Inflammatory demyelinating diseases of the central nervous system in adults at the Brazzaville University Hospital Center, Congo

Background Inflammatory demyelinating diseases (IDDs) of the central nervous system (CNS) are a heterogeneous group of autoimmune disorders that cause neurological disabilities. Data on these diseases is scarce in sub-Saharan Africa. Objectives To describe the epidemiological, clinical, and paraclinical aspects of CNS IDDs in adults in Brazzaville; to describe the therapeutic strategies implemented; to evaluate the outcome of pathological entities at hospital discharge. Methods This was a retrospective descriptive study carried out in the neurology department of the Brazzaville University Hospital Center. The study period was from January 2018 to December 2023. The study included patients aged 15 years or older. Diagnosis was based on MRI, clinical data, and routine laboratory tests, in accordance with international consensus criteria for each type of CNS IDDs. The evolution of CNS IDDs was assessed using EDSS scores, determined at admission and at hospital discharge. Results Of the 44 patients included in the study, 29 (65.9%) were women and 15 (34.1%) were men. Their mean age was 36.8 ± 12.4 years. The following CNS IDDs were identified: neuromyelitis optica spectrum disorders (n = 15; 34.1%), idiopathic transverse myelitis (n = 14; 31.8%), unclassified forms of transverse myelitis (n = 6; 13.6%), autoimmune encephalitis (n = 4; 9.1%), acute disseminated encephalomyelitis (n = 3; 6.8%), and neurolupus (n = 2; 4.6%). Intravenous corticosteroid therapy with methylprednisolone was administered to all patients, followed by oral prednisolone. Baseline immunosuppressive therapy was initiated in 5 (11.4%) patients with neuromyelitis optica spectrum disorders (n = 3) or neurolupus (n = 2). The average hospital stay was 11 days. At hospital discharge, three types of outcomes for CNS IDDs were recorded: marked outcome for idiopathic transverse myelitis and neuromyelitis optica spectrum disorders; mild to moderate outcome for unclassified forms of transverse myelitis, autoimmune encephalitis, and acute disseminated encephalomyelitis; unfavorable outcome for neurolupus. Conclusion The spectrum of CNS IDDs in adults in Brazzaville is broad. Overall, the therapeutic strategies used have shown satisfactory efficacy. The unavailability of intravenous immunoglobulins, plasma exchanges, and advanced immunomodulators is an obstacle to recovery and survival for patients with either clinical deterioration or clinical stabilization in response to corticosteroid treatment.