Increasing Frequency of Parkinsonian Syndrome as a Reason for Admission to the Neurology Department of Befelatanana University Teaching Hospital, Madagascar

  • Nomena Finiavana Rasaholiarison Neurology Department, University of Fianarantsoa, Madagascar
  • Jemissair Glorien Lemahafaka Neurology Department, University of Toliara, Madagascar
  • Lala Andriamasinavalona Rajaonarison Neurology Department, University of Antsiranana, Madagascar
  • Manambina Ratsimandresy Neurology Department, University of Antananarivo, Madagascar
  • Jenny Larissa Rakotomanana Neurology Department, University of Antananarivo, Madagascar
  • Alain Djacoba Tehindrazanarivelo Neurology Department, University of Antananarivo, Madagascar
Keywords: Frequency, Antananarivo, Parkinsonian Syndrome


The number of parkinsonian syndrome patients in Africa is increasing. This study evaluated the increasing number of parkinsonian syndrome (PS) patients admitted to a hospital in Madagascar. A comparison was carried out between parkinsonism syndrome plus (PS+) and idiopathic Parkinson's Disease (PD) cases. Retrospectively, case records of patients with parkinsonism was reviewed between 2009 and 2018 in the Neurology Department of Befelatanana University Teaching Hospital, Antananarivo. Out of the 7343 patients seen in the unit over this period, 157 patients with PS were retained. It was found that PS frequency has increased significantly as a reason for admission since 2013. PS as a reason for admission rose from 0.64 % in 2009 to 29.30 % in 2018. The median age of diagnosis of PS was 60.75 years ± 10.66. The mean age of disease onset was 57.95 years ± 10.99, with a mean diagnosis delay of 3.19 years and a sex ratio of 1.275. Among those with PS, 112 (71.33%) had PD and and 45 (28.66%) had other parkinsonian syndromes. It was also found that patients with PD had a longer diagnosis delay (p = 0.039), a higher Mini-Mental Status Examination (MMSE) scores (p = 0.035), and they were more dopa-sensitive (p = 0.007) than those with other parkinsonian syndromes. In the facility in Madagascar, the number of referrals for PS and PD has increased over time and they have the same features as parkinsonian syndromes in other African countries.


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1. Akinyemi, R. O. (2012). Epidemiology of parkinsonism and parkinson's disease in Sub-Saharan Africa: Nigerian profile. Journal of neurosciences in rural practice, 3(03), 233-234.
2. Alvarez, M. V., Evidente, V. G. H., & Driver-Dunckley, E. D. (2007). Differentiating Parkinson's disease from other parkinsonian disorders. Seminars in neurology 27(4), 356-362.
3. Bostantjopoulou, S., Logothetis, J., Katsarou, Z., & Mentenopoulos, G. (1991). Clinical observations in early and late onset Parkinson's disease. Functional neurology, 6(2), 145-149.
4. Buchman, A.S., Leurgans, S.E., Yu, L., Wilson, R.S., Lim, A.S., James, B.D., Shulman, J.M. and Bennett, D.A. (2016). Incident parkinsonism in older adults without Parkinson disease. Neurology, 87(10), pp.1036-1044.
5. Chrysostome, V., & Tison, F. (2015). Maladie de Parkinson, Epidémiologie, Paris, Elsevier Manson.
6. Cilia, R., Akpalu, A., Cham, M., Bonetti, A., Amboni, M., Faceli, E., & Pezzoli, G. (2011). Parkinson's disease in sub-Saharan Africa: step-by-step into the challenge. Neurodegenerative Disease Management, 1(3), 193-202.

7. Darweesh, S.K., Wolters, F.J., Postuma, R.B., Stricker, B.H., Hofman, A., Koudstaal, P.J., Ikram, M.K. & Ikram, M.A. (2017). Association between poor cognitive functioning and risk of incident parkinsonism: the Rotterdam study. JAMA neurology, 74(12), pp.1431-1438.
8. El-Tallawy, H. N., Farghaly, W. M., Shehata, G. A., Rageh, T. A., Hakeem, N. M. A., Abd Al Hamed, M., & Badry, R. (2013). Prevalence of Parkinson's disease and other types of Parkinsonism in Al Kharga district, Egypt. Neuropsychiatric disease and treatment, 9, 1821.
9. Feldman, A. L., Johansson, A. L., Nise, G., Gatz, M., Pedersen, N. L., & Wirdefeldt, K. (2011). Occupational exposure in parkinsonian disorders: a 43-year prospective cohort study in men. Parkinsonism & related disorders, 17(9), 677-682.
10. Femi, O. L., Ibrahim, A., & Aliyu, S. (2012). Clinical profile of parkinsonian disorders in the tropics: Experience at Kano, northwestern Nigeria. Journal of neurosciences in rural practice, 3(03), 237-241.
11. Ferrazzi C, Heritier C, Savasta M. (2015). Dynamique des Réseaux Neuronaux du Mouvement : Maladie de Parkinson. Grenoble.
12. Holden, S. K., Van Dok, E., & Pelak, V. S. (2019). Co-occurrence of convergence insufficiency and cognitive impairment in parkinsonian disorders: a pilot study. Frontiers in neurology, 10, 864.
13. Hughes, A. J., Daniel, S. E., Ben‐Shlomo, Y., & Lees, A. J. (2002). The accuracy of diagnosis of parkinsonian syndromes in a specialist movement disorder service. Brain, 125(4), 861-870.
14. INSTAT (2012-2013). Résumé des rapports sur l’ENSOMD.
15. Kurland, L. T., Hauser, W. A., Okazaki, H., & Nobrega, F. T. (1969). Epidemiologic studies of parkinsonism with special reference to the cohort hypothesis. In Third Symposium on Parkinson's Disease (pp. 12-16). E & S Livingstone, Edinburgh.
16. Levin, J., Kurz, A., Arzberger, T., Giese, A., & Höglinger, G. U. (2016). The differential diagnosis and treatment of atypical parkinsonism. Deutsches Ärzteblatt International, 113(5), 61.
17. Okubadejo, N. U., Ojo, O. O., & Oshinaike, O. O. (2010). Clinical profile of parkinsonism and Parkinson's disease in Lagos, Southwestern Nigeria. BMC neurology, 10(1), 1-6.

18. Rajput, A. H. (1992). Frequency and cause of Parkinson's disease. Canadian Journal of neurological sciences, 19(S1), 103-107.
19. Rajput, A. H., Rajput, A., & Rajput, M. (2003). Epidemiology of parkinsonism. In Handbook of Parkinson's disease (pp. 36-61). CRC Press.
20. Rasaholiarison, NF., Razafimahefa, J., & Rakotomalala, JL., & Tehindrazanarivelo, AD. (2019). Fréquence et profil clinique de la maladie de Parkinson et des autres syndromes Parkinsoniens vus au service de neurologie de l'hôpital Befelatanana Antananarivo. Pan Afr. Med. J, 33, 229.
21. Rittman, T., Ghosh, B.C., McColgan, P., Breen, D.P., Evans, J., Williams-Gray, C.H., Barker, R.A., & Rowe, J.B. (2013). The Addenbrooke's Cognitive Examination for the differential diagnosis and longitudinal assessment of patients with parkinsonian disorders. Journal of Neurology, Neurosurgery & Psychiatry, 84(5), 544-551.
22. Rocca, W. A., Bower, J. H., McDonnell, S. K., Peterson, B. J., & Maraganore, D. M. (2001). Time trends in the incidence of parkinsonism in Olmsted County, Minnesota. Neurology, 57(3), 462-467.
23. Savica, R., Grossardt, B.R., Bower, J.H., Ahlskog, J.E., Boeve, B.F., Graff-Radford, J., Rocca, W.A. & Mielke, M.M. (2017). Survival and causes of death among people with clinically diagnosed synucleinopathies with parkinsonism: a population-based study. JAMA neurology, 74(7), pp.839-846.
24. Tolosa, ES., Martin, WE., & Cohen, HP. (1975). Patterns of clinical response and plasma dopa levels in Parkinson's disease. Neurology, 25, 177183.
25. Uitti, R. J., Ahlskog, J. E., Maraganore, D. M., Muenter, M. D., Atkinson, E. J., Cha, R. H., & O'Brien, P. C. (1993). Levodopa therapy and survival in idiopathic Parkinson's disease: Olmsted County project. Neurology, 43(10), 1918-1918.
26. Van Den Eeden, S. K., Tanner, C. M., Bernstein, A. L., Fross, R. D., Leimpeter, A., Bloch, D. A., & Nelson, L. M. (2003). Incidence of Parkinson's disease: variation by age, gender, and race/ethnicity. American journal of epidemiology, 157(11), 1015-1022.
27. Vidailhet, M. (2018). Epidemiologie de la maladie de Parkinson, données nationales. BEH, 8-9, 126.
28. Wenning, G. K., Ben-Shlomo, Y., Hughes, A., Daniel, S. E., Lees, A., & Quinn, N. P. (2000). What clinical features are most useful to distinguish definite multiple system atrophy from Parkinson's disease? Journal of Neurology, Neurosurgery & Psychiatry, 68(4), 434-440.
29. Winikates, J., & Jankovic, J. (1999). Clinical correlates of vascular parkinsonism. Archives of neurology, 56(1), 98-102.
How to Cite
Rasaholiarison, N. F., Glorien Lemahafaka, J., Andriamasinavalona Rajaonarison , L., Ratsimandresy, M., Larissa Rakotomanana, J., & Djacoba Tehindrazanarivelo, A. (2022). Increasing Frequency of Parkinsonian Syndrome as a Reason for Admission to the Neurology Department of Befelatanana University Teaching Hospital, Madagascar. European Scientific Journal, ESJ, 18(17), 129.
ESJ Natural/Life/Medical Sciences