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Research paper
Clinical features and prognosis of amyotrophic lateral sclerosis in Africa: the TROPALS study
  1. Jaime Luna1,2,
  2. Mouhamadou Diagana1,2,3,
  3. Leila Ait Aissa4,
  4. Meriem Tazir4,
  5. Lamia Ali Pacha4,
  6. Imen Kacem5,6,
  7. Riadh Gouider5,6,
  8. Franclo Henning7,8,
  9. Anna Basse9,
  10. Ousmane Cisse9,
  11. Agnon Ayélola Koffi Balogou10,
  12. Damelan Kombate10,
  13. Mendinatou Agbetou11,12,
  14. Dismand Houinato1,2,11,12,
  15. Athanase Millogo1,2,13,14,
  16. Thierry Agba15,
  17. Mouftao Belo15,
  18. Marie Penoty1,2,16,
  19. Marie Raymondeau-Moustafa1,2,17,
  20. Bello Hamidou1,2,
  21. Philippe Couratier1,2,16,
  22. Pierre Marie Preux1,2,17,
  23. Benoit Marin1,2,17
  24. TROPALS Collaboration
    1. 1 INSERM, U1094, Tropical Neuroepidemiology, Limoges, France
    2. 2 UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges, Limoges, France
    3. 3 Département de Neurologie, CHU de Nouakchott, Nouakchott, Mauritania
    4. 4 Laboratoire de Recherche en Neurosciences, Service de Neurologie, CHU Mustapha, Sidi M’Hamed, Algeria
    5. 5 Faculty of Medicine of Tunis, University Tunis el Manar, La Manouba, Tunisia
    6. 6 Department of Neurology, Razi Hospital, La Manouba, Tunisia
    7. 7 Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
    8. 8 Centre for Research in Neurodegenerative Disease, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
    9. 9 Département de Neurologie, CHNU Fann, UCAD, Dakar, Senegal
    10. 10 Département de Neurologie, CHU Campus Université de Lomé, Lomé, Togo
    11. 11 Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Benin
    12. 12 Neurology Unit, CNHU Cotonou, Cotonou, Benin
    13. 13 Département de Neurologie, CHU Sourô Sanou, Bobo-Dioulasso, Burkina Faso
    14. 14 University of Ouagadougou, Ouagadougou, Burkina Faso
    15. 15 Université de Lomé, Lomé, Togo
    16. 16 CHU Limoges, Service de Neurologie, Centre Expert SLA, Limoges, France
    17. 17 CHU Limoges, Centre d’Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France
    1. Correspondence to Benoit Marin, UMR Inserm 1094 NET, Limoges 78000, France; benoit.marin{at}


    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.

    • amyotrophic lateral sclerosis
    • clinical features
    • prognosis
    • riluzole
    • Africa

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    • PMP and BM contributed equally.

    • Collaborators TROPALS Collaboration (in alphabetical order of country): Algeria-Alger: Leila Ait Aissa, Lamia Ali Pacha, Meriem Tazir; Algeria-Annaba: Toubal Nadia; Benin: Constant Adjien, Atokè Mendinatou Agbetou, Gilbert Avode, Dismand Houinato; Burkina Faso: Athanase Millogo; France: Philippe Couratier, Bello Hamidou, Jaime Luna, Benoît Marin, Marie Penoty, Pierre Marie Preux, Marie Raymondeau-Moustafa; Gabon: Yvonne Assegone Zeh, Philomène Kouna Ndouongo, Gertrude Mouangue, Edgard Ngoungou; Guinea: Fode Abass Cisse, Amara Cisse, Lansana Laho Diallo; Mali: Sara Diakite, Youssoufa Maiga; Mauritania: Mouhamadou Diagana, Cheikh Ould Hace, Abderrahmane Moulaye; Senegal: Anna Basse, Ousmane Cisse, Amadou Gallo Diop, Ndiaye Mansour; South Africa: Franclo Henning; Togo Lome I: Kombate Damelan, Agnon A Koffi Balogou; Togo Lome II: Thierry Agba, Mouftao Belo, Anayo Nyinévi; Tunisia: Amina Gargouri, Riadh Gouider, Imen Kacem.

    • Contributors All authors contributed significantly to this paper. PMP, BM and MD conceived the study. PMP, BM MD and PC established the objectives and the study design. MD, LAA, MT, LAP, IK, RG, FH, AB, OC, AAKB, DK, MA, DH, AM, TA and MB contributed to data acquisition. MN, BH, MR and JL performed management and validation of the data. PC reviewed the medical records. All authors contributed to interpretation of the results. JL, BH and BM performed statistical analyses. JL wrote the first manuscript version. All authors contributed to the final manuscript in terms of intellectual content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The TROPALS study followed all the dictates of the Declaration of Helsinki and was reviewed in July 2011 by an institutional review board (Comité de Protection des Personnes Sud-Ouest et Outre-mer IV, Limoges, France). All data were anonymised to protect privacy.

    • Provenance and peer review Not commissioned; externally peer reviewed.