Overview

Little PD-related studies have been published from Africa, so far.^1,2 However, because Africa is experiencing a demographic transition, the population will become much older by 2015 (increase in the percentage of persons aged 65 and over),^2,3 and diseases predominantly affecting older persons, such as PD are expected to become more common. To date, there have been no case– control or cohort studies of PD in Africa, and there is no information regarding environmental or genetic risk factors for PD in Africa. Data on several aspects of PD, including drug responsiveness, quality of life, survival, and other socioeconomic effects of PD in Africa are also lacking.¹

We believe that a large international collaboration addressing these issues would fill a large gap in knowledge about movement disorders in Africa, because the greatest challenges facing researchers in Africa are the scarcity of money, manpower, and materials. Although the WHO estimates that one neurologist is needed for a population of 100,000 people,³ in Africa, there are an estimated 0.3 neurologists per million.⁴

Such a scientific effort would not only benefit African populations by allowing them to plan for their future health care needs, but also benefit the world population by providing more clues regarding the etiology of PD, either genetic or environmental.^1,2 The identification of environmental causes (i.e. neurotoxins) aims to possibly reduce PD incidence by preventing the exposure.

The project

The aim of our project is:

1. to study the epidemiology (prevalence, risk factors) of PD and other  parkinsonian disorders in Sub-Saharan Africa population;

2. to characterize the genetics profile of all patients with PD trough DNA analysis;

3. to investigate motor and non-motor clinical features of PD in these countries. Particular interest will be focused on the relationship among disease duration, the duration of levodopa treatment and motor fluctuations/dyskinesieas.

Primary objectives:

- Clinical screening of all patients with extrapyramidal symptoms in order to identify any individuals with Parkinson's disease and provide long-term treatment with dopaminergic drugs (levodopa and dopamine agonists)

- Prevalence estimate of idiopathic PD, atypical parkinsonisms, parkinsonism with dementia and secondary parkinsonisms.

- Detailed assessment of clinical features, including non-motor symptoms and motor complications.

- Identification of risk factors: 1) Environmental 2) Genetic

Secondary objectives:

- Adequate training on PD and similar syndromes for local physicians

- Screening of new patients with suspected parkinsonism by local doctors and creation of complete patient files, including medical history questionnaire and basic clinical assessment form

Achievements so far

We started our project in Ghana (Comboni Polyclinic, Sogakofe; Korle Bu Teaching Hospital, Accra) in December 2008 and recently extended to Zambia (Mtendere Hospital, Chirundu) in May 2010.

So far we identified over 30 subjects with probable idiopathic Parkinson’s Disease, most of whom never treated before with any dopaminergic medication.

Some patients subject had over 10-year disease duration and showed an impressive improvement of motor performance and quality of life after the initiation of chronic levodopa treatment.

Notably, this patient provided us of some insights into the mechanisms of motor fluctuations, as he started showing dyskinesias just few weeks after the initiation of low-doses of chronic levodopa treatment.

We believe that this latter finding gives a compelling evidence that disease progression –and not long lasting levodopa treatment- plays a central role in the development of dyskinesias.

In addition, we identified a subject with atypical parkinsonism such as probable Progressive Supranuclear  Palsy,

few subjects with additional dementia (including probable Lewy bodies dementia)

and two cases with secondary parkinsonism due to diffuse cerebrovascular disease. Furthemore, we reviewed several subjects with other movement disorders, such as sporadic and familial essential tremor

and dystonia

among others.

All patients gave consent to make these movies.

(Last update 08 June 2010)

References

1. Okubadejo NU, Bower JH, Rocca WA, Maraganore DM.Parkinson’s Disease in Africa: A Systematic Review of Epidemiologic and Genetic Studies. Mov Disord 2006; 21(12) 2150–2156.

2. Dotchin C, Msuya O, Kissima J, Massawe J, Mhina A, Moshy A, Aris E, Jusabani A, Whiting D, Masuki G, Walker R. The prevalence of Parkinson's disease in rural Tanzania. Mov Disord. 2008 Aug 15;23(11):1567-672

3. Heligman L, Chen N, Babakol O. Shifts in the structure of population and deaths in less developed regions. In: Gribble JN, Preston SH, editors. The Epidemiological Transition. Policy and Planning Implications for Developing Countries. Washington, DC: National Academy Press; 2000. p 9–41.

4. Medina MT, Munsat T, Potera-Sanchez A, et al. Developing a neurology training program in Honduras: A joint project of neurologists in Honduras and the World Federation of Neurology. J Neurol Sci 2007;253:7–17.

5. Bower JH, Zenebe G. Neurologic services in the nations of Africa. Neurology 2005;64:412–415.

6. World Health Organization, Neuroscience Programme. Research protocol for measuring the prevalence of neurological disorders in developing countries. Geneva: World Health Organization; 1981.

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