Salam Koussa

Lebanese Hospital Geitaoui-UMC · Neurology

Background: Verbal fluency tasks are frequently used for neuropsychological assessment in clinical practice and research. It consists of two tasks namely category and letter fluency tests. Objective: To determine normative values in category (animals, vegetables, fruits) and letter fluency [Mim () "M", Alif () "A", Baa () "B"] tasks in Arabic la...

Aim: To evaluate the correlation between the Expanded Disability Status Scale (EDSS) in multiple sclerosis (MS) subjects, and the severity of lower urinary tract symptoms (LUTS), the bother caused by these symptoms and subjects' quality of life (QoL). Material and methods: This cross-sectional study included 50 subjects with persistent LUTS seco...

Objectives In the absence of a simple validated instrument to screen for cognitive impairment among illiterate Lebanese older adults, the aims of this study were to validate an Arabic version of the Test of Nine Images (A-TNI93) adapted by the Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l’Univesité Sa...

Background: The need for complete urodynamic evaluation in Multiple Sclerosis (MS) patients with Lower Urinary Tract Symptoms (LUTS) is not fully established in the literature. The objective was to evaluate the effect of urodynamics in MS patients with LUTS on treatment outcomes. Methods: MS patients with LUTS were recruited. On their first visit,...

The majority of disease-modifying drugs (DMDs) available for the management of active relapsing–remitting multiple sclerosis (RMS) depend on continuous drug intake for maintained efficacy, with escalation to a more active drug when an unacceptable level of disease activity returns. Among continuously applied regimens, interferons and glatiramer ace...

Background: Multiple sclerosis (MS) is often associated with fatigue, with an increased prevalence of sleep disorders compared to the general population, notably restless legs syndrome (RLS). The aim of this study was to evaluate the prevalence and severity of RLS as well the co-occurrence of spinal demyelination lesions in patients with MS in Leb...

With evolving diagnostic criteria and the advent of new oral and parenteral therapies for MS, most current diagnostic and treatment algorithms need revision and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and in time, and exclude alternative diseases that can explain the f...

HYPOTHESIS / AIMS OF STUDY Lower urinary tract symptoms (LUTS) are a major clinical problem and a significant cause of disability in multiple sclerosis (MS) patients. The need for complete urodynamic evaluation in such patients is not fully established in the literature. Some authors recommend to limit the first evaluation in these patients to plas...

HYPOTHESIS / AIMS OF STUDY: When evaluating multiple sclerosis (MS) patients with lower urinary tract symptoms (LUTS), clinicians rarely order urodynamics and rely instead on history, ultrasound, uroflowmetry and bladder diary (BD) to clearly evaluate the patient’s lower urinary tract function. BD is the only objective patient-generated method that...

Background: The Mini-Mental State Examination (MMSE) has not been validated in the Lebanese population and no normative data exist at the national level. Objective: To evaluate the reliability and validity of an Arabic version of MMSE developed by the "Groupe de Travail sur les Démences de l'Université Saint Joseph" (A-MMSE(GTD-USJ)) and to prov...

Distal hereditary motor neuropathies (dHMNs) are a heterogeneous group of diseases, resembling Charcot–Marie–Tooth syndromes, but characterized by an exclusive involvement of the motor part of the peripheral nervous system. Here, we describe two new compound heterozygous mutations in VRK1, the vaccinia-related kinase 1 gene, in two siblings from a...

La fatigue est un symptome tres frequent dans la sclerose en plaques (SEP) puisqu’elle concerne 50 a 90 % des patients selon les etudes. Ses causes sont multiples incluant la perte axonale, le deficit moteur, la depression, les poussees de SEP et les troubles du sommeil. Les troubles du sommeil ont ete incrimines dans la fatigue mais ne sont pas en...

Alzheimer's disease (AD) is a chronic neurodegenerative disorder presenting as progressive cognitive decline with dementia that does not, to this day, benefit from any disease-modifying drug. Multiple etiologic pathways have been explored and demonstrate promising solutions. For example, iron ion chelators, such as deferoxamine, are a potential the...

Morvan syndrome (MoS) is a rare paraneoplastic autoimmune disorder characterized by peripheral nerve hyperexcitability, autonomic dysfunction, and sleep disorders. Systemic lupus erythmatosus (SLE) cooccurs in 6–10% of patients with thymoma. It may occur before, concurrently with, or after thymoma diagnosis. This paper reports the first case of coo...

With evolving diagnostic criteria and the advent of new oral and parenteral therapies for MS, most current diagnostic and treatment algorithms need reevaluation and updating. The diagnosis of MS relies on incorporating clinical and para clinical findings to prove dissemination in space and in time, and exclude alternative diseases that can explain...

Natalizumab, a highly specific alpha4-integrin antagonist, , has recently been registered across the Middle East and North Africa region. It improves clinical and magnetic resonance imaging (MRI) outcomes and reduces the rate of relapse and disability progression in relapsing-remitting multiple sclerosis (MS). Natalizumab is recommended for patient...

Leg ulcers in β-thalassaemia intermedia (TI) patients are a relatively common occurrence that have an 8% prevalence. Both the pathophysiology and treatment of this condition have not been well-elucidated. This is mainly because of the rarity of the disease and the lack of well-structured studies. The goal of this study was to better explore the ris...

Objective: The prevalence of multiple sclerosis (MS) in Lebanon is unknown, as there are no available or reliable epidemiological studies to date. The circumstances of Middle East countries are different from those of Europe and North America in terms of differential diagnoses and disease management. The aim of the conference is to establish guide...

Pregabalin, a molecule with similar structure of GABA neurotransmitter, initially developed as an antiepileptic, is now commonly used in the treatment of painful peripheral neuropathies. We report an 82-year-old man who presented with confusion, urinary incontinence and gait instability. He was receiving pregabalin for a left L5 radicular pain. Lab...

Many neurologic and psychiatric manifestations have been associated with systemic lupus erythematosus. Narcolepsy, currently hypothesized as related to an autoimmune process, has been rarely associated with systemic lupus erythematosus. We report a 36-year-old woman who presented with narcolepsy and who subsequently developed systemic lupus erythem...

Many neurologic and psychiatric manifestations have been associated with systemic lupus erythematosus. Narcolepsy, currently hypothesized as related to an autoimmune process, has been rarely associated with systemic lupus erythematosus. We report a 36-year-old woman who presented with narcolepsy and who subsequently developed systemic lupus erythem...

4280 Beta thalassemia intermedia syndromes are serious conditions for which there is no satisfactory therapy to correct the underlying globin chain imbalance. Some agents that induce fetal globin gene expression have ameliorated anemia in thalassemia patients by reducing the imbalance in alpha: non-alpha globin synthesis, but none have been broadly...

BACKGROUND: Cladribine provides immunomodulation through selective targeting of lymphocyte subtypes. We report the results of a 96-week phase 3 trial of a short-course oral tablet therapy in patients with relapsing-remitting multiple sclerosis. METHODS: We randomly assigned 1326 patients in an approximate 1:1:1 ratio to receive one of two cumulat...

Percutaneous endoscopic gastrostomy (PEG), the modality of choice for long-term enteral access, is generally a safe procedure but can be associated with many potential complications. Report two different and late complications of PEG in two patients fed at home, leading them to the emergency department. A 75-year-old man and a 14-year-old young man...

Objectives To present neurological involvement in Behçet's disease, its prognosis and treatment. Methods Our study was retrospective and was done at Hotel-Dieu Hospital of Beirut between 1980 and 2005. All these patients fulfilled the International Study Group criteria for diagnosis of Behçet's disease. Results Neurological involvement was observ...

To present neurological involvement in Behçet's disease, its prognosis and treatment. Our study was retrospective and was done at Hotel-Dieu Hospital of Beirut between 1980 and 2005. All these patients fulfilled the International Study Group criteria for diagnosis of Behçet's disease. Neurological involvement was observed in 13% (22/170) of our pat...

beta-Thalassemia major is a debilitating disease with a considerable incidence in Lebanon (around 2-3% carriership). The present article describes our experience to this day with 214 patients, emphasizing the survival of beta-thalassemia major and development of complications among patients with different parameters. Fifteen deaths were reported. T...

Two patients with cerebral dural sinus thrombosis (CST) following cisplatin therapy are presented. Cisplatin is a well-recognized risk factor for coagulation disorders and thrombosis, but is not known to be associated with CST. Clinicians should be aware of the potential risk for the development of CST following cisplatin therapy.

A genome-wide screen using 382 STR markers to localize and identify the gene implicated in early-onset dementia (EOD) without bone cysts in a Lebanese family with three affected subjects was conducted. A unique locus homozygous by descent at chromosome 6p21.2 locus was identified. Candidate genes were explored by fluorescent sequencing and the effe...

Cardiovascular impairment is a major cause of morbidity and mortality in patients with thalassemia intermedia. In this study, echocardiographic assessment of left heart condition was performed in patients with thalassemia intermedia, and its relation to hematologic variables--amino terminal pro-brain natriuretic peptide (NT-proBNP), ferritin, hemog...

Although bone regrowth following craniocervical decompression has been rarely reported to cause late recurrence of Chiari symptoms, syringomyelia has not been observed in such cases. We report a unique case of cervical syringomyelia resulting from spontaneous regeneration of the posterior C1 arch after foramen magnum decompression. A 38-year-old ma...

This study evaluated the benefits and impact of ICU therapeutic interventions on the survival and functional ability of severe cerebrovascular accident (CVA) patients. Sixty-two ICU patients suffering from severe ischemic/haemorrhagic stroke were evaluated for CVA severity using APACHE II and the Glasgow coma scale (GCS). Survival was determined us...

Introduction: Thalassemia intermedia (TI) is a heterogeneous genetic disease affecting the β-globin chain of the hemoglobin molecule resulting in a unique and wide clinical spectrum. The majority of TI patients are mildly anemic requiring merely occasional blood transfusions. Their mild anemia might be tolerable at a young age but over years it is...

Background: Unlike patients with thalassemia major (TM), those with thalassemia intermedia (TI) do not require regular blood transfusion therapy but remain susceptible to iron overload due to increased intestinal iron uptake triggered by ineffective erythropoiesis. TI patients can accumulate 1–3.5 g of excess iron per year, and effective monitoring...

IntroductionThe epileptogenic potential of quinolones differs from one product to the other. The rare epileptic seizures induced by gatifloxacin were seen with the intravenous route.PatientsWe report two old ladies presenting with generalized status epilepticus after being treated orally with normal doses of gatifloxacin, with a good recovery. Past...

The epileptogenic potential of quinolones differs from one product to the other. The rare epileptic seizures induced by gatifloxacin were seen with the intravenous route. We report two old ladies presenting with generalized status epilepticus after being treated orally with normal doses of gatifloxacin, with a good recovery. Past medical history of...

Beta-thalassemia is a hereditary anemia that is quite prevalent in Lebanon. Most patients with beta-Thalassemia are treated and followed up mostly at a multidisciplinary center, located in the suburban area of Beirut: the Chronic Care Center (CCC), operational since 1994. We will review the experience with beta-Thalassemia accumulated through this...

Epileptic seizures complicating treatment with selective inhibitors of phosphodiesterase type 5 are scarcely reported. A previously non-epileptic 78-year-old patient presented with a partial epileptic seizure following oral intake, for the second time, of 10mg of vardenafil (Levitra). The brain MRI failed to show any preexisting lesion. To our know...

Introduction Epileptic seizures complicating treatment with selective inhibitors of phosphodiesterase type 5 are scarcely reported. Case report A previously non-epileptic 78-year-old patient presented with a partial epileptic seizure following oral intake, for the second time, of 10mg of vardenafil (Levitra®). The brain MRI failed to show any pree...

IntroductionMegalencephalic leukoencephalopathy with subcortical cysts is a rare disease with autosomal recessive inheritance.Materials and methodsTwo brothers born from a consanguineous marriage, presenting with the phenotype of the disease, their parents, brothers and sisters were examined. Magnetic resonance imaging of the brain was performed fo...

Megalencephalic leukoencephalopathy with subcortical cysts is a rare disease with autosomal recessive inheritance. Two brothers born from a consanguineous marriage, presenting with the phenotype of the disease, their parents, brothers and sisters were examined. Magnetic resonance imaging of the brain was performed for the two patients. Sequence ana...

Multiple sclerosis (MS) is almost always diagnosed in current medical practice on the basis of clinical, biologic and imaging criteria without need for tissue diagnosis. There are, however, rare pseudo tumoral cases of MS with atypical clinical and imaging features that suggest initially a neoplastic or an infectious processes and in which a stereo...

Twelve thalassaemia major patients have been given deferiprone 75 mg/kg body weight daily as iron chelation therapy for 5 years. Their ages ranged from 18 to 34 years (mean 24.2) at the end of the study. Two patients were hepatitis C virus (HCV) mRNA positive and a further 5 were positive for HCV antibody. The mean serum ferritin level fell signifi...

Present clinical features of brucellosis in Lebanon. Eighty-eight patients were seen at Hotel-Dieu de France Hospital of Beirut between 1994 and 2002. Diagnostic criteria were brucellar agglutinins at a titer; 1/160 with symptoms suggestive of brucellosis in the absence of other diagnosis and a therapeutic response. Out of the 88 hospitalized patie...

We report a retrospective analysis of 15 cases of neurobrucellosis. Initial clinical manifestations consisted of meningoencephalitis in 5 patients, acute and subacute meningitis in 4, intracranial hypertension in 2, polyradiculoneuritis with albumin-cell dissociation in 2 (one with cerebral and subarachnoid hemorrhage), and transverse myelitis and...

We report the case of a 77-year-old patient who presented a postural and kinetic tremor of the upper and lower limbs of sub acute onset, which revealed a vitamin B12 deficiency and resolved rapidly after the treatment. Such a presentation is rare.

A previously non-epileptic 17-year-old patient presented with 2 generalized epileptic seizures, which occurred at 6 months of interval, following the oral intake of 200-250 mg of tramadol. Urine analysis showed only the product and its metabolites. Epileptic seizures induced by tramadol and high risk factors are described and discussed.

Extramedullary hematopoiesis is a common compensatory phenomenon to chronic hemolytic anemias including thalassemia. Several sites can be involved including the liver, the spleen, the lymph nodes, and other less common locations. Spinal cord compression may result in the rare cases wherein the hematopoietic develops intraspinally. Treatment of such...

We report a case of hemicerebellitis in a 13-year-old girl presenting with symptoms of intracranial hypertension with acute onset. MRI of the brain revealed a unilateral cerebellar swelling with foliaform enhancement. The patient was still symptomatic even with high doses of intravenous steroids, so we decided to operate on her for diagnosis and de...

Sickle cell disease (SCD) is an inherited autosomal recessive disorder of the beta-globin chain. Despite the fact that all subjects with SCD have the same single base pair mutation, the severity of the clinical and hematological manifestations is extremely variable. This study examined for the first time in Lebanon the correlation between the clini...

Exposure to hepatitis C virus (HCV), hepatitis G virus (HGV) and the carrier 'rate' for hepatitis B virus (HBsAg) were investigated in thalassaemia patients in Lebanon, a group that has not been studied in the past. The HCV genotypes and their distribution in the 395 thalassaemics, all of whom had been registered at the Chronic Care Center (CCC) in...

We report 4 cases of toxic leucoencephalopathy after heroin inhalation. The clinical features, which usually occur some days or even longer after the last heroin consumption, are dominated by a cerebellar syndrome. The cerebellar hemispheres are almost always affected; the cerebral hemispheres, the cerebellar peduncles and the pyramidal tract may b...

Beta-thalassemia requires life-long treatment, including regular blood transfusion and daily iron chelation by desferrioxamine, which places considerable burden on the social and psychological life of patients. It is expected that oral chelation therapy, which is easier to administer, would improve their psychosocial status. In this sutdy, intervie...

We report the case of a 41 year old patient who developed a severe cerebellar ataxia. MRI findings were suggestive of myelin damage with symmetrical involvement of the cerebellar hemispheres and, to a lesser extent, the decussation of the superior cerebellar peduncles, the corticospinal tracts and the centrum semiovale. He had been inhaling heroin...

The authors report a case of intraspinal neurenteric cyst in a 22-month-old child, who presented with acute paraplegia following a vesicourethrogram. Despite 8 days' delay in surgical decompression, he made a complete neurological recovery. Neurenteric cysts are rare congenital lesions of the spinal canal lined with an epithelium of endodermal orig...

Iron-chelating therapy with deferoxamine in patients with thalassemia major has dramatically improved the prognosis of this disease. However, the limitations of this treatment have stimulated the design of alternative orally active iron chelators. To compare the effectiveness and safety of, and compliance with, oral deferiprone (L1), and deferoxami...

A case of adrenoleukodystrophy in a 9-year old boy revealed by a predominant frontal syndrome is reported. Brain MRI showed an unusual pseudo-tumoral frontal lesion. The diagnosis was confirmed by increased plasma levels of very long chain fatty acids. His young brother had an isolated adrenal insufficiency with normal brain MRI. The frontal predom...