Comparison of Symptom Distribution and Severity in People with Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder in Zambia
Alexandra Simpson1, Dominique Mortel2, Sarah Braun3, Lorraine Chishimba4, Mashina Chomba5, Gloria Habanyama4, Frighton Mutete6, Naluca Mwendaweli4, Stanley Zimba4, Deanna Saylor7
1University of Virginia, 2Phoebe Neurology, 3University Teaching Hospital, Lusaka, Zambia, 4University Teaching Hospital, 5University of Zambia, 6Livingstone University Teaching Hospital, 7Johns Hopkins Hospital
Objective:

Characterize the cross-sectional prevalence and severity of symptoms among people with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) in Zambia.  

Background:

MS is one of the most common neurological disorders globally. Epidemiological studies report rising rates in areas of lowest prevalence, including in sub-Saharan Africa, but limited literature exists on symptom burden and severity in people with MS and NMOSD in this region.   

Design/Methods:

We conducted a cross-sectional cohort study of adults with MS, clinically isolated syndrome (CIS) and NMOSD and collected demographics, disease characteristics, and patient-reported outcomes (PROs) between 2019 and 2023. For this study, we focused on the MS Self-Assessment Questionnaire (SAQ) rating participants’ level of impairment with regard to common symptoms in MS and the Patient Determined Disease Steps (PDDS) to assess disability. Descriptive statistics are presented with comparison between subgroups using Wilcoxon Rank-Sum or Fisher’s exact tests. 

Results:

Of 39 participants, 22 had MS/CIS and 17 had NMOSD. The majority were women (64%) and Black (92%), with mean±standard  deviation (SD) age of 36.3±9.8 years. Most participants self-reported moderate disability with a median PDDS of 3 (interquartile range [IQR]: 1,5). The most commonly reported symptoms were difficulty completing daily activities (82%), walking (77%), balance (77%), and fatigue (68%). People with MS/CIS reported higher severity of cognitive (1 vs 0, p<0.001) and speech (0 [IQR: 0,1] vs 0 [IQR: 0,0], p=0.02) symptoms than those with NMOSD. Participants with NMOSD reported significantly higher severity of visual symptoms (4 vs 1.5, p=0.04) than participants with MS/CIS.

Conclusions:

In a Zambian cohort of people with MS/CIS, and NMOSD, a wide array of symptoms were common, especially problems with ambulation, fatigue, and balance and moderate disability was common. These findings highlight the need for earlier diagnosis and more treatment options to improve outcomes among people with MS in Zambia and other similar low-resourced settings.

10.1212/WNL.0000000000208951
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