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BACKGROUND: In sub-Saharan Africa (SSA), few studies have been reported on inflammatory demyelinating diseases of the central nervous system (CNS). Neuromyelitis optica spectrum disorders (NMOSD) seems to be the most frequent inflammatory demyelinating disease of CNS in sub-Saharan Africans or people of sub-Saharan African descent. METHODS: We report the observations of seven patients from Niger diagnosed with inflammatory demyelinating diseases of CNS over a period of 21 years (1996-2017). RESULTS: They were four women and three men aged 19 to 66 years (mean age: 37 years), with no known past medical history. Four patients were diagnosed with NMOSD (2 men and 2 women) and the three other patients with multiple sclerosis (MS, 2 women and 1 man). The three patients diagnosed with MS had the relapsing-remitting form. The cerebrospinal fluid study revealed the presence of oligoclonal bands in the three patients. Of the patients diagnosed with NMOSD, two patients negative anti-aquaporin 4 antibodies (anti-MOG antibodies not done), one of whom had bilateral optic neuritis (ON) with longitudinally extensive transverse myelitis (LETM) and the other unilateral ON with LETM. Two patients with MS were treated with interferon beta-1a and the third patient with azathioprine. The Expanded Disability Status Scale ranged from 1 to 2 in these three patients at the time of initiation of background treatment. Azathioprine was the treatment prescribed in the four patients with NMOSD. We did not find any case of acute disseminated encephalomyelitis. CONCLUSION: Our case series suggests the rarity of inflammatory demyelinating diseases of CNS in Niger, and NMOSD seems to be more frequent than MS.

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We report the first documented case of Lewis-Sumner syndrome observed in the Department of Neurology of the National Hospital of Niamey, Niger. It was a 53-year-old man with no known past medical history, who presented paresthesia on the right hand in the median nerve territory about 2 weeks after a flu-like syndrome. The symptoms progressed rapidly in two weeks with asymmetric sensitivomotor involvement of the 4 limbs with a predominance to the upper limbs. The electrophysiological study revealed persistent motor conduction blocks with a decrease in sensory amplitudes and sensory conduction velocities. Cerebrospinal fluid study revealed a proteinorachia at 0.4g/l with normal glycorachia without meningitis. After ruling out other systemic and infectious diseases that explains the clinical picture, the diagnosis of Lewis-Sumner syndrome has been established in the patient based on clinical and electrophysiological arguments. The patient was treated with intravenous immunoglobulins 0.4g/kg per day during 5 days with a good clinical response.

Nous rapportons le premier cas documenté du syndrome de Lewis-Sumner (SLS) observé dans le service de neurologie de l'hôpital national de Niamey, Niger. Il s'agissait d'un homme de 53 ans, sans antécédents pathologiques connus, qui a présenté environ deux semaines après un syndrome pseudogrippal, des paresthésies dans la main droite dans le territoire du nerf médian. L'évolution s'est faite de façon rapidement progressive en deux semaines avec une atteinte sensitivomotrice asymétrique des quatre membres avec une prédominance aux membres supérieurs. L'étude électrophysiologique révélait la présence des blocs de conduction moteurs persistants, avec une diminution des amplitudes sensitives et des vitesses de conduction sensitive. L'étude du liquide céphalorachidien révélait une protéinorachie à 0,4 g/l, une glycorachie normale sans méningite. Après avoir éliminé certaines maladies systémiques et infectieuses pouvant expliquer le tableau clinique, le diagnostic du SLS a été établi chez notre patient sur la base des arguments cliniques et électrophysiologiques. Le patient fut traité par des immunoglobulines intraveineuses à la dose de 0,4 g/kg par jour pendant cinq jours avec une bonne réponse clinique.

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We report the first two cases of clinically definite multiple sclerosis in Niger over a period of 20 years (1996-2016). They were a 19-year-old woman and a 46-year-old man, native from Niger, who had never left the country and had recurrently presented sensory and motor disorders and ophthalmologic disorders. The cerebrospinal magnetic resonance imaging had revealed suggestive lesions of multiple sclerosis. After ruling out other etiologies with similar clinical pictures, the diagnosis of multiple sclerosis had been considered in our two patients according to the revised criteria of McDonald 2010.

Nous rapportons les deux premiers cas de sclérose en plaques cliniquement définie au Niger sur une période d'activité en neurologie de 20 ans (1996-2016). Il s'agissait d'une jeune femme de 19 ans et d'un homme de 46 ans, originaires du Niger et n'ayant jamais quitté le pays, qui avaient présenté de façon récurrente des troubles sensitivomoteurs et ophtalmologiques. L'imagerie par résonnance magnétique cérébrospinale a mis en évidence des lésions suggestives de la sclérose en plaques. Après avoir éliminé les autres affections pouvant donner des tableaux cliniques similaires grâce à un bilan exhaustif, le diagnostic de sclérose en plaques a été posé chez nos deux patients selon les critères révisés clinico-radiologiques de McDonald 2010.

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Devic's neuromyelitis optica is a chronic inflammatory demyelinating disease of the central nervous system that mainly affects spinal cord, optic nerve and brain regions with high aquaporin 4 antigen expression. We report the first documented case of Devic's neuromyelitis optica in Niger. It was a 66-year-old black man who had presented a rapidly progressive flaccid tetraplegia associated with vesico-sphincteral disorders, in whom magnetic resonance imaging had shown longitudinally extensive transverse cervical myelitis with positive anti-NMO antibodies

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Neuromyelitis optica (NMO-SD) or Devic disease is an acute transverse myelitis associated with an optic neuritis united -or bilateral. It is an inflammatory disease very disabling evolving by thrust. The long-term prognosis is also difficult to predict due to comorbidities which determine the evolution and the quality of life of patients. The objective of our study was to determine the different types of co-morbidities found in patients with NMO -SD.Methods: It was a descriptive study through a review of the literature on PubMed with the combination (Neuromyelitis optica, comorbidity). The data analysis was made on the software SPSS 23 Results: Total 27 articles were published and available on PubMed (June 2017). Among these 27 work we included ten (10) specific studies of co-morbidities in the NMO-SD. Three categories of illnesses have been reported in these 10 articles including coexisting diseases with the NMO-SD without any risk factor common or similar

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