Emerging picture of multiple sclerosis in Kenya

Abstract

Objective: To report on the occurrence of clinical multiple sclerosis among indigenous Bantu African Kenyans who have never been out of the country. Design: A retrospective study. Setting: A private neurology and clinical electrophysiology clinic. Subjects: All the patients referred to the clinic by neurologists and other specialists for electrophysiological tests with diverse neurological complaints. The patients examined and diagnosed as having multiple sclerosis on clinical grounds and established criteria are reported. Results: Out of 2831 patients referred for electrophysiological tests over a ten year period, nine patients were diagnosed as having definite multiple sclerosis on clinical grounds. Four of these had supporting laboratory findings (MRI scans, CSF studies and visual evoked responses). The presenting symptoms were predominantly visual disturbances and somatic sensorimotor disturbances which were seen in all the patients. Cerebellar dysfunction was observed less frequently, in less than half of the patients while sphincter disturbances were conspicuously rare. The sex distribution was overwhelmingly in favour of the female at a ratio of 7:2. Apart from two patients of Indo-asian ethnicity, all the others were indigenous Bantu Africans who had never travelled outside their country before the onset of the illness. Conclusions: Multiple sclerosis occurs amongst Bantu Africans and may not be as rare as previously suggested and its prevalence is certainly on the increase. The development of higher incidence rates in communities where the illness was previously unknown may present opportune settings for the study of aetiological factors of this illness as it emerges. There is a need therefore for proper epidemiological studies to evaluate these factors, especially environmental factors, as the new disease continues to appear.