs. The aim of this study was to evaluate the knowledge and perception of the people in Morocco toward organ donation as well as to identify the reasons and determinants for refusal of organ donation. This opinion survey included a representative sample of 2000 participants in Morocco, and data related to sociodemographic characteristics, knowledge and self-opinion about organ donation, and reasons behind refusal were collected. Statistical analysis showed that 55.2% of the participants were women, the median age was 21 years, and 60.8% of included participants had secondary education. Almost two-thirds of surveyed participants (62.3%) showed a low to mid-level of knowledge about organ donation and transplantation in Morocco. About half of the interviewed participants (48.8%) refused to donate their organs. Concern about risk of medical error and the belief in trafficking of procured organs were the main reasons for refusal, seen in 66% and 62% of the interviewees, respectively. Univariate and multivariate logistic regression models showed that the older, the less educated and the less informed a person is, the less he accepted organ donation. Therefore, promotion of organ donation in Morocco should involve a regular information and awareness among the general population