Transcript Parkinsons Disease in Africa

Parkinson’s Disease in Africa
Jacques Doumbé MD
Department of Neurology
Douala Laquintinie Hospital
Cameroon
Introduction 1
• Access to care continue to be limited in most
countries.
• Most people with Parkinson Disease(PD) have
likely not been diagnosed and never been
treated.
• In some regions of the world,none of those
that have been identified as having PD
received care for their condition.
Introduction 2
• To help increase access to care and to train
providers around the world using technology,
the Movement Disorder Society(MDS)
launched a Telemedicine Task Force in 2012.
• MDS sponsors pilot projects in
care,education,and research that can lay the
foundation for reaching the majority of people
with PD.
Definition 1
• PD is a clinical syndrome caused by lesions in
basal ganglia,predominantly in the substantia
nigra,that produce deficits in motor behavior.
• The syndrome was first cogently described by
James Parkinson in 1817 and named paralysis
agitans by Marshall Hall in 1841.
• Both description and label stress reduction in
muscle power unduly,however,omitting rigidity
and slowness of movement(akinesia),crucial to
the characteristic tetrad known as TRAP:
Definition 2
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•
•
•
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Resting Tremor
Cogwheel Rigidity
Bradykinesia/ Akinesia
Postural reflex impairment.
Of this tetrad,only resting tremor is truly
suggestive of PD,and early sign that may remain
prominent even late in the disorder.
• The others occur in varying degrees in orther
forms of parkinsonism.
Classification
• Parkinsonism is associated with several
pathologic processes that damage the
extrapyramidal system.
• Its many causes are divided into :
– Primary,or idiopathic(PD)
– Secondary parkinsonism(drugs,toxins,vascular
disease,trauma,tumor,infectious agents)
– Parkinson-plus syndromes
– Heredodegenerative diseases.
Diagnosis 1
• The cardinal signs and symptoms of PD,when
present in their entirety, impart the wellknown clinical picture of resting
tremor,rigidity,akinesia,and impairment of
postural reflexes.
• The diagnostic approach has been categorized
as:
• Clinically possible PD,the presence of any one
of the salient features;
Diagnosis 2
• Clinically probable PD,combination of any two
cardinal features;
• Clinically definite,any combination of three of
the four features.
• When not all the signs are evident,patient
must be re-examined at several- month
intervals.
Epidemiology 1
• There is limited data in sub-saharan Africa.
• Articles published fell into four
categories:clinical series(n=18),prevalence
studies(n=8),incidence studies(n=1),genetic
studies(n=3).
• The clinical series documented the occurrence
of PD in Africa and described its clinical
characteristics.
Epidemiology 2
• The prevalence studies suggested some
intracontinental geographic variation in PD
prevalence.
• The published reports on PD in Africa
emanated from 14 countries:
– Eastern Africa (Kenya,Uganda,Tanzania,Ethiopia);
– Western Africa(Nigeria,Senegal,Gana,Togo);
Epidemiology 3
• Northern Africa (Libya,Tunisia,Algeria);
• Southern Africa ( Zimbabwe,South Africa);
• Central Africa ( Cameroon).
Epidemiology 3
• The majority of prevalence studies used a
WHO screening instrument and protocol for
neurologic diseases.
• This WHO instrument was developed to
measure the prevalence of common
neurologic conditions in developing countries.
• The prevalence was between 7-20/100 000 .
Epidemiology 4
• The bulk of PD literature from Africa derived
from clinical series of patients with neurologic
diseases published either by foreign
neurologists practicing in Africa or by African
Neurologists.
• The only incidence study of PD in Africa was
conducted in Libya. The crude incidence rate
of PD was 4,5/100 000 per year;however,no
sex or age-specific data were provided.
Epidemiology 5
• An observational,cross-sectional study was
conducted by Cubo et al,2013, to compare the
clinical profile of a Cameroonian cohort of PD
to the Spanish PD cohort:
• 74 patients with PD were included and there
were no significant differences between the
Spanish and Cameroonian cohort in terms of
gender,age,PD duration and presence of
comorbidities.
Epidemiology 6
• Cameroonian PD patients were more affected
in terms of motor severity,cognitive
impairment,psychosis,patient and caregiver
quality of live.
• In terms of treatments: cameroonian patients
reported an intermittent use of PD therapies
mainly due to economical limitations.
Epidemiology 7
• PD therapies in Cameroon included levodopa
(77%),anticholinergics (21,6%), ergotic
dopamine agonists (1,4%).
• Anticholinergics therapy costs 3.5
euros/monthly
• Levodopa costs 25 euros monthly.
Epidemiology 8
• In another recent study by Kuate et
al,2013,conducted in a hospital in
yaoundé,city capital of Cameroon,out of 4526
admissions between 2005-2011,20,1% were
given a neurological diagnosis,and 2.9% were
diagnosed with PD.
Limitations 1
• The median number of neurologists per 100000
population is 0.6 in the low-income countries. In
Cameroon, 1 neurologist per 1million population.
• The median number of neurological nurses per
100 000 population across different income
groups of countries also varies. It is 0 for lowincome countries, 5,04 for higher middle-income
countries,and 0.38 for mild- income countries.
Limitations 2
• The frequency of neurological disorders in
various settings is a rough estimate; data were
not collected and calculated using stringent
epidemiological research methods as for
prevalence studies.
• PD,like many other chronic diseases receives
little recognition in the developing world.
Implications 1
• Neurologists are essential in order to provide
comprehensive neurological care and training.
• The inequity in the number of neurologists
observed across countries in different income
groups needs to be specifically dealt with.
• While training for neurologists is being
pursued,specialized neurological nursing
training has been neglected even in developed
countries.
Implications 2
• In countries where no formal training facilities
exist for neurological nursing,general nurses
can be trained to provide specific neurological
care.
• Integration of neurological care for common
illnesses into primary health care is essential
for extending health services to underserved
areas in developing countries.
Conclusion
• PD occurs worldwide but little is known about
PD in Africa because:
• Lack of neurologists and neurological nurses
• Lower income
• Lack of solid health information system.