Hardiman, O. et al. Amyotrophic lateral sclerosis. Nat. Rev. Dis. Primers 3, 17071 (2017).

Article  PubMed  Google Scholar 

Turner, M. R. et al. Primary lateral sclerosis: consensus diagnostic criteria. J. Neurol. Neurosurg. Psychiatry 91, 373–377 (2020).

Article  PubMed  PubMed Central  Google Scholar 

Turner, M. R. & UK MND Clinical Studies Group Diagnosing ALS: the Gold Coast criteria and the role of EMG. Pract. Neurol. 22, 176–178 (2022).

Article  PubMed  PubMed Central  Google Scholar 

Brooks, B. R., Miller, R. G., Swash, M., Munsat, T. L. & World Federation of Neurology Research Group on Motor Neuron Disease El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Amyotroph. Lateral Scler. Other Mot. Neuron Disord. 1, 293–299 (2000).

Article  CAS  Google Scholar 

Kissani, N. et al. Why does Africa have the lowest number of neurologists and how to cover the gap? J. Neurol. Sci. 434, 120119 (2022).

Article  PubMed  Google Scholar 

World Health Organization. Global status report on neurology. Institutional Repository for Data Sharing https://iris.who.int/items/e1df0531-a7b8-4eed-8235-227dd2f8c158 (2025).

Wolfson, C., Gauvin, D. E., Ishola, F. & Oskoui, M. Global prevalence and incidence of amyotrophic lateral sclerosis. a systematic review. Neurology 101, e613–e623 (2023).

Article  PubMed  PubMed Central  Google Scholar 

Marin, B. et al. Juvenile and adult-onset ALS/MND among Africans: incidence, phenotype, survival: a review. Amyotroph. Lateral Scler. 13, 276–283 (2012).

Article  PubMed  Google Scholar 

Henning, F. et al. Incidence of motor neuron disease/amyotrophic lateral sclerosis in South Africa: a 4-year prospective study. Eur. J. Neurol. 28, 81–89 (2021).

Article  CAS  PubMed  Google Scholar 

Osuntokun, B. O. et al. Neurological disorders in Nigerian Africans: a community-based study. Acta Neurol. Scand. 75, 13–21 (1987).

Article  CAS  PubMed  Google Scholar 

Osuntokun, B. O., Adeuja, A. O. & Bademosi, O. The prognosis of motor neuron disease in Nigerian Africans. A prospective study of 92 patients. Brain 97, 385–394 (1974).

Article  CAS  PubMed  Google Scholar 

Akpalu, A., Adjei, P., Nkromah, K., Poku, F. O. & Sarfo, F. S. Neurological disorders encountered at an out-patient clinic in Ghana’s largest medical center: a 16-year review. eNeurologicalSci 24, 100361 (2021).

Article  PubMed  PubMed Central  Google Scholar 

Sene, D. F. et al. Epidemiological and clinical aspects of amyotrophic lateral sclerosis in neurological clinic of Dakar. Dakar Med. 49, 167–171 (2004).

PubMed  Google Scholar 

Tomik, B. et al. Phenotypic differences between African and white patients with motor neuron disease: a case-control study. J. Neurol. Neurosurg. Psychiatry 69, 251–253 (2000).

Article  CAS  PubMed  PubMed Central  Google Scholar 

Radhakrishnan, K., Ashok, P. P., Sridharan, R. & Mousa, M. E. Descriptive epidemiology of motor neuron disease in Benghazi, Libya. Neuroepidemiology 5, 47–54 (1986).

Article  CAS  PubMed  Google Scholar 

Rashed, H. R. & Tork, M. A. Diagnostic delay among ALS patients: Egyptian study. Amyotroph. Lateral Scler. Frontotemporal Degener. 21, 416–419 (2020).

Article  PubMed  Google Scholar 

Soliman, R., Onbool, E., Omran, K. & Fahmy, N. Clinical and epidemiological characteristics of amyotrophic lateral sclerosis in an Egyptian cohort. Neurol. Sci. 46, 1225–1236 (2025).

Article  PubMed  Google Scholar 

Kacem, I. et al. Epidemiological and clinical features of amyotrophic lateral sclerosis in a Tunisian cohort. Amyotroph. Lateral Scler. Frontotemporal Degener. 21, 131–139 (2020).

Article  CAS  PubMed  Google Scholar 

Wall, D. W. & Gelfand, M. Motor neuron disease in Rhodesian Africans. Brain 95, 517–520 (1972).

Article  CAS  PubMed  Google Scholar 

Life expectancy at birth, total (years) — sub-Saharan Africa 1960–2023. World Bank Group https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=ZG (2023).

South African population statistics. stats sa https://www.statssa.gov.za/?p=18056 (2025).

Floudiotis, N., Modi, G. & Mochan, A. Motor neuron disease in black African patients at a tertiary care hospital in Soweto, South Africa. J. Neurol. Sci. 451, 120710 (2023).

Article  PubMed  Google Scholar 

Nel, M. et al. Revealing the mutational spectrum in Southern Africans with amyotrophic lateral sclerosis. Neurol. Genet. 8, e654 (2022).

Article  PubMed  PubMed Central  Google Scholar 

Logroscino, G. & Piccininni, M. Amyotrophic lateral sclerosis descriptive epidemiology: the origin of geographic difference. Neuroepidemiology 52, 93–103 (2019).

Article  PubMed  Google Scholar 

Melka, D. et al. Epidemiological and clinical profile of amyotrophic lateral sclerosis in Ethiopia: a 5-year multicenter retrospective study. Amyotroph. Lateral Scler. Frontotemporal Degener. 24, 678–686 (2023).

Article  CAS  Google Scholar 

Dekker, M. C. J., Urasa, S. J., Aerts, M. B. & Howlett, W. P. Motor neuron disease in sub-Saharan Africa: case series from a Tanzanian referral hospital. J. Neurol. Neurosurg. Psychiatry 89, 1349–1350 (2018).

Article  PubMed  Google Scholar 

Luna, J. et al. Clinical features and prognosis of amyotrophic lateral sclerosis in Africa: the TROPALS study. J. Neurol. Neurosurg. Psychiatry 90, 20–29 (2019).

Article  PubMed  Google Scholar 

Cosnett, J. E., Bill, P. L. & Bhigjee, A. I. Motor neuron disease in Blacks. Epidemiological observations in Natal. S. Afr. Med. J. 76, 155–157 (1989).

CAS  PubMed  Google Scholar 

Ido, B. J. F. et al. Epidemiology, clinical features, and management of amyotrophic lateral sclerosis in the neurology department of the Bogodogo University Hospital in Ouagadougou, Burkina Faso. Amyotroph. Lateral Scler. Frontotemporal Degener. 27, 224–226 (2026).

Article  CAS  PubMed  Google Scholar 

Wändell, P. et al. Amyotrophic lateral sclerosis (ALS) among immigrant groups and Swedish-born individuals: a cohort study of all adults 18 years of age and older in Sweden. J. Neurol. 269, 1989–1995 (2022).

Article  PubMed  Google Scholar 

Oliveira Santos, M., Gromicho, M., Pinto, S., Pronto-Laborinho, A. C. & de Carva, M. Clinical characteristics in amyotrophic lateral sclerosis with Sub-Saharan Africa ancestry — a Portuguese hospital-based cohort study. Clin. Neurol. Neurosurg. 227, 107674–107674 (2023).

Article  PubMed  Google Scholar 

Imam, I. & Ogunniyi, A. What is happening to motor neuron disease in Nigeria? Ann. Afr. Med. 3, 1–3 (2004).

Google Scholar 

Kvalsund, M. et al. Electrodiagnostic consultations in Zambia: referral characteristics and neuromuscular disorders. J. Neurol. Sci. 397, 150–154 (2019).

Article  PubMed  Google Scholar 

Wu, G. et al. Shared burden of ultra-rare genetic variants across a spectrum of motor neuron diseases. Transl. Neurodegener. 14, 54 (2025).

Article  CAS  PubMed  PubMed Central  Google Scholar 

Moodley, K., Bill, P. L. A., Bhigjee, A. I. & Patel, V. B. A comparative study of motor neuron disease in HIV-infected and HIV-uninfected patients. J. Neurol. Sci. 397, 96–102 (2019).

Article  PubMed  Google Scholar 

Albertyn, C. H. et al. Adaptation and norming of the Edinburgh Cognitive And Behavioural Amyotrophic Lateral Sclerosis Screen (ECAS) for three language groups in South Africa. Amyotroph. Lateral Scler. Frontotemporal Degener. 23, 532–541 (2022).

Article  CAS  PubMed  Google Scholar 

Soliman, R. et al. Egyptian adaptation and validation of the Edinburgh Cognitive and Behavioral Amyotrophic Lateral Sclerosis Screen (ECAS-EG). Neurol. Sci. 44, 1871–1880 (2023).