[Multiple sclerosis in Tunisia. Clinical study].
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Biomedical subjects
Publications and source records attributed to M Ben Hamida.
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A door-to-door survey was made in Kelibia, Tunisia to determine the prevalence of major neurologic disorders, including epilepsy. The survey was made according to a World Health Organization (WHO) protocol (1981). All individuals responding positively to the screening tool were examined by a neurologic team using well-defined diagnostic criteria. One hundred forty-one individuals, alive on prevalence day (July 1, 1985), were identified as having active epilepsy, giving a crude prevalence ratio of 4.04 per 1,000 and an age-adjusted (on WHO population) prevalence ratio of 3.64 per 1,000. Prevalence ratios increase with age (in children and young adults with the highest prevalence ratio at approximately 20 years) and decrease after 40 years. The most frequently identified type was generalized convulsive seizures (93%). The most frequently associated conditions were cerebral palsy and mental retardation.
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A histomorphometric analysis of the superficial peroneal nerve was made in 15 cases of leprosy. Thirteen patients presented clinical signs of leprous neuropathy, while the other two showed only cutaneous signs of leprosy. The presence of M. leprae in all the nerves sampled, and the appearance of the histologic lesions, made it possible to confirm the diagnosis of leprosy and to specify the type of leprosy in each case, even in the absence of clinical signs of leprous neuropathy. Correlation of the histomorphometric results with the duration of development of the disease and with the time elapsing before treatment showed, in the beginning stage, a considerable reduction in myelinated and unmyelinated never fibres and a proliferation of Schwann cells, as well as segmental demyelination and axonal degeneration of the teased fibres. When treated early, the evolution of the lepromatous type (LL) appears favourable, with apparent regeneration of the nerve fibres. When treatment is not instituted early, gradual loss of nerve fibres, axonal degeneration of all the teased fibres, proliferation of the Schwann cell processes devoid of axons, and increase in endoneural connective tissue lead to a severe degeneration of the nerve. This unfavorable development appears to progress faster in the absence of treatment or when treatment is irregular. In the borderline lepromatous (BL) and borderline tuberculoid (BT) types, nerve degeneration appears to be more rapid than in the type LL.
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Urodynamic exploration with cystometry was performed at random on 55 of the 195 patients suffering from hereditary spinocerebellar degeneration (Friedreich's disease 43 cases, Pierre-Marie hereditary ataxia nine cases, Strumpell-Lorrain disease three cases). The authors observed disturbances in continence without urinary disorders, even when the bladder was atonic. In the case of Friedreich's disease, among the 18 patients with urgent urination or with urinary leakage, the bladder was found to be normal in only two cases. Although 25 patients evidenced no urinary disturbances, a through study revealed nine abnormal bladders. In the case of Pierre-Marie disease, six normal bladders and three pathological bladders were found. A single abnormal bladder was found in Strumpell-Lorrain disease. Two types of pathological bladder were observed: the atonic bladder was compared with the traumatic bladder, and was found primarily in conjunction with peripheral sensory disturbances. The hypertonic bladder appears when sensory involvement is not evident. The authors discuss the pathophysiology of these disturbances of continence.
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