Epidemiology of non-fatal cerebrovascular stroke and transient ischemic attacks in Al Quseir, Egypt

Hamdy N El-Tallawy,1 Wafaa MA Farghaly,1 Ghaydaa A Shehata,1 Nabil M Abdel-Hakeem,2 Tarek A Rageh,1 Reda Badry,1 Mahmoud R Kandil1 1Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University Hospital, 2Department of Neurology, Faculty of Medicine, Al-Azhar University, Assiut branch, Assuit, Egypt Background and purpose: Stroke is a medical emergency that can cause permanent neurological damage, complications, and disability. We aim to determine the epidemiology of non-fatal cerebrovascular stroke (CVS) and transient ischemic attacks (TIAs) in Al Quseir City, Red Sea, Egypt. Methods: The total population (n=33,285) was screened through a door to door study by three specialists of neurology and 15 female social workers (for demographic data collection). All suspected stroke patients were subjected to a full clinical examination, computerized tomography (CT) and/or magnetic resonance imaging (MRI) of their brain, blood sugar, lipogram, serum uric acid, complete blood cells, blood urea, and serum creatinine, as well as evaluated by Barthel Index and Scandinavian Stroke Scale. Carotid doppler, echocardiography, and thyroid functions were done for selected cases. Results: CVS was recorded among 130 patients out of 19,848 subjects aged 20 years and more, yielding a total prevalence of 6.55/1,000 population. From June 1, 2010 to May 31, 2011, 36 patients were recorded to have stroke within 1-year, yielding an incidence rate of 1.81/1,000. Prevalence and incidence rates were higher among males than females, and both indices increased steadily with advancing age to reach the highest prevalence (37.02/1,000) and incidence rate (9.5/1,000) among aged persons 60 years and more. Conclusion: The prevalence of non-fatal stroke in Al Quseir city (6.55/1,000) was at the lower range of that recorded in developing countries (5–10/1,000) and slightly higher than that recorded in industrialized countries (5/1,000 population). Ischemic stroke is the most common type of stroke. The prevalence of TIAs was 0.15/1,000. Keywords: stroke, TIAs, epidemiology, Egyp

Prevalence of multiple sclerosis in Al Quseir city, Red Sea Governorate, Egypt

Hamdy N El-Tallawy,1 Wafaa M A Farghaly,1 Reda Badry,1 Nabil A Metwally,2 Ghaydaa A Shehata,1 Tarek A Rageh,1 Mohamed Abd El Hamed,1 Mahmoud R Kandil1 1Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt; 2Department of Neurology and Psychiatry, Al Azhar University Hospital, Assiut Branch, Assiut, Egypt Background: Multiple sclerosis (MS) is a chronic and disabling disorder with considerable social effects and economic sequelae. It is one of the major causes of disability in young adults.Objectives: This study aimed at detecting the prevalence of MS among the population of Al Quseir city.Methods: This study is a part of door-to-door survey of major neurological disorders that was conducted in Al Quseir city, Red Sea Governorate, Egypt. The sample size was 33,285 persons. The youngest patient was 17 years old. The number of people at and above 17 years of age was 21,827. They were screened by three neurologists. Then, the positive cases were subjected to meticulous clinical evaluation by three staff members of Department of Neurology, Assiut University Hospital, Egypt. Essential investigations were done.Results: A total of three cases of MS were diagnosed with an age-specific prevalence ≥17 years of 13.7/100,000. Keywords: prevalence, multiple sclerosis, Al Quseir, door-to-door survey&nbsp

Prevalence of Parkinson’s disease and other types of Parkinsonism in Al Kharga district, Egypt

Hamdy N El-Tallawy,1 Wafaa M Farghaly,1 Ghaydaa A Shehata,1 Tarek A Rageh,1 Nabil M Abdel Hakeem,2 Mohamed Abd Al Hamed,1 Reda Badry1 1Department of Neurology, Assiut University, 2Al-Azhar University – Assiut branch, Assiut, Egypt Abstract: Parkinson’s disease (PD) is a common neurodegenerative disorder in older people. The prevalence of PD varies among ethnic and geographic groups around the world. In this study, we aimed to estimate the prevalence of PD and other types of Parkinsonism in persons aged ≥40 years in the Al Kharga district of Egypt. The study was conducted on the total population of Al Kharga district (62,583 persons) between 2005 and 2009 and involved three neurology specialists and 15 female social workers undertaking a door-to-door survey. Suspected cases of Parkinsonism were subjected to meticulous clinical and neurological examination by three neurology staff members from Assiut University hospital who carried out their examinations separately. Of the total population surveyed, 15,482 persons were aged ≥40 years and 49 of these were identified as having Parkinsonism (prevalence: 316.50 per 100,000 people [95% confidence interval {CI} 240.21–404.98]). Of the 49, 33 fulfilled the diagnostic criteria for PD, giving a prevalence rate of 213.15/100,000 (95% CI 150.51–285.80) while 14 fulfilled those for vascular Parkinsonism, with a prevalence rate of 90.43/100,000 (95% CI 49.60–137.78). Postencephalitic and unspecified Parkinsonism each had a prevalence rate of 6.46/100,000. The prevalence of Parkinsonism was found to increase steadily with age, and the prevalence of all types of Parkinsonism was statistically higher in rural compared with urban communities, with no significant difference between men and women. Keywords: epidemiology, door-to-door survey, PD, postencephalitic Parkinsonis

Epidemiology of nonfatal stroke and transient ischemic attack in Al-Kharga District, New Valley, Egypt

Wafaa MA Farghaly,1 Hamdy N El-Tallawy,1 Ghaydaa A Shehata,1 Tarek A Rageh,1 Nabil M Abdel-Hakeem,2 Mohamed A Abd Elhamed,1 Bastawy MA Al-Fawal,3 Reda Badry1 1Department of Neurology, Faculty of Medicine, Assiut University, Assiut, 2Department of Neurology, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut, 3Aswan Health Insurance Hospital, Ministry of Health, Aswan, Egypt Background: Stroke is a medical emergency. Nonfatal stroke may cause permanent neurologic damage, complications, and disability. The aim of this study was to determine the epidemiology of nonfatal stroke in Al-Kharga District, New Valley, Egypt. Methods: The total population (62,583) was screened via a door-to-door study by three neurology specialists and 15 female social workers for demographic data collection. All subjects with probable stroke were subjected to a full clinical examination, neuroimaging (computed tomography and/or magnetic resonance imaging of the brain), and laboratory investigations including blood sugar, lipid profile, serum uric acid, a complete blood count, blood urea, and serum creatinine. Stroke severity and outcome were assessed using the Scandinavian Stroke Scale and Barthel Index. Carotid Doppler, echocardiography, and thyroid function tests were done in selected cases. Results: During the study period (June 1, 2005 to May 31, 2008), 351 subjects were diagnosed as having suffered a cerebrovascular stroke at some point during their lives, yielding a total lifetime prevalence of 5.6 per 1,000 population. Of these, 156 subjects were identified as having suffered a stroke during the year from January 1 to December 31, 2007, with an incidence rate of 2.5 per 1,000. Both prevalence and incidence rates were higher in urban (5.8 per 1,000 and 2.6 per 1,000, respectively) than rural communities (5.2 per 1,000 and 2.3 per 1,000), and were higher in males (6.1 per 1,000 and 2.7 per 1,000, respectively) than in females (5.1 per 1,000 and 2.3 per 1,000). Thrombotic stroke had the highest prevalence and incidence rates (4.2 per 1,000 and 1.7 per 1,000, respectively), whereas subarachnoid hemorrhage had the lowest prevalence and incidence rates (0.03 per 1,000 and 0.02 per 1,000). Conclusion: The prevalence of cerebrovascular accident in Al-Kharga lies in the lower range of that in developing countries, and is similar to that in industrialized countries. Keywords: prevalence, incidence, stroke, Egyp

Epidemiology and clinical presentation of stroke in Upper Egypt (desert area)

Hamdy N El Tallawy,1 Wafaa M Farghaly,1 Reda Badry,1 Nermin A Hamdy,2 Ghaydaa A Shehata,1 Tarek A Rageh,1 Nabil A Metwally,3 Enas M Hassan,2 Sayed S Elsayed,2 Mohamed A Yehia,2 Wael T Soliman2 1Department of Neurology and Psychiatry, Assiut University, Assiut, 2Department of Neurology, El Minia University, El-Minia City, 3Department of Neurology, Al-Azhar University (Assuit Branch), Assiut, Egypt Background: Stroke is a common cause of morbidity and mortality worldwide. Four out of five strokes occur in the low- and middle-income countries. This study aims to find lifetime prevalence of stroke in Upper Egypt and to identify clinical presentations and possible risk factors of stroke in this population.Methods: This is a door-to-door (every door) study conducted on all inhabitants in Al Kharga district (representative of western desert) and Al Quseir city (representative of eastern desert). The study was conducted in two stages, and every stage consisted of three phases (screening, diagnostic, and investigatory).Results: The total lifetime prevalence of stroke was 8.5/1,000 in the population aged 20 years and more. It increased with advancing age and was higher among males than females among all age groups except in the childbearing period (20 years to <40 years of age). Lifetime prevalence of ischemic stroke (7.2/1,000) was higher than hemorrhagic stroke (1.1/1,000). Hemiparesis and hemiplegia were the commonest presentation of stroke. Headache, vomiting, and vertigo were found to be significantly more common accompaniments of hemorrhagic stroke. The most common risk factor was hypertension, followed by hyperlipidemia and diabetes mellitus.Conclusion: The total lifetime prevalence of stroke in the population aged 20 years and more in Upper Egypt (desert area) lies within the range that is recorded in developing countries. Clinical presentation and risk factors are similar to those recorded from developing and developed countries. Keywords: stroke, epidemiology, Upper Egypt, desert are

Spectrum of epilepsy – prevalence, impact, and treatment gap: an epidemiological study from Al-Quseir, Egypt

Hamdy N El-Tallawy,1 Wafaa M Farghaly,1 Tarek A Rageh,1 Ghaydaa A Shehata,1 Nabil A Metwally,2 Reda Badry,1 Mohammed A Sayed,3 Ahmed M Abdelwarith,2 Mahmoud R Kandil,1 Mohamed A Hamed,1 Khaled O Mohamed,1 Amal M Tohamy11Department of Neurology, Assiut University, Assiut, 2Department of Neurology, Faculty of Medicine, Al-Azhar University – Assiut Branch, Assiut, 3Department of Neurology, Sohag University, Sohag, EgyptBackground: Epidemiology continues to be an important research tool in the study of epilepsy and related disorders, providing a better understanding of the frequency, causes, and natural history of the disorder.Objective: To estimate the prevalence of epilepsy in Al-Quseir, Red Sea Governorate, Egypt, and its magnitude of treatment gap.Methods: The study was part of a door-to-door study, including every door, to screen all inhabitants in Al-Quseir (33,818 inhabitants) by three specialists of neurology and 15 female social workers (for demographic data collection) using a standardized screening questionnaire. All suspected cases were subjected to detailed history, clinical examination, and electroencephalogram. Neuroimaging studies and estimation of serum drug level were done in select cases if needed.Results: The study revealed that the lifetime prevalence rate of epilepsy in Al-Quseir is 5.5/1,000, with the highest peak during early childhood, while that of active epilepsy is 3.3/1,000 population. The annual incidence rate is 48/100,000, and the age-specific incidence rate has a U-shaped pattern with two peaks of incidence in early infancy and elderly life. Localization-related epilepsy is the most frequently encountered type (58.8%). The treatment gap of epilepsy in Al-Quseir is 83.8%.Conclusion: The lifetime prevalence of epilepsy in Al-Quseir city, Red Sea Governorate, was 5.5/1000. Keywords: epidemiology, epilepsy, treatment gap, Egypt, Al-Quseir, epidemiolog

Door-to-door survey of major neurological disorders (project) in Al Quseir City, Red Sea Governorate, Egypt

Hamdy NA El Tallawy,1 Wafaa MA Farghaly,1 Tarek A Rageh,1 Ghaydaa A Shehata,1 Reda Badry,1 Nabil A Metwally,2 Esam A El Moselhy,2 Mahmoud Hassan,2 Mohamed A Sayed,3 Ahmed A Waris,1 Yaser Hamed,2 Islam Shaaban,2 Mohamed A Hamed,1 Mahmoud Raafat Kandil11Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt; 2Department of Neurology and Public Health, Faculty of Medicine, Al-Azhar University (Assiut branch), Assiut, Egypt; 3Department of Neurology, Faculty of Medicine, Sohag University, Sohag, EgyptAbstract: A door-to-door survey, including every household, was conducted for all inhabitants of Al Quseir City (33,283), Red Sea Governorate, Egypt by three specialists of neurology as well as nine senior staff members of neurology and 15 female social workers to assess the epidemiology of major neurological disorders. Over six phases, from July 1, 2009 to January 31, 2012, screening of all eligible people in the population was carried out, by which case ascertainment of all major neurological disorders included in the study was done according to the accepted definitions and diagnostic criteria of the World Health Organization. The order of frequency of prevalence of the studied neurological disorders was dementia (3.83% for those aged > 60 years), migraine (2.8% for those aged > 8 years), stroke (6.2/1000 for those aged > 20 years), epilepsy (5.5/1000), Parkinson’s disease (452.1/100,000 for those aged > 40 years), cerebral palsy (3.6/1000 among children 37 years), chorea (21.03/100,000), athetosis (15/100,000), and multiple sclerosis (13.74/100,000). The incidence rates of stroke, epilepsy, and Bell’s palsy were 181/100,000, 48/100,000, and 98.9/100,000 per year, respectively.Keywords: prevalence, incidence, neurological disorder