Neurology

Since the study by Dean, almost 40 years ago, there has been no systematic South African study on the prevalence of multiple sclerosis (MS) using the modern diagnostic criteria. KwaZulu-Natal (KZN), one of the nine provinces in South Africa, is home to 9.9 million people belonging to all racial groups. To determine the period prevalence of MS in KZN in the different racial groups, using the revised McDonald's criteria. The charts of all KZN patients given the diagnosis of MS were reviewed to confirm the diagnosis. All patients were contacted telephonically over a period of one month (July 2005) to determine whether they were still alive and still resident in KZN. Clinical, laboratory and treatment data were also extracted from the charts. The crude period prevalence per 100 000 for whites was 25.63, for Indians 7.59, people of mixed ancestry 1.94 and for blacks 0.22. The corresponding age standardized prevalence per 100 000 were 25.64, 7.15, 1.72 and 0.23, respectively. The clinical features were similar to that seen in the Western world. Up to half of the 167 patients had significant motor disability and optic neuritis was seen in 43/167 (25.7%) of patients. Whilst all traceable MRI brain scans showed some abnormality, 96/139 (69.1%) met three of the four McDonald's MRI criteria. CSF oligoclonal bands were present in 102 of 124 (82.3%) samples tested. MS in KZN is more frequent than previously believed and occurs in all racial groups being most frequent in whites followed by Indians. MS, although rare, does occur in blacks. The increased prevalence figures may reflect better case ascertainment and use of modern diagnostic techniques. However, an absolute increase in numbers cannot be excluded.

Background: The distinct clinicoradiological syndrome of reversible basal ganglia lesions associated with extrapyramidal movement disorders in uremic patients has rarely been described in the literature. There have been no reported cases from Africa. Methods: This study is a retrospective analysis of uremic patients presenting with extrapyramidal movement disorders in Durban, South Africa from 2003 to 2016. A review of all published studies was also undertaken. Results: Seven patients who presented with this syndrome were identified. An additional 41 cases were reported in the literature. Our seven cases showed similar characteristics to those previously reported. All patients were of Asian ethnicity and had dialysis dependent renal failure, 86% (6/7) due to diabetic nephropathy. The most frequent presentation was parkinsonism (5/7) followed by chorea (1/7) and dystonia (1/7). Typical neuroimaging findings included bilateral symmetrical basal ganglia abnormalities that were hypodens...

South Africa has the world's largest antiretroviral programme which has resulted in an increase in life expectancy in persons living with HIV. Parkinson's disease (PD) is an age-related neurodegenerative disorder. No data has been published in this setting with regards to the interaction between PD and people infected with HIV. This was a retrospective study which matched two HIV non-infected PD patients to one HIV-infected patient with PD. Patients with secondary causes of Parkinsonism were excluded. Demographic, clinical and laboratory data were extracted from the charts. Hoehn and Yahr scale was used to assess PD severity. Twenty PD patients were recruited from 1 January 2008 to 31 October 2020 and were diagnosed with HIV for a median of 72 months. The median age at onset of PD was 52 years. All patients were on antiretroviral therapy. There were no statistically significant differences in the levodopa equivalent daily dose, clinical phenotype, impulse control disorders (ICDs) and frequency of a positive family history between the two groups. HIV-infected patients had a higher frequency of dopamine dysregulation syndrome. At the end of follow-up, 3 (15%) PLH-PD had moderate to severe PD compared to 16 (40%) of PD controls. The OR of having moderate to severe PD in HIV non-infected PD patients was 4. Persons living with HIV and Parkinson's disease present with PD symptoms at a younger age, progress slower to a severe stage and respond well to dopaminergic replacement therapy.