The clinicodemographic profile of multiple sclerosis at Aga Khan University Hospital (Nairobi)

Background: Multiple sclerosis (MS) is the leading cause of nontraumatic disability in young adults and is the most common immune-mediated inflammatory demyelinating disease of the CNS. MS was initially considered to be rare in sub-Saharan Africa (SSA). However, there have been reports of rising trends of MS in regions with previously low prevalence. Objective: The primary objective of this study was to describe the demographic and clinical characteristics of MS patients at AKUHN. Methods: Medical records of patients with MS at the AKUHN were obtained using the ICD 10 code search at the medical records section of the hospital between the period of January 2008 and December 2018. Basic clinicodemographic data such as age, sex, date of diagnosis, presenting clinical symptoms, EDSS scores and first magnetic resonance imaging (MRI) findings were recorded. Other variables such as number of relapses since date of diagnosis and prior disease modifying therapies were also obtained. Results: We identified 99 MS patients, of which 79 were female and 68 were native Africans. Seventy-eight patients had RRMS while the rest had progressive MS. The average age of onset was 30.7 years. Fifty-four patients had vitamin D deficiency/insufficiency. One-third (33.3%) of patients had sensory symptoms at onset. The median EDSS at the last visit (2) was significantly lower than the median EDSS at the first visit (3). The mean duration from symptom onset to first MRI was 5.04 years. Thirty-nine out of 63 patients had positive CSF OCBs, while 20 out of 45 patients have abnormal VEP. Patients with RRMS who had received DMT had significantly lower relapse rates than those who were not on DMT. The time to first relapse was significantly lower in RRMS patients than SPMS patients. Eleven out of 52 patients were noncompliant to DMT. Conclusion: Majority of our cohort had relapsing disease. There was a significant delay between symptom onset and neuroimaging. A small number of patients were inappropriately on DMT. The clinical characteristics of our patients largely resemble those of AA