Inflammatory demyelinating diseases of the central nervous system in Niger. 2019

H Assadeck, and M Toudou Daouda, and É Adehossi Omar, and Z Mamadou, and F Hassane Djibo, and D Douma Maiga
Service de médecine interne et spécialités médicales, Hôpital National de Niamey, BP 238, Niamey, Niger; Faculté des sciences de la santé, Université Abdou Moumouni de Niamey, Niamey, Niger. Electronic address: assadeckhamid@yahoo.fr.

BACKGROUND In sub-Saharan Africa (SSA), few studies have been reported on inflammatory demyelinating diseases of the central nervous system (CNS). Neuromyelitis optica spectrum disorders (NMOSD) seems to be the most frequent inflammatory demyelinating disease of CNS in sub-Saharan Africans or people of sub-Saharan African descent. METHODS We report the observations of seven patients from Niger diagnosed with inflammatory demyelinating diseases of CNS over a period of 21 years (1996-2017). RESULTS They were four women and three men aged 19 to 66 years (mean age: 37 years), with no known past medical history. Four patients were diagnosed with NMOSD (2 men and 2 women) and the three other patients with multiple sclerosis (MS, 2 women and 1 man). The three patients diagnosed with MS had the relapsing-remitting form. The cerebrospinal fluid study revealed the presence of oligoclonal bands in the three patients. Of the patients diagnosed with NMOSD, two patients negative anti-aquaporin 4 antibodies (anti-MOG antibodies not done), one of whom had bilateral optic neuritis (ON) with longitudinally extensive transverse myelitis (LETM) and the other unilateral ON with LETM. Two patients with MS were treated with interferon beta-1a and the third patient with azathioprine. The Expanded Disability Status Scale ranged from 1 to 2 in these three patients at the time of initiation of background treatment. Azathioprine was the treatment prescribed in the four patients with NMOSD. We did not find any case of acute disseminated encephalomyelitis. CONCLUSIONS Our case series suggests the rarity of inflammatory demyelinating diseases of CNS in Niger, and NMOSD seems to be more frequent than MS.

UI MeSH Term Description Entries
D007166 Immunosuppressive Agents Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of T-CELLS or by inhibiting the activation of HELPER CELLS. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of INTERLEUKINS and other CYTOKINES are emerging. Immunosuppressant,Immunosuppressive Agent,Immunosuppressants,Agent, Immunosuppressive,Agents, Immunosuppressive
D007249 Inflammation A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. Innate Inflammatory Response,Inflammations,Inflammatory Response, Innate,Innate Inflammatory Responses
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009103 Multiple Sclerosis An autoimmune disorder mainly affecting young adults and characterized by destruction of myelin in the central nervous system. Pathologic findings include multiple sharply demarcated areas of demyelination throughout the white matter of the central nervous system. Clinical manifestations include visual loss, extra-ocular movement disorders, paresthesias, loss of sensation, weakness, dysarthria, spasticity, ataxia, and bladder dysfunction. The usual pattern is one of recurrent attacks followed by partial recovery (see MULTIPLE SCLEROSIS, RELAPSING-REMITTING), but acute fulminating and chronic progressive forms (see MULTIPLE SCLEROSIS, CHRONIC PROGRESSIVE) also occur. (Adams et al., Principles of Neurology, 6th ed, p903) MS (Multiple Sclerosis),Multiple Sclerosis, Acute Fulminating,Sclerosis, Disseminated,Disseminated Sclerosis,Sclerosis, Multiple
D009188 Myelitis, Transverse Inflammation of a transverse portion of the spinal cord characterized by acute or subacute segmental demyelination or necrosis. The condition may occur sporadically, follow an infection or vaccination, or present as a paraneoplastic syndrome (see also ENCEPHALOMYELITIS, ACUTE DISSEMINATED). Clinical manifestations include motor weakness, sensory loss, and incontinence. (Adams et al., Principles of Neurology, 6th ed, pp1242-6) Demyelinative Myelitis,Transverse Myelitis,Myelitis, Acute Transverse,Myelitis, Necrotizing,Myelitis, Paraneoplastic,Myelitis, Postinfectious,Myelitis, Postvaccinal,Myelitis, Subacute Transverse,Postinfectious Myelitis,Transverse Myelopathy Syndrome,Acute Transverse Myelitis,Myelitides, Subacute Transverse,Myelitis, Demyelinative,Necrotizing Myelitis,Paraneoplastic Myelitis,Postvaccinal Myelitis,Subacute Transverse Myelitis,Transverse Myelitis, Acute,Transverse Myelitis, Subacute,Transverse Myelopathy Syndromes
D009548 Niger A republic in western Africa, north of NIGERIA and west of CHAD. Its capital is Niamey. Republic of Niger
D009902 Optic Neuritis Inflammation of the optic nerve. Commonly associated conditions include autoimmune disorders such as MULTIPLE SCLEROSIS, infections, and granulomatous diseases. Clinical features include retro-orbital pain that is aggravated by eye movement, loss of color vision, and contrast sensitivity that may progress to severe visual loss, an afferent pupillary defect (Marcus-Gunn pupil), and in some instances optic disc hyperemia and swelling. Inflammation may occur in the portion of the nerve within the globe (neuropapillitis or anterior optic neuritis) or the portion behind the globe (retrobulbar neuritis or posterior optic neuritis). Neuropapillitis,Retrobulbar Neuritis,Anterior Optic Neuritis,Posterior Optic Neuritis,Anterior Optic Neuritides,Neuritides, Anterior Optic,Neuritides, Optic,Neuritides, Posterior Optic,Neuritides, Retrobulbar,Neuritis, Anterior Optic,Neuritis, Optic,Neuritis, Posterior Optic,Neuritis, Retrobulbar,Neuropapillitides,Optic Neuritides,Optic Neuritides, Anterior,Optic Neuritides, Posterior,Optic Neuritis, Anterior,Optic Neuritis, Posterior,Posterior Optic Neuritides,Retrobulbar Neuritides
D002493 Central Nervous System Diseases Diseases of any component of the brain (including the cerebral hemispheres, diencephalon, brain stem, and cerebellum) or the spinal cord. CNS Disease,Central Nervous System Disease,Central Nervous System Disorder,CNS Diseases,Central Nervous System Disorders
D003711 Demyelinating Diseases Diseases characterized by loss or dysfunction of myelin in the central or peripheral nervous system. Clinically Isolated CNS Demyelinating Syndrome,Clinically Isolated Syndrome, CNS Demyelinating,Demyelinating Disorders,Demyelination,Demyelinating Disease,Demyelinating Disorder,Demyelinations

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