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IntroductionStroke is a very common neurological condition that cause pertinent disability in half of the cases, especially in sub-Saharan Africa. They represent the second most common cause of death in Africa.ObjectiveTo evaluate the prognostic value of the intake period of patients suffering from these conditions on the survival time of one month of hospitalization at Bangui, Central African Republic.MethodologyWe conducted a cross-sectional study at the Neurological Departments of friendship Sino-Central hospital, Internal Medicine Department of the community hospital and intensive care units of these hospitals from February to August 2019. Data were collected using a questionnaire based on the modified World Health Organization‘s one on neurological disorders.ResultsA total of 154 patients were included, with a mean age of 63.15 ±10.98 years and extremes ranging from 38 to 91 years. A male predominance was noted (60%) with a sex ratio (M/F) of 1.5. For 75 subjects (49.35%), care was taken with a hospital admission period of less than 24 hours, while for 78 other (50.65%) the admission period was more than one day. The average time to admission of patients received early was 1.00 day and the time to admission of those who came late was 4.9±2.33 days with a statistical significant difference (p < 0.0001). Median admission delay for patients treated late was 4 days. Pre-hospital and hospital determinants by admission delay were level of education of patients, history of hypertension, infectious complications of stroke and bedsores. The survival time was better in the group of patients who were treated early (p=0.0039).ConclusionThis study shows the negative impact of late management on the survival time of patients.

Background The term Nodding Syndrome (NS) refers to an atypical and severe form of childhood epilepsy characterized by a repetitive head nodding (HN). The disease has been for a long time limited to East Africa, and the cause is still unknown. The objective of this study was to confirm the existence of NS cases in Central African Republic (CAR). Methodology/Principal findings This was a cross-sectional descriptive study in the general population. The identification of NS cases was conducted through a door-to-door survey in a village near Bangui along the Ubangui River. Based on Winkler’s 2008 and the World Health Organization (WHO)’s 2012 classifications, the confirmation of cases was done by a neurologist who also performed the electroencephalograms. No laboratory tests were done during this investigation. Treatment was offered to all patients. A total of 6,175 individuals was surveyed in 799 households. After reviewing the cases, we identified 5 NS cases in girls aged between 8 and 16. The age of onset of the seizures was between 5 and 12 years of age. Two cases were classified as "HN plus" according to Winkler’s 2008 classification. Four NS cases were classified as probable and one as confirmed according to the WHO’s 2012 classification. Three of them presented with developmental delay and cognitive decline, and one had an abnormally low height-for-age z-score. Electroencephalographic abnormalities were found in four patients. Conclusions/Significance Nodding Syndrome cases were described in CAR for the first time. Despite certain peculiarities, these cases are similar to those described elsewhere. Given that only a small part of the affected area was investigated, the study area along the Ubangui River needs to be expanded in order to investigate the association between Onchocerca volvulus and NS and also evaluate the real burden of NS in CAR., Author summary Nodding Syndrome (NS) is a form of severe epilepsy that affects children in Africa. Thousands of children have been affected since its first description 60 years ago in East Africa, particularly Tanzania, South Sudan, and Uganda. Its evolution is marked by the appearance of many serious complications such as stunting, wasting, delayed sexual development, and psychiatric illness that can lead to death in some cases. Both the future of the affected children and the present of the adults in charge of them are hampered by an intolerable level of social and economic harm. Here, we describe new cases of NS that emerged in a context of extreme poverty in the Central African Republic (CAR). Because the area at risk of NS was partially investigated in this study, we urge to carry out a larger-scale study in order to assess the real burden of NS in CAR and draw the attention of public authorities.

International audience

Infection with HIV is one of the deadliest epidemics of our time and its type is widespread in the Central African Republic. It is frequently accompanied by neurological complications. Objective: To contribute to a better understanding of neurocognitive disorders in patients living with HIV (PLHIV) in Bangui, and to identify associated factors using the International HIV Dementia Scale (IHDS) as a screening tool. We conducted a descriptive and analytical cross-sectional study from 1 December 2014 to 30 January 2015, in a cohort of patients seen on one of the supported sites in Bangui. A total of 400 patients were received in follow-up visit during the study period of which 244 met the inclusion criteria. The prevalence of neurocognitive disorders was 25%, 95% CI [19.70 - 30.92]. The mean age of subjects was 42.77 ± 9.58 with extremes ranging from 24 - 64 years. The sex ratio (F/M) was 4.5 in. The average score for different tests was 10.93 ± 1.13 with extremes of 7 and 12. The disorder was more about the gestural sequence. Determinants of neurocognitive disorders in the cohort were older age and lower educational level (p < 0.05). It is useful to conduct further studies to confirm these results by combining a battery of neuropsychological tests to recommend this test for all the support sites of PLHIV in the country.

Introduction L’epilepsie est une maladie neurologique tres frequente. En Afrique et en centrafrique en particulier, cette pathologie est moins documentee nous faisant craindre une stigmatisation des patients qui en sont victimes. Objectifs Les auteurs rapportent les resultats d’une etude CAP en population generale en vue d’evaluer les connaissances sur cette affection et l’ampleur de l’epilepsie en vue de la sortir de l’ombre. Patients et Methodes Il s’agissait d’une etude transversale prospective et descriptive de type porte-a-porte qui s’etait deroulee sur une periode de trois mois, de janvier a mars 2017, au sein de la population rurale d’une commune situee a 600 km de Bangui a l’ouest de la Republique centrafricaine. Ont ete inclus dans l’etude les sujets de deux sexes, âges d’au moins 10 ans, pouvant s’exprimer verbalement, qu’ils soient souffrant ou non d’epilepsie, et ayant donne leur consentement eclaire. Resultats Sur 1023 personnes interviewees, 12 etaient epileptiques soit une prevalence de 11,7 %. L’âge moyen etait de 45 ans. Les antecedents familiaux d’epilepsie chez 12 % de l’echantillon. Au total, 74,8 % connaissaient la maladie surtout crise tonico-clonique generalisee. La notion de contagiosite etait de 75,3 % des cas. La contamination salivaire etait evoquee dans 63,8 % des cas. Un total de 52,9 % avaient cite une lesion du cerveau et 43,2 % une cause hereditaire. Au total, 71,9 % des enquetes souhaitaient ne pas utiliser les objets d’un epileptique. Discussion C’est la premiere etude realisee en Republique centrafricaine en population generale en vue d’evaluer l’ampleur de la maladie epileptique. Elle demontre une prevalence elevee, et confirme la meconnaissance de la population des autres formes de l’epilepsie. Il y a necessite de mener des compagnes de sensibilisation afin de mieux faire connaitre cette affection pour esperer une prise en charge efficiente. Conclusion L’etude nous a permis de determiner la prevalence de l’epilepsie en milieu rural centrafricain. Elle montre que l’epilepsie reste une maladie ignoree dont les victimes souffrent en douceur sans assistance.

International audience

Introduction L’infection par le virus de l’immunodeficience humaine (VIH) est de type generalise en Republique centrafricaine. Elle est frequemment accompagnee de complications neurologiques, parmi lesquelles nous avons les troubles neurocognitifs. Objectifs Contribuer a une meilleure connaissance des troubles neurocognitifs chez les personnes vivant avec le VIH (PVVIH), identifier les facteurs associes, en utilisant l’International HIV Dementia Scale comme outil de depistage. Patients et methodes Nous avons realise une etude transversale descriptive et analytique allant du 1 er decembre 2014 au 30 janvier 2015, dans une cohorte de patients suivis sur un des sites de prise en charge a Bangui. Les sujets inclus etaient des PVVIH âgees de 18 ans et plus, traitees par les ARV depuis au moins un mois, ayant un dossier medical a jour, ne presentant ni d’infection intercurrente aigue, ni d’affection psychiatrique ou un traitement antipsychotique. Resultats Au total 244 patients ont ete inclus. Soixante et un avaient une perturbation aux tests neurocognitifs apparies a 183 temoins. La prevalence des troubles neurocognitifs etait de 25 %, IC95 % [19,70–30,92]. L’âge moyen des sujets presentant ces TNC etait de 42,77 ± 9,58. Le sex-ratio (F/H) etait de 4,5. Le score moyen aux differents tests etait de 10,93 ± 1,13. Les facteurs determinant les troubles neurocognitifs etaient l’âge eleve et le bas niveau d’instruction ( p Discussion Le concept des troubles neurocognitifs associes au VIH a ete tres tot mis en evidence puis categorise parmi les symptomes du sida. Plusieurs batteries de tests ont ete proposees pour leur depistage parmi lesquelles l’International HIV Dementia Scale. Il nous a permis d’identifier les patients a risque de troubles neurocognitifs sans la necessite des tests neuropsychologiques sophistiques. Conclusion Il est utile de mener d’autres etudes combinant une batterie des tests neuropsychologiques afin de recommander ce test pour tous les sites de prise en charge des PVVIH du pays. Informations complementaires Communication affichee.