Damelan Kombate

Clinical features and prognosis of amyotrophic lateral sclerosis in Africa: the TROPALS study

Objective We describe and compare the sociodemographic and clinical features, treatments, and prognoses and survival times of patients with amyotrophic lateral sclerosis (ALS) in Africa. Methodology We conducted a multicentre, hospital-based cohort study in Africa. Patients with ALS diagnosed in the neurology departments of participating hospitals from 2005 to 2017 were included. Subgroup analysis was performed by subcontinent. Survival analyses were conducted using the Cox proportional hazards model. Results Nine centres from eight African countries participated. A total of 185 patients with ALS were included: 114 from Northern Africa, 41 from Western Africa and 30 from Southern Africa. A male predominance (male to female ratio 2.9) was evident. The median age at onset was 53.0 years (IQR 44.5–64.0 years). The onset was bulbar in 22.7%. Only 47 patients (26.3%) received riluzole, mainly in Northern and Western Africa. The median survival from the time of diagnosis was 14.0 months (95% CI 10.7 to 17.2 months). The median survival was longer in Northern Africa (19.0 months, 95% CI 10.8 to 27.2 months) than in Western (4.0 months, 95% CI 0.8 to 7.1 months) and Southern (11.0 months, 95% CI 5.6 to 16.4 months) Africa (Breslow test, p<0.0001). Both subcontinental location and riluzole treatment independently affected survival. Conclusion More African patients with ALS were male and younger and exhibited a lower proportion of bulbar onset compared with patients with ALS from Western nations. Survival was consistent with that in Western registers but far shorter than what would be expected for young patients with ALS. The research improves our understanding of the disease in Africa.

Transe et épilepsie en milieu tamberma au Togo. Études cliniques, électroencéphalographiques et neuropsychologiques de six cas d’odueri (« celles qui tombent »)

Il n’est pas toujours facile de distinguer les vraies crises epileptiques des comportements cliniques spectaculaires, les deux pouvant etre associes ou non. Notre etude avait pour objectif de determiner si les transes que presentaient certaines femmes au cours des rites funeraires etaient en rapport avec des crises epileptiques. Materiels et methodes. Une enquete neuroepidemiologique sur l’epilepsie en milieu tamberma au Togo, menee du 30 novembre 2001 au 29 janvier 2002, a recense 6 femmes qui entraient en transe et tombaient (odueri) lors des rites funeraires (tibenti). Elles ont beneficie d’un examen clinique, neuropsychologique, electroencephalographique et ont ete suivies pendant 5 ans. Resultats. Leur âge moyen etait de 31 ± 12,4 ans ; 5 d’entre elles ne savaient ni lire ni ecrire ; toutes avaient des activites professionnelles et etaient animistes. L’examen clinique et les EEG etaient normaux. Pendant 5 ans, aucune modification clinique ni electroencephalographique n’a ete notee.Elles presentaient 4 fois plus de troubles anxieux severes et 2 fois plus de troubles depressifs severes que les temoins. Conclusion. Des investigations cliniques, electroencephalographiques et un suivi sur une longue periode permettent de distinguer une crise epileptique d’une transe.