Parkinson Disease in sub-Sahara Africa: Challenges, Awareness, Access and Care: A Review

Background: Parkinson‟s disease (PD) is the second most common neurodegeneratrive disorder after Alzheimer‟s disease in the world today. PD affects 62 million people and resulted in about 117,400 deaths globally. PD mortality and disability is especially minimal in Sub-Sahara Africa (SSA) which accounts for as much as 21% of all the PD deaths. PD has no cure but medications, surgery and physical treatment provide relief. Methods: We reviewed the literature on PD in SSA. We searched the MEDLINE, PUBMED and African Journal online for studies on PD in Sub-Sahara Africa, and included those that were community based, conducted in any Sub-Sahara Africa country and reported on challenges, awareness, mortality, risk factors and care. Results: We found few community-based studies. Most of the studies were hospital based. There were few studies on PD mortality and risk factors in SSA. Few studies dealt with issues of access to PD care. Most of the studies on PD care showed that care is still not mostly supportive. South Africa performs slightly better than other SSA. Conclusion: There have not been many studies on optimal Parkinson disease care in SSA. The few studies seen showed that care has not been majorly supportive.

Keywords: Parkinson Disease, Challenges, Awareness, Access and Care.

Dotchin CL, Msuya O, Walker RW. The challenge of Parkinson‟s disease management in Africa. Age Ageing. 2007;36:122–127.

Winkler AS, Tütüncü E, Trendafilova A, Meindl M, Kaaya J, Schmutzhard E, et al. Parkinsonism in a population of northern Tanzania: a community-based door-to-door study in combination with a prospective hospital-based evaluation. J Neurol. 2010;257:799–805.

Femi OL, Ibrahim A, Aliyu S. Clinical profile of parkinsonian disorders in the tropics: Experience at Kano, northwestern Nigeria. J Neurosci Rural Pract. 2012;3:237–241.

Cubo E, Doumbe J, Martinez-Martin P, Rodriguez-Blazquez C, Kuate C, Mariscal N, et al. Comparison of the clinical profile of Parkinson‟s disease between Spanish and Cameroonian cohorts. J Neurol Sci. 2014;336:122–126.

Bower JH, Teshome M, Melaku Z, Zenebe G. Frequency of movement disorders in an Ethiopian university practice. Mov Disord. 2005;20:1209–1213.

Dotchin C, Jusabani A, Walker R. Three year follow up of levodopa plus carbidopa treatment in a prevalent cohort of patients with Parkinson‟s disease in Hai, Tanzania. J Neurol. 2011;258:1649–1656.

Ogunniyi A. Treatment of parkinsonian syndromes in developing countries. Afr J Med Med Sci. 1997;26:101–103.

Mokaya J, Dotchin CL, Gray WK, Hooker J, Walker RW. The accessibility of Parkinson‟s disease medication in Kenya: results of a national survey. Mov Disord Clin Pract. 2016;3:376–381. 

Mshana G, Dotchin CL, Walker RW. „We call it the shaking illness‟: perceptions and experiences of Parkinson‟s disease in rural northern Tanzania. BMC Public Health. 2011;11:219.

Dotchin C, Walker R. The management of Parkinson‟s disease in sub-Saharan Africa. Expert Rev Neurother. 2012;12:661–666.

Cilia R, Akpalu A, Sarfo FS, Cham M, Amboni M, Cereda E, et al. The modern pre-levodopa era of Parkinson‟s disease: insights into motor complications from sub-Saharan Africa. Brain Neurological Disorders: Public Health Challenges. Geneva: World Health Organization; 2006.

Akinyemi RO. Epidemiology of Parkinsonism and Parkinson‟s disease in Sub-Saharan Africa: Nigerian profile. J Neurosci Rural Pract. 2012;3:233–234.

Blanckenberg J, Bardien S, Glanzmann B, Okubadejo NU, Carr JA. The prevalence and genetics of Parkinson‟s disease in sub-Saharan Africans. J Neurol Sci. 2013;335:22–25.

Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson‟s disease: a clinicopathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55:181–184.

Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, et al. MDS clinical diagnostic criteria for Parkinson‟s disease. Mov Disord. 2015;30:1591–1601.

Tucci A, Charlesworth G, Sheerin UM, Plagnol V, Wood NW, Hardy J. Study of the genetic variability in a Parkinson‟s Disease gene: EIF4G1. Neurosci Lett. 2012;518:19–22.

Okubadejo N, Britton A, Crews C, Akinyemi R, Hardy J, Singleton A, et al. Analysis of Nigerians with apparently sporadic Parkinson disease for mutations in LRRK2, PRKN and ATXN3. PLoS One. 2008;3:e3421.

Blanckenberg J, Ntsapi C, Carr JA, Bardien S. EIF4G1 R1205H and VPS35 D620N mutations are rare in Parkinson‟s disease from South Africa. Neurobiol Aging. 2014;35:445.e1–3.

Hauser RA, Grosset DG. [(123) I]FP-CIT (DaTscan) SPECT Brain Imaging in Patients with Suspected Parkinsonian Syndromes. J Neuroimaging. 2011 Mar 16.

Wirdefeldt K, Adami HO, Cole P, Trichopoulos D, Mandel J. Epidemiology and etiology of Parkinson's disease: a review of the evidence. Eur J Epidemiol. 2011 Jun. 26 Suppl 1:S1-58.

Anderson P. More Evidence Links Pesticides, Solvents, With Parkinson's. Medscape Medical News. Available at http://www.medscape.com/viewarticle/804834. Accessed: June 11, 2013.

Pezzoli G, Cereda E. Exposure to pesticides or solvents and risk of Parkinson disease. Neurology. 2013 May 28. 80(22):2035-41.

Liu R, Guo X, Park Y, Huang X, Sinha R, Freedman ND, et al. Caffeine Intake, Smoking, and Risk of Parkinson Disease in Men and Women. Am J Epidemiol. 2012 Apr 13.

Haylett WL, Keyser RJ, du Plessis MC, van der Merwe C, Blanckenberg J, Lombard D, et al. Mutations in the parkin gene are a minor cause of Parkinson‟s disease in the South African population. Parkinsonism Relat Disord. 2012;18:89–92.

Keyser RJ, Oppon E, Carr JA, Bardien S. Identification of Parkinson‟s disease candidate genes using CAESAR and screening of MAPT and SNCAIP in South African Parkinson‟s disease patients. J Neural Transm (Vienna) 2011;118:889–897.

Keyser RJ, Lesage S, Brice A, Carr J, Bardien S. Assessing the prevalence of PINK1 genetic variants in South African patients diagnosed with early- and late-onset Parkinson‟s disease. Biochem Biophys Res Commun. 2010;398:125–129.

Hoops S, Nazem S, Siderowf AD, Duda JE, Xie SX, Stern MB. Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson.

Bardien S, Marsberg A, Keyser R, Lombard D, Lesage S, Brice A, et al. LRRK2 G2019S mutation: frequency and haplotype data in South African Parkinson‟s disease patients. J Neural Transm (Vienna) 2010;117:847–853.

World Bank World Development Indicators: Population Dynamics 2014. [cited 2014 July 3]. Available from: http://data.worldbank.org.

Dotchin C, Msuya O, Kissima J, Massawe J, Mhina A, Moshy A, et al. The prevalence of Parkinson‟s disease in rural Tanzania. Mov Disord. 2008;23:1567–1572.

Gibb WR, Lees AJ. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson‟s disease. J Neurol Neurosurg Psychiatry. 1988;51:745–752.

Fall PA, Axelson O, Fredriksson M, Hansson G, Lindvall B, Olsson JE, et al. Age-standardized incidence and prevalence of Parkinson‟s disease in a Swedish community. J Clin Epidemiol. 1996;49:637–641.

Wright Willis A, Evanoff BA, Lian M, Criswell SR, Racette BA. Geographic and ethnic variation in Parkinson disease: a population-based study of US Medicare beneficiaries. Neuroepidemiology. 2010;34:143–151.

Talabi OA. A 3-year review of neurologic admissions in University College Hospital Ibadan, Nigeria. West Afr J Med. 2003;22:150–151.

Lombard A, Gelfand M. Parkinson‟s disease in the African. Cent Afr J Med. 1978;24:5–8.

Atadzhanov M, Mwaba P. Disorders of the basal ganglia at the University Teaching Hospital, Lusaka. Med J Zambia. 2009;36:78–84.

National Collaborating Centre for Chronic Conditions (UK) Parkinson‟s Disease: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care. London: Royal College of Physicians; 2006.

Grimes D, Gordon J, Snelgrove B, Lim-Carter I, Fon E, Martin W, et al. Canadian guidelines on Parkinson‟s disease. Can J Neurol Sci. 2012;39(4 Suppl 4):S1–S30.

WHO. Atlas: Country Resources for Neurological Disorders 2004. Geneva: World Health Organization; 2004.

Jung A, Raman A, Mallewa M, Solomon T. Neurology research and teaching in Malawi. Clin Med (Lond) 2009;9:570–571.

Dotchin CL, Akinyemi RO, Gray WK, Walker RW. Geriatric medicine: services and training in Africa. Age Ageing. 2013;42:124–128.

Walker R. Parkinson‟s disease in Sub-Saharan Africa. Moving Along. 2013;17:1–23.

Walker R, Ebeneezer L, Dotchin C, Hind L, Msuya M, Daniels M, et al. A Parkinson‟s disease nurse specialist course for East Africa [abstract] Movement Disorders. 2013;28 Suppl 1:1073.

Hauser RA, Grosset DG. [(123) I]FP-CIT (DaTscan) SPECT Brain Imaging in Patients with Suspected Parkinsonian Syndromes. J Neuroimaging. 2011 Mar 16.

Wirdefeldt K, Adami HO, Cole P, Trichopoulos D, Mandel J. Epidemiology and etiology of Parkinson's disease: a review of the evidence. Eur J Epidemiol. 2011 Jun. 26 Suppl 1:S1-58.

Anderson P. More Evidence Links Pesticides, Solvents, With Parkinson's. Medscape Medical News. Available at http://www.medscape.com/viewarticle/804834. Accessed: June 11, 2013.

Pezzoli G, Cereda E. Exposure to pesticides or solvents and risk of Parkinson disease. Neurology. 2013 May 28. 80(22):2035-41.

Liu R, Guo X, Park Y, Huang X, Sinha R, Freedman ND, et al. Caffeine Intake, Smoking, and Risk of Parkinson Disease in Men and Women. Am J Epidemiol. 2012 Apr 13.

Ballard PA, Tetrud JW, Langston JW. Permanent human parkinsonism due to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP): seven cases. Neurology. 1985 Jul. 35(7):949-56.

Tanner CM, Ottman R, Goldman SM, Ellenberg J, Chan P, Mayeux R, et al. Parkinson disease in twins: an etiologic study. JAMA. 1999 Jan 27. 281(4):341-6.

Polymeropoulos MH, Lavedan C, Leroy E, Ide SE, Dehejia A, Dutra A, et al. Mutation in the alpha-synuclein gene identified in families with Parkinson's disease. Science. 1997 Jun 27. 276(5321):2045-7.

Krüger R, Kuhn W, Müller T, Woitalla D, Graeber M, Kösel S, et al. Ala30Pro mutation in the gene encoding alpha-synuclein in Parkinson's disease. Nat Genet. 1998 Feb. 18(2):106-8.

Bekris LM, Mata IF, Zabetian CP. The genetics of Parkinson disease. J Geriatr Psychiatry Neurol. 2010 Dec. 23(4):228-42.

Alcalay RN, Caccappolo E, Mejia-Santana H, Tang MX, Rosado L, Ross BM, et al. Frequency of known mutations in early-onset Parkinson disease: implication for genetic counseling: the consortium on risk for early onset Parkinson disease study. Arch Neurol. 2010 Sep. 67(9):1116-22.

Samanta J, Hauser RA. Duodenal levodopa infusion for the treatment of Parkinson's disease. Expert Opin Pharmacother. 2007 Apr. 8(5):657-64.

Vekrellis K, Xilouri M, Emmanouilidou E, Rideout HJ, Stefanis L. Pathological roles of a-synuclein in neurological disorders. Lancet Neurol. 2011 Nov. 10(11):1015-25.

Kordower JH, Chu Y, Hauser RA, Freeman TB, Olanow CW. Lewy body-like pathology in long-term embryonic nigral transplants in Parkinson's disease. Nat Med. 2008 May. 14(5):504-6.

Dalvin LA, Damento GM, Yawn BP, Abbott BA, Hodge DO, Pulido JS. Parkinson Disease and Melanoma: Confirming and Reexamining an Association. Mayo Clin Proc. 2017 Jul. 92 (7):1070-1079.

Mulcahy, N. Melanoma, Parkinson's: See One, Be Aware of the Other. Medscape Medical News. Available at http://www.medscape.com/viewarticle/883195. July 19, 2017; Accessed: July 26, 2017.

Constantinescu R, Elm J, Auinger P, Sharma S, Augustine EF, Khadim L, et al. Malignant melanoma in early-treated Parkinson's disease: the NET-PD trial. Mov Disord. 2014 Feb. 29 (2):263-5.

De Pablo-Fernandez E, Goldacre R, Pakpoor J, Noyce AJ, Warner TT. Association between diabetes and subsequent Parkinson disease: A record-linkage cohort study. Neurology. 2018 Jun 13.

Muangpaisan W, Mathews A, Hori H, Seidel D. A systematic review of the worldwide prevalence and incidence of Parkinson's disease. J Med Assoc Thai. 2011 Jun. 94(6):749-55.

Weintraub D, Comella CL, Horn S. Parkinson's disease--Part 3: Neuropsychiatric symptoms. Am J Manag Care. 2008 Mar. 14(2 Suppl):S59-69.

Reid WG, Hely MA, Morris JG, Loy C, Halliday GM. Dementia in Parkinson's disease: a 20-year neuropsychological study (Sydney Multicentre Study). J Neurol Neurosurg Psychiatry. 2011 Sep. 82(9):1033-7.

Parkinson's Tied to Higher Risk of Osteoporosis and Osteopenia. Medscape. Apr 3 2014.

Torsney KM, Noyce AJ, Doherty KM, et al. Bone health in Parkinson's disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2014 Mar 21.

Tolosa E, Gaig C, Santamaría J, Compta Y. Diagnosis and the premotor phase of Parkinson disease. Neurology. 2009 Feb 17. 72(7 Suppl):S12-20.

King J. New contrast agent enables earlier diagnosis in Parkinson's. Medscape Medical News. June 18, 2013.

Seibyl J, Jennings D, Grachev I, Coffey C, Marek K. Accuracy of DaTscan™ (ioflupane I 123 injection) in diagnosis of early parkinsonian syndromes (PS) [abstract 191]. Presented at:2013 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI); June 10, 2013; Vancouver, British Columbia, Canada.

Braak H, Ghebremedhin E, Rüb U, Bratzke H, Del Tredici K. Stages in the development of Parkinson's disease-related pathology. Cell Tissue Res. 2004 Oct. 318(1):121-34.

Kang JH, Irwin DJ, Chen-Plotkin AS, Siderowf A, Caspell C, Coffey CS, et al. Association of Cerebrospinal Fluid ß-Amyloid 1-42, T-tau, P-tau181, and a-Synuclein Levels With Clinical Features of Drug-Naive Patients With Early Parkinson Disease. JAMA Neurol. 2013 Aug 26.

Jeffrey S. Biomarkers for Parkinson's Diagnostic, Prognostic. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/810262. Accessed: September 9, 2013.

Grosset D, Taurah L, Burn DJ, MacMahon D, Forbes A, Turner K, et al. A multicentre longitudinal observational study of changes in self reported health status in people with Parkinson's disease left untreated at diagnosis. J Neurol Neurosurg Psychiatry. 2007 May. 78(5):465-9.

Caslake R, Macleod A, Ives N, Stowe R, Counsell C. Monoamine oxidase B inhibitors versus other dopaminergic agents in early Parkinson's disease. Cochrane Database Syst Rev. 2009. (4):CD006661.

Antonini A, Cilia R. Behavioural adverse effects of dopaminergic treatments in Parkinson's disease: incidence, neurobiological basis, management and prevention. Drug Saf. 2009. 32(6):475-88.

Bayulkem K, Lopez G. Clinical approach to nonmotor sensory fluctuations in Parkinson's disease. J Neurol Sci. 2011 Nov 15. 310(1-2):82-5.

Miyasaki JM, Shannon K, Voon V, Ravina B, Kleiner-Fisman G, Anderson K, et al. Practice Parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006 Apr 11. 66(7):996-1002.

Zesiewicz TA, Sullivan KL, Arnulf I, et al. Practice Parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010 Mar 16. 74(11):924-31.

Stocchi F, Rascol O, Kieburtz K, et al. Initiating levodopa/carbidopa therapy with and without entacapone in early Parkinson disease: the STRIDE-PD study. Ann Neurol. 2010 Jul. 68(1):18-27.

Hauser RA, McDermott MP, Messing S. Factors associated with the development of motor fluctuations and dyskinesias in Parkinson disease. Arch Neurol. 2006 Dec. 63(12):1756-60.

Rascol O, Brooks DJ, Korczyn AD, De Deyn PP, Clarke CE, Lang AE. A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa. 056 Study Group. N Engl J.