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An intensive search over a two-year period for cases of cerebellar and spinocerebellar degenerations in Benghazi, Libya, made through polyclinics, university hospitals and a centre for the handicapped, revealed a total of 52 patients, among whom 30 were index cases; the remainder were detected on family study. Twenty-five patients lived in Benghazi, giving a crude prevalence of 4.8/100 000 population. There were 24 patients (10 families) with hereditary spastic paraplegia (HSP), 13 (9 families) with early onset cerebellar ataxia with retained tendon reflexes (EOCA), 3 with Friedreich's ataxia (FA), 5 (1 family) with late onset cerebellar ataxia (LOCA) with pigmentary retinal degeneration and autosomal dominant inheritance, 6 single cases of LOCA and 1 with ataxia telangiectasia. There were 14 families with definite autosomal recessive inheritance and only 2 with dominant transmission. The large family size (average of 6.2 children per married woman in the patient group) and the high rate of consanguineous marriages contribute to the high incidence of familial cases, especially those with autosomal recessive inheritance. Nerve conduction studies were normal in HSP and abnormal in EOCA and FA. Computed tomographic scans revealed atrophy of the brainstem and cerebellum in 3 cases of EOCA and 2 with LOCA. No indigenous forms of the disease were observed and the clinical features differed little from the descriptions in literature. However, the relative rarity of patients with FA, in comparison with other types of hereditary ataxias, is striking.

The present documentation of 23 female patients with pseudotumour cerebri seen in Benghazi, North-Eastern Libya, over a period of 2 years constituted 21 cases with idiopathic pseudotumour and 2 patients with associated endocrine diseases. The clinical, laboratory and CT scan findings indicated idiopathic hypoparathyroidism in 1 case. The association of pseudotumour and hypothyroidism in a 40-year-old woman is suggested to be more than coincidental. The patient group was significantly more obese. Moderate to severe visual loss occurred in 9 patients. The incidence and extent of visual impairment did not correlate with the duration of symptoms, degree of obesity, use of contraceptive pills, steroid treatment, the presence of systemic hypertension, menstrual irregularity or empty sella. The incidence of 1.7 per 100,000 for the total and 3.6 per 100,000 for the female population in Benghazi observed in the present study is believed to be more than the frequency (as assessed by the hospital incidence) reported from other regions. A high prevalence of obesity may partly explain the increased occurrence of pseudotumour cerebri in North-Eastern Libya.

Out of 329 cases of stroke registered in Benghazi between November 1, 1983 and October 30, 1984, 63 patients comprising 32 males and 31 females belonged to the 15-40-year age group (stroke in the young). The annual age-specific crude incidence of stroke in the young was 39.3 and 40.3 per 100,000 for men and women, respectively. The age-adjusted incidence rate for both sexes for the age-specific (15-40 years) population was 47 per 100,000. The sex-dependent difference in the incidence was not statistically significant. These results emphasize that the high incidence of stroke in the young in Benghazi is not a reflection of the age distribution of the population. Hypertension, diabetes mellitus, heart disease and hypercholesterolemia were important components of high stroke profile in the young. One or more risk factors were identified in 78% of total young stroke victims and in all the patients under the age of 30. Eight young stroke subjects died during the study period.

An intensive search for 2 years for patients with Bell's palsy, conducted through the polyclinics, university hospitals and physiotherapy centres in Benghazi, revealed a total of 242 cases. The average annual incidence per 100,000 population was 23.35 and the age-adjusted incidence 35.72. The incidence increased with age up to the sixth decade. Seasonal clustering was noted in the months of December and January. Hypertension and diabetes mellitus were associated in 4.1% and 7% of patients, respectively. Only four patients presented during pregnancy. Recurrent facial paralysis was encountered in 5.4% of patients and was characterized by male preponderance and a tendency to recur more frequently on the same side as the initial paralysis. Familial incidence and bilateral involvement were rare features. Twelve per cent of patients who were followed up had moderate to severe residual weakness.

A total of 23 patients with motor neuron disease (MND), encompassing 17 cases of amyotrophic lateral sclerosis, 4 of progressive muscular atrophy and 2 of progressive bulbar palsy, was diagnosed in Benghazi, north-eastern Libya, between 1980 and 1985. The male to female ratio was 2.3:1. The average incidence of MND was 0.89/100,000 population/year (0.87 when age and sex-adjusted to the Libyan population). Eighteen patients were alive on the prevalence day, September 15, 1985, which provided a prevalence rate of 3.47/100,000 population (3.42 if adjusted). Age-specific incidence rates were highest in the 50- to 59-year-old age group, 8.14/100,000/year for men and 6.10/100,000/year for women. The median age at the time of diagnosis was 51 years, and the median duration for the 5 dead MND patients after the onset of the disease was 30 months. The median survival time for all MND cases combined was 42 months.

During a 12 month study period, a total of 329 incident cases of stroke occurred in Benghazi, Libya. This provided an unadjusted annual incidence rate for stroke of 63 per 100,000 population; the corresponding rates for the male and female were 69 and 58 per 100,000 respectively. The sex dependent difference in the incidence was not statistically significant. Cerebral infarction was the commonest type of stroke accounting for 80.9%. The incidence rates increased with age in all categories of stroke. Hypertension and ischaemic heart disease were common risk factors among the male patients, while diabetes and hypercholesterolaemia were more frequent in the female patients.

An epidemiologic study of adult patients (aged greater than 15 years) with epilepsy was made over a 2-year period, through the policlinics, EEG laboratory, and university hospitals in Benghazi, northeastern Libya. Based on a total of 568 patients (310 male and 258 female), the prevalence rate on 31 December 1984 was 2.3/1,000 in the population above the age of 15 years (1.9, if age standardized). The age-specific prevalence per 1,000 population decreased from 3.6 in the 15-24 year age group to 1 in the greater than 60-year age group. For 70.8% of the patients the onset of epilepsy occurred in the first 2 decades of life, and for 7.6% it commenced after the age of 40. The duration of epilepsy when first seen in the study period was less than 1 year in 14.6%, and greater than 10 years in 25.7%. The percentages of primary generalized, partial seizures secondarily generalized, simple partial, and partial complex seizures were 55.6, 18.8, 10.4, and 14.6%, respectively. Antecedents that could be considered potential causes of epilepsy were found in 17.5% of cases. Fifty-five patients had status epilepticus, 24 of whom had symptomatic epilepsy and eight recurrent status. EEG revealed generalized epileptic activity in 199 cases and focal seizure activity in 118. Computerized tomography (CT) scan, done in 219 patients, disclosed abnormal results in 50. Among those with abnormal CT scans, 84% had partial seizures. Monotherapy with carbamazepine or phenytoin was used in the majority of cases. The influence of social, cultural, and religious factors in the diagnosis and management of epilepsy as seen in Benghazi are discussed.

An epidemiological study of Parkinsonism was carried out in Benghazi situated in North-Eastern Libya. On the prevalence day, January 1, 1985, a total of 163 patients with Parkinson's disease were found living in the investigated area, which had a population of 518,745. The crude prevalence rate was 31.4 per 100,000 population and the incidence rate was 4.5 per 100,000 population per year. The average age at death was 71.2 years and the mean duration of the illness was 6.7 years. Our findings suggest that the risk of Parkinson's disease observed in the present study is intermediate to that reported among the white and black races and comparable with the yellow race and the Sardinians.

A search for Libyan patients with multiple sclerosis (MS) was made in Benghazi, located on the southern Mediterranean coast at a latitude of 32 degrees N. Twenty-one clinically definite and probable cases were detected during the period July 1982-June 1984. On the basis of 2 probable incidental cases, the incidence for 1983 was 0.8 per 100 000 of the population at risk (10-50 years). On July 1st, 1984, the rough prevalence rate for the total population was 4 per 100 000 and the age-adjusted prevalence rate was 5.9 per 100 000. This study suggests that Benghazi falls within the medium frequency band for MS. High prevalence of brainstem involvement and cerebellar dysfunction and infrequent occurrence of the severe optic-spinal form and sphincter disturbance indicates that the present group of patients resembles Western pattern of MS as opposed to Asian MS.