Cases of neuromyelitis optica spectrum disorder from the East Africa region, highlighting challenges in diagnostics and healthcare access
| العنوان: | Cases of neuromyelitis optica spectrum disorder from the East Africa region, highlighting challenges in diagnostics and healthcare access |
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| المؤلفون: | Adil Suleiman, Dilraj Sokhi, Juzar Hooker, Soraiya Manji, Peter Mativo |
| المصدر: | eNeurologicalSci, Vol 22, Iss, Pp 100320-(2021) eNeurologicalSci |
| بيانات النشر: | Elsevier BV, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | nd, not done, Pediatrics, medicine.medical_specialty, Neurology, MRI, Magnetic resonance imaging, IPND, International Panel for NMOSD Diagnosis, LETM, Longitudinally extensive tranverse myelitis, Azathioprine, OCBs, Oligoclonal bands, Disease, lcsh:RC346-429, RTX, Rituximab, 03 medical and health sciences, 0302 clinical medicine, Pathognomonic, MOG, Myelin oligodendrocyte glycoprotein, Epidemiology, medicine, EDSS, Extended Disability Status Scale, Spectrum disorder, 030212 general & internal medicine, PLEX, Plasma exchange, NMOSD, Neuromyelitis optica spectrum disorder, RRMS, Relapsing-remitting multiple sclerosis, lcsh:Neurology. Diseases of the nervous system, CSF, Cerebrospinal fluid, Neuromyelitis optica, Sub-Saharan Africa, CNS, Central nervous system, business.industry, ICD-10, nternational Classification of Diseases version 10, medicine.disease, HSV-2, Herpes simplex virus type 2, Neuromyelitis optica spectrum disorder, HIV, Human immunodeficiency virus, IVMP, Intravenous methylprednisolone, Neuro-inflammation, Neuro-immunology, ON, Bilateral simultaneous or sequential optic neuritis, Original Article, Rituximab, MMF, Mycophenolate mofetil, business, TPHA, Treponema pallidum haemagglutination assay, 030217 neurology & neurosurgery, medicine.drug |
| الوصف: | Background Neuromyelitis optica spectrum disorder (NMOSD) is an auto-immune disease of the central nervous system (CNS) associated with the IgG-antibody against aquaporin-4 (AQP4-IgG). There is little published epidemiology of NMOSD from sub-Saharan Africa (SSA). Methods We retrospectively collated NMOSD cases admitted to our tertiary regional neurology centre. Results We identified 11 cases (10 female, average age 30 years). 64% (7/11) were seropositive for AQP4-IgG, measured using indirect immunofluorescence. The remaining cases could either not afford tests, or had pathognomonic radiological features. 57% (4/7) of seropositive cases had concurrent/recent CNS infection. All patients were treated with high-dose intravenous methylprednisolone (IVMP), and 36% (4/11) also had plasma exchange. Only 55% (6/11) of the patients were seen by a neurologist at presentation: they had less relapses (1.3 vs 2.4), less diagnostic delay (2.3 vs 7.4 months), and were less disabled at the end of our review period. 10 cases were immunosuppressed long-term: 60% on mycophenolate, 30% azathioprine, and one on rituximab. Conclusion Our study is the largest case series of NMOSD from the East Africa region. Patients faced challenges of access to appropriate and affordable testing, and timely availability of a neurologist at onset, which had impacts on their functional outcomes. The majority of the seropositive cases had recent/concurrent CNS infections, suggesting triggered auto-immunity. Highlights • This is the largest case series of NMOSD from the East Africa region. • Early involvement of neurologists translated to early diagnoses and better outcomes. • There remain challenges in accessing appropriate diagnostics for NMOSD. • Half the seropositive cases had recent infections, suggesting triggered auto-immunity. |
| تدمد: | 2405-6502 |
| DOI: | 10.1016/j.ensci.2021.100320 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::107e1f430965f0ef8d3fc4024d8b5a0e https://doi.org/10.1016/j.ensci.2021.100320 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....107e1f430965f0ef8d3fc4024d8b5a0e |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 24056502 |
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| DOI: | 10.1016/j.ensci.2021.100320 |