Rania Zouari

Background: Traditional health practitioners (THP) and complementary and alternative medicines (CAM) play a well‐recognized role in Africa. However, their role in treating movement disorders (MD) remains poorly studied. Objective: This large multicenter continental study aimed to investigate the prevalence of seeking and consulting THPs and using CAMs among people with MDs in different African countries and the associated factors of their use. Methods: This study involved 12 sites within 11 African countries. We developed and distributed a structured questionnaire that documented frequency, attitudes, beliefs, and factors related to patients' engagement with THPs and use of CAMs. Results: We surveyed 1158 participants with MDs from 11 African countries in different regions of the continent. Overall engagement with THP and CAM use were reported in about a third (319 [27.5%] and 356 [30.7%], respectively) of individuals with MDs, which was associated with delayed diagnosis and medical treatment initiation and significantly varied by country, reaching up to 80%, particularly among individuals from sub‐Saharan Africa (SSA) and those with hyperkinetic MDs. Common contributing factors included unavailability, unaffordability, and lack of access to health services; misconceptions regarding disease nature; lack of curative response to medications; feeling of stigma; rural residence and patients' ethnicity; and levels of education and employment. These factors were more pronounced in patients in SSA. Conclusion: Seeking THPs and using CAM are widespread practices in African countries and have a negative impact on patients' care. Their use is related to inadequate health‐care services, misconceptions, and other factors, which are modifiable and mandate immediate and comprehensive actions. © 2026 International Parkinson and Movement Disorder Society.

A mild ataxia-dominant phenotype of Phosphomannomutase 2-congenital disorders of glycosylation (PMM2-CDG) in a Tunisian Family: broadening the geographical scope

Background: Neuromyelitis Optica (NMO) is an autoimmune neurological disorder affecting the central nervous system mainly the spinal cord and optic nerves. Typically, patients develop a severe optic neuritis and/or a longitudinally extensive transverse myelitis. Nevertheless, unusual presentation may occur especially related to lesions in brainstem or affecting large cerebral areas. Cortical blindness is very uncommon in NMO. Case presentation: We report the case of a 65-year-old woman admitted to our department for acute-onset bilateral blindness followed by paraplegia and bowel dysfunction. On examination, she had a flaccid paraplegia with pyramidal syndrome and a sharp T6 sensory level. Her ophthalmological examination revealed a markedly reduced visual acuity with a normal anterior ocular segment and fundus examination and normal response to light. Brain and spine Magnetic Resonance Imaging showed large extensive lesions affecting both occipital lobes along with longitudinally extensive myelitis suggestive of NMO. The patient was positive for anti-aquaporin 4 antibodies. After IV methylprednisolone and plasmapheresis then oral corticosteroids and azathioprine, her visual acuity significantly improved but she was left with a spastic paraplegia. Conclusion: visual impairment typically occurs in patients with NMO as part of an optic neuritis. However, in the presence of severe bilateral visual loss and the lack of signs of optic nerve damage, cortical blindness should highly be considered and Brain imaging should be performed in order to locate lesions within occipital lobes.

Paraneoplastic myelopathy (PM) is an enigmatic immune‐mediated disorder rarely associated with breast cancer (BC) and anti‐Ri antibodies. Sometimes diagnosis is difficult due to the heterogeneity of symptoms and the timing of their onset. Herein, we report the case of a woman presenting with cervical myelopathy causing spastic left hemiplegia and painful spasms. Diagnosis of PM was confirmed through the positivity of well‐characterized onconeural antibodies (anti‐Ri) and the discovery of BC after a clinical examination and multiple investigations. We highlight, through this case, the importance of onconeural antibodies in the diagnosis of paraneoplastic neurological syndromes and associated cancer.

Background: Systemic lupus erythematosus (SLE) is a common autoimmune disease with various symptoms involving multiple organs. Neuropsychological manifestations are various and generally serious. Leukoencephalopathy is particularly rare but life-threatening in patients with SLE. Results: Here, we describe the case of a young woman who developed a subacute onset intracranial hypertension, papillar edema on fundus examination, diffuse cerebral edema on brain CT scan, and diffuse leukoencephalopathy on brain magnetic resonance imaging (MRI). The immunological workup was positive for antinuclear antibodies, anti-DNA and anti-extractable nuclear antigens (ENA) antibodies. She was ultimately diagnosed with SLE and experienced significant improvement after treatment with high dose of corticosteroids, acetazolamide, and immunosuppressant. We additionally review the previously reported cases of SLE with diffuse cerebral edema and leukoencephalopathy with a focus on the possible pathophysiological mechanisms of such association. Conclusions: We highlight, through this case report and the literature review, the importance of considering SLE in patients with cerebral edema and diffuse leukoencephalopathy and treating it aggressively.

Background : Sarcoidosis is a rare idiopathic systemic inflammatory disease that mainly affects the lymph nodes, lungs, skin and eyes. Nervous system involvement is only seen in 5% of cases of sarcoidosis. Cerebral vasculitis, is particularly uncommon in patients with sarcoidosis, with serious outcome. Case presentation : We reported the case of a 55 years-old female who developed a severe hemicranial headache with nausea and vomiting. She had a history of erythema nodosum. The clinical examination showed left arm weakness and central facial paralysis, along with brisk tendon reflexes and arthralgia. Brain MRI showed a moderate subarachnoid hemorrhage, multiple acute lacunar infracts, and a large ischemic stroke over the right superficial sylvian territory; and MR angiography revealed a Moya-Moya like vasculopathy pattern and the occlusion of intracranial internal carotid arteries. Extensive laboratory workup including infectious serologies and vasculitis screen was negative; and Angiotensin-converting enzyme levels were normal. Findings in the CT chest and abdomen scan, and Broncho alveolar lavage confirmed the diagnosis of sarcoidosis. Conclusions : Cerebrovascular manifestation are uncommon in sarcoidosis. Multiple factors seem to be involved in the pathogenesis of sarcoidosis related vasculopathy. The diagnosis should be considered when recurrent infracts and hemorrhage are encountered in a patient having systemic symptoms of sarcoidosis.