Neuromyelitis optica spectrum disorders (NMO-SD) in a Sub-Saharan Africa country: A preliminary study of sixteen Senegalese cases

Neuromyelitis Optica Spectrum Disorders in Black African: Experience of Togo (2015–2020)

“…This is comparable to the low frequency reported in black African: four cases in 5 years in Mali, 10 seven cases in 6 years in Ivory Coast, 14 and sixteen cases in 7 years in Senegal. 13 This contrasts with some studies that have shown a high prevalence in non-Caucasian populations. 7 16 This relative rarity of NMOSD in black African could be related to an underestimation in connection with the difficulties of access to care and the lack of knowledge of health professionals in black African.…”

“…Thus, the medullary presentation is almost constant and the opticomedullary presentation is frequent, while encephalic presentations such as area postrema syndrome are rare, as reported in Senegal. 13 …”

“…Since Osuntokun in Nigeria in 1970, 8 cases of NMO/NMOSD have been reported in black African countries. 9 10 11 12 13 14 In Togo, nearly 55% of the population lives in multidimensional poverty, the guaranteed interprofessional minimum wage (GIMW) is 35,000 CFA francs ($US64), while the rate of health insurance coverage is estimated at nearly 5%. We conducted a hospital-based study with the objective of describing possible peculiarities of NMOSD in our setting.…”

Rectifying global inequities in neuromyelitis optica diagnosis and treatment

“…8,9 Many countries cannot access a consistent supply of oral antitransplant medicines, let alone intravenous regulatory agencies-approved DMTs for NMO. Based on clinical experience and several reports from geographically diverse settings, [10][11][12][13][14][15] this often leads to one of the following suboptimal situations in lowerincome countries: no immunosuppressive therapy, intermittent immunosuppression, under-dosing, chronic oral steroids with their various side effects, or use of cyclophosphamide or methotrexate with serious potential risks to women of childbearing potential. Rituximab, an efficacious agent in NMO, usually given intravenously, remains variably available, and even biosimilars of rituximab are too costly for many health systems.…”

“…Tracking disease incidence and outcomes to identify missed opportunities-Monitoring and evaluation of NMO treatment in lower-income settings could clarify the true incidence, prevalence, and outcomes of NMO during optimal care and alert clinicians when current efforts are insufficient. To date, many reports on NMOSD in lowest-income settings report few data on treatment and clinical outcomes, [10][11][12][13][14][15][16] necessitating vigilance and monitoring of future regional and global efforts.…”