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Journal Article Meta-Analysis Systematic Review Ppublish 44 citations

PubMed: 28864674 DOI: 10.1212/WNL.0000000000004537

Neurologic complications of sickle cell disease in Africa: A systematic review and meta-analysis.

Neurology 89(14):1516-1524

Authors: Jean Jacques Noubiap, Michel K Mengnjo, Nicolas Nicastro, Joseph Kamtchum-Tatuene

Affiliations

  • From the Department of Medicine (J.J.N.), Groote Schuur Hospital and University of Cape Town, South Africa; Department of Medicine and Medical Specialties, Faculty of Medicine and Biomedical Sciences (M.K.M.), University of Yaoundé, Cameroon; Division of Neurorehabilitation, Department of Clinical Neurosciences (N.N.), Geneva University Hospitals, Switzerland; Brain Infections Group, Institute of Infection and Global Health (J.K.-T.), University of Liverpool; and Department of Neurology (J.K.-T.), The Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
  • From the Department of Medicine (J.J.N.), Groote Schuur Hospital and University of Cape Town, South Africa; Department of Medicine and Medical Specialties, Faculty of Medicine and Biomedical Sciences (M.K.M.), University of Yaoundé, Cameroon; Division of Neurorehabilitation, Department of Clinical Neurosciences (N.N.), Geneva University Hospitals, Switzerland; Brain Infections Group, Institute of Infection and Global Health (J.K.-T.), University of Liverpool; and Department of Neurology (J.K.-T.), The Walton Centre for Neurology and Neurosurgery, Liverpool, UK.

Abstract

OBJECTIVE

To summarize prevalence data on the neurologic complications of sickle cell disease (SCD) in Africa.

METHODS

We searched EMBASE, PubMed, and African Index Medicus to identify all relevant articles published from inception to May 31, 2016. Each study was reviewed for methodologic quality. A random-effects model was used to estimate the prevalence of neurologic complications of SCD across studies.

RESULTS

Thirty-one studies were included. Methodologic quality was high or moderate in 90% of studies. Stroke, conditional and abnormal cerebral blood flow, seizures, and headache were the complications most frequently reported, with overall prevalence rates of 4.2%, 10.6%, 6.1%, 4.4%, and 18.9%, respectively. Some complications, like silent brain infarcts, peripheral neuropathies, neurocognitive deficits, or moyamoya disease, have been rarely or not studied at all in the African setting. Incidence data were scarce and of poor quality.

CONCLUSIONS

The burden of neurologic complications of SCD is important in Africa and most likely underestimated. A better evaluation of this burden requires larger prospective studies using standard up-to-date screening methods. Accessibility to diagnostic tools such as neuroimaging, transcranial Doppler, EEG, and neuropsychological evaluation, as well as to preventive and therapeutic interventions and trained health care providers, should be improved in routine clinical practice.

MeSH

Cells, Anemia, Sickle Cell, Prevalence, Neurology

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