26 May 2026

Abstract

Motor neuron disease (MND) refers to a group of neurodegenerative diseases that cause motor neuron degeneration and death. The most common subtype, amyotrophic lateral sclerosis (ALS), is characterized by both upper and lower motor neuron impairment, which can manifest clinically in the bulbar region or asymmetrically in a limb. Typically, the disease progresses over several months, and death from respiratory failure occurs within 2–5 years of onset. As we highlight in this Review, data on MND in Africa are sparse, although common observations in this region — and in other populations with relatively low life expectancy — include apparent earlier disease onset and lower disease incidence compared with the rest of the world. In view of the HIV epidemic in Africa, we critically examine the evidence for an association between ALS and HIV infection. We briefly discuss conditions that might be regarded as ALS mimics and summarize the limited data on MND genetics in this region. Other issues pertinent to people living with MND in Africa include the absence of cognitive and behavioural data and the limited access to multidisciplinary clinics, therapies and palliative care. We share our perspective on how the ALS Africa Network is coordinating a shift in the African MND landscape to improve patient care.

Key points

• People with amyotrophic lateral sclerosis (ALS) in African are likely to have a similar disease phenotype to those elsewhere in the world, but some features of the disease, such as mean age of onset, might be influenced by life expectancy in socioeconomically constrained settings.
• Pathogenetic data on ALS and other motor neuron diseases in Africa are sparse, although some regional differences have been observed.
• A link between ALS and HIV infection has been proposed; however, the frequencies of HIV infection are similar between individuals with and without ALS in regions of high HIV prevalence in Africa, so the relationship is probably coincidental.
• Certain diseases that are virtually exclusive to Africa share some features with ALS and should be considered in the differential diagnosis.
• The ALS Africa network has been established to support neurologists and positively influence patient care across Africa.

Source: Nature Reviews Neurology