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Summary: Purpose: Cerebral malaria (CM) is suspected to be a potential cause of epilepsy in tropical areas. The purpose of this article was to evaluate the relationship between CM and epilepsy in Gabon. Methods: A matched case–control study was carried out on a sample of subjects aged six months to 25 years and hospitalized between 1990 and 2004 in three hospitals in Libreville, Gabon. Cases were defined as patients suffering from epilepsy and confirmed by a neurologist. Controls were defined as patients without epilepsy. The exposure of interest was CM according to WHO criteria. Results: In total, 296 cases and 296 controls were included. Of these, 36 (26 cases and 10 controls) had a CM history. The adjusted odds ratio (aOR) to develop epilepsy after CM was 3.9 [95% CI: 1.7–8.9], p < 0.001. Additional risk factors were identified: family history of epilepsy: aOR = 6.0 [95% CI: 2.6–14.1], p < 0.0001, and febrile convulsions: aOR = 9.2 [95% CI 4.0–21.1], p < 0.0001. Conclusions: This first case–control study on that issue suggests that epilepsy-related CM is an underrecognized problem. It emphasizes the need for further studies to better evaluate the role of convulsions during CM.

Twenty-six of 95 adults treated for tuberculous spondylitis, between 1982 and 1993, underwent surgery. Twenty-one exhibited neurological deficits: radicular deficits: 4, and progressive spinal cord syndromes: 17 (incomplete: 13, complete, of acute onset: 4). Vertebral body compression fracture was the most prominent finding. Indications for surgery were neurologic: 11, mechanical: I, etiologic: 1, and mixed: 13. Twelve patients had vertebrectomies, 3 laminotomies and 11 laminectomies. The average follow-up was 23 months. The neurological recovery was complete in 16 cases, partial in 4 cases and unchanged in one case. Bony consolidation occurred after 3–5 months. The medicosurgical treatment produced a very high cure rate, so rapidly, that it became the treatment of choice in our setting. Moreover, that allows to specify the diagnosis. Anterior decompression and fusion is recommended in the cervical and lumbar spine. In the thoracic segment, significant kyphosis is infrequent, so that surgical correction is rarely necessary. Laminotomy may occasionally be indicated for posterior decompression for abscess. Laminectomy is now preferred for uncommon cases of thoracolumbar posterior compression by tuberculous arachnoiditis or associated posterior vertebral tuberculosis. Indications for open biopsy are discussed.

RESUME Introduction: L\'hyperexcitabilite neuronale observee dans les crises epileptiques serait la resultante d\'un desequilibre entre une inhibition par l\'acide ?-amino butyrique (GABA) et l\'excitation par le glutamate, en faveur de ce dernier. Objectif: Le but de notre travail est de determiner les taux seriques de glutamate, lactate, lacticodeshydrogenase et glutamine chez les epileptiques gabonais afin d\'evaluer leur pouvoir informant dans le pronostic et le suivi des epilepsies dans notre environnement. Methodes: L\'etude a porte sur 43 patients des deux sexes dont l\'âge moyen est de 31,4±23,9 ans (avec des extremes allant de 2 a 75 ans) hospitalises et vus en consultations externes, faisant principalement une crise par mois (76,7%) et une predominance des crises generalisees (67,4%). Resultats: Les etiologies les plus frequemment retrouvees concernent les accidents vasculaires cerebraux (26,1%) et les infections (11,6%). Une augmentation nette des taux seriques de glutamate est observee, allant de 147 a 600 μmol/l, pour une moyenne de 351,7±119,6 μmol/l (normale: 40-120 μmol/l). Conclusion: Cette etude preliminaire appelle des recherches complementaires sur des series longitudinales concernant les clairances hemato-meningees du glutamate pour bien cerner les problemes d\'excitotoxicite lies au glutamate. SUMMARY Introduction: The neuronal excitability which can be observed during the epilepsial crisis should be the result of a disequilibrium between the inhibitory action of GABA (y-Amino Butyric Acid) and the excitatory action of glutamate, in favour of the latest. Objectives: The main goal of our study is to determine the glutamate seral in Gabonese people suffering from epilepsy in order to evaluate their informative power for the pronostic and the follow-up of epileptic crisis in our environment. Methods: The study has concerned 43 patients of both sexes whom medium age was 31,4±23,9 years (from 2 to 75 years old), hospitalised and from external consulting. Results: Results obtained showed increased levels of seral glutamate (351,7±119,6 μmol/l, from 147 to 600 μmol/l (normal range from 40 to 120 μmol/l). This preliminary study needs to be completed with longitudinal assays of glutamate in order to improve the pronostic of epilepsy. Key Words: Afrique, Epilepsie, Gabon, Glutamate, Africa, Epilepsy, Gabon, Glutamate Af. Jnl. Neurological Sci Vol.23(1) 2004

Objectif: Rapporter notre experience sur le devenir fonctionnel de dix huit (18) patients operes pour une myelopathie cervicarthrosique (MPCA) invalidante et suivis sur une periode de 4 a 15 ans. Patients et methods: Cette etude retrospective (1982 a 1999) a concerne 18 patients operes pour une myelopathie cervicarthrosique dont le handicap fonctionnel a ete evalue selon la classification de Nurick: grade III: 9, grade IV: 6, grade V: 3 . Treize d\'entre eux se plaignaient egalement d\'une cervicalgie-8, cervicobrachialgie-3 ou d\'une paresthesie-2. Tous presentaient un deficit moteur (tetraparesie: 13, paraparesie: 4, tetraplegie: 1) et une spasticite. La voie d\'abord cervicale antero-laterale droite fut la seule utilisee. La duree moyenne de suivi a ete de 6,9 ans. Resultats: Les plaintes douloureuses ont disparu. La recuperation neurologique a ete complete (Grade 0): 1 , quasi complete (Grade I): 9 ou incomplete (Grade II): 7; le deficit moteur est reste inchange dans un cas de Grade IV. Toutes les lesions ont consolide entre 3 et 5 mois. Conclusion: La myelopathie cervicarthrosique necessite une prise en charge pluridisciplinaire precoce des patients et un long suivi. SUMMARY Objective: Report our experience on functional results of 18 patients operated on for cervical spondylotic myelopathy with functional disability and a follow-up of four to fifteen years. Patients and methods: This retrospective study (1982 to 1999) concerned 18 patients operated on for cervical spondylotic myelopathy. The functional disability was evaluated according to the Nurick\'s classification: grade III: 9, grade IV: 6, grade V: 3. Thirteen of them complained about neck pain-8, brachialgia-3 or paresthesia-2. All patients presented various progressive spinal cord lesions (tetraparesis: 13, paraparesis: 4, tetraplegia: 1). They had also spasticity. Anterior approach were performed in the 18 cases. The average follow-up was 6.9 years. Results: All patients obtained fusion, and stability was achieved after 3-5 months. The neurogical recovery was complete(grade 0-I) in 10 cases, partial (grade II) in 7 cases, unchanged (grade IV) in one case. Conclusion: The analysis of material and socio economic difficulties obliges us to reduce the treatment length by favouring surgical intervention associated with kinesitherapy not only in relatively advanced lesions (grade III-V) but also in patients with grade II. Key Words: cervical spondylotic myelopathy; surgical treatment; anterior approach; Gabon; Afrique; Cervicarthrose; Gabon; Mylopathie cervicarthrosique Af. Jnl Neurological Sciences Vol.23(1) 2004