Neurocysticercosis and epilepsy in sub-Saharan Africa

Neurocysticercosis in a Nigerian woman -missed diagnosis of a neglected disease and surgical management

Neurocysticercosis is a rarely diagnosed but significant clinical problem from infestation with taenia solium. It occurs as a result of ingestion of infested pork and the mode of transmission is usually feco-oral. It is commonly associated with non-specific neurologic manifestations expected of intracranial space-occupying lesions with its most common neurological presentation being seizures. However, its diagnosis without seizure is rarely reported. We report a recent experience in this regard and outcome of this disease which was inadvertently managed surgically. A good history and high index of suspicion especially in developing and low socioeconomic region is helpful for diagnosis in the presence of appropriate radiological findings. Prognosis is good when treatment is tailored to well selected cases. Treatment options include medical with or without surgical removal of encapsulated cyst. A high index of suspicion will be helpful in making appropriate diagnosis and proper management of this disease.

[Neuroradiological and pathohistological markers of the main epileptogenic substrates in children. Other cerebral disorders]

High-resolution MRI is an important tool in the diagnosis of structural epilepsy |in determining the seizure initiation zones, identification of the mechanisms of epileptogenesis in predicting outcomes and preventing postoperative complications in patients. In this article we have tried to demonstrate the neuroradiological and pathohistological characteristics of the main epileptogenic substrates in children using modern classification. The second part of the article is devoted to the spectrum of epileptogenic cerebral disorders, in addition to cortical malformations.

Unlocking the hidden burden of epilepsy in Africa: Understanding the challenges and harnessing opportunities for improved care

Background

Epilepsy is a common neurological disorder that affects many people in Africa, yet the burden of the disease is often hidden. The management of epilepsy in Africa is often inadequate due to a lack of awareness and education, limited access to diagnostic tools and treatments, inadequate coordination of care, and the stigma associated with the condition.

Method

A comprehensive literature review was conducted to gather information on the epidemiology, diagnosis, management, and outcomes of epilepsy in Africa. The review included studies from peer-reviewed journals, government reports, and gray literature.

Results

The review revealed a high burden of epilepsy in Africa. The studies also showed a significant gap in the availability and accessibility of diagnostic tools, antiepileptic drugs, and specialized therapies such as physical, occupational, and speech therapy. Additionally, the review found that cultural beliefs and practices, socioeconomic factors such as poverty and lack of access to healthcare, and the stigma associated with the condition, also pose significant challenges to managing epilepsy in Africa.

Conclusion

The study highlights the urgent need for improved epilepsy management in Africa. Additionally, the study calls for further research on epilepsy in Africa and collaboration between all stakeholders to improve the management of epilepsy in Africa.

Knowledge and misconceptions about epilepsy among people with epilepsy and their caregivers attending mental health clinics: A qualitative study in Taenia solium endemic pig-keeping communities in Tanzania

OBJECTIVE

Taenia solium (T. solium) neurocysticercosis (NCC) affects the central nervous system and is associated with 30% of acquired epilepsy in some endemic areas. Epilepsy is a stigmatizing disease in many societies and people with epilepsy (PWE) and their families experience discrimination. This study aimed to explore the knowledge, perceptions, and experiences of epilepsy among PWE and their caregivers attending mental health clinics.

METHODS

In T. solium endemic areas of Tanzania, PWE and their caregivers attending mental health clinics were identified and their informed consent was sought prior to study participation. In-depth interviews were conducted in Swahili language and analyzed thematically. The coding was undertaken by two independent researchers using NVivo (Version 12, QSR International).

RESULTS

Thirty-eight participants were interviewed. Three themes were identified during the analysis, namely, knowledge about epilepsy; perception of epilepsy; and experience with epilepsy among PWE and their caregivers. Participants commonly defined epilepsy as a "falling disease," perceived to be caused by witchcraft, and were unaware of the association between T. solium and epilepsy. Stigmatization of epilepsy was reported as a problem. Reported treatment patterns after the initial onset of epilepsy varied widely; however, patients usually began treatment with traditional healing methods, and only later opted for biomedical treatment. Patients had generally poor adherence to antiseizure medication, which could be caused by inadequate knowledge or irregular supply.

SIGNIFICANCE

Level of knowledge about epilepsy was low, and NCC was not mentioned as a cause of epilepsy among participants. Epilepsy was generally perceived to be the result of witchcraft, evil spirits, or curses. Health education is needed, including an explanation of the model of T. solium transmission and the insistence on hygiene measures. This could reduce the number of new infections with T. solium, improve access to prompt biomedical treatment, and improve the lives of PWE.

Cerebral Taenia crassiceps larvae infection in a 71-year-old immunocompetent male

We report a rare case of a cerebral infection with Taenia crassiceps tapeworm larvae in an immunocompetent 71-year-old German male. Initially, an intracerebral malignoma was suspected after the patient experienced stroke-like symptoms. After surgery, helminth larvae, later identified as T. crassiceps, were detected. Identification on the species level was possible by specific PCR and sequencing. After complete surgical removal, the patient was treated with albendazole and dexamethasone for two weeks. No residual symptoms were reported up to date.

Assessing the burden of Taenia solium cysticercosis in Burundi, 2020

Background

Taenia solium cysticercosis is a zoonotic disease that is endemic in many low- and middle-income countries where risk factors for disease transmission are present. The economic impact of cysticercosis on public health and on the pig production sector is not well known in many of those countries, including Burundi. This study aimed at estimating the burden of T. solium cysticercosis in Burundi including data on humans and pigs.

Methods

Epidemiological and economic data were collected from literature up to July 30, 2021 and governmental and non-governmental agencies. Direct and indirect costs for neurocysticercosis (NCC)-associated epilepsy and losses due to porcine cysticercosis were estimated to assess the economic burden, while the health burden was estimated using zoonotic disability-adjusted life years (zDALYs). Different probability distributions (Uniform, Beta, Dirichlet and Gamma) were applied depending on the type of epidemiological parameter. Monte Carlo simulations and 100,000 iterations were used to calculate the 95% uncertainty interval (UI) for each parameter and perform sensitivity analyses.

Results

In Burundi, 4.26 million USD (95% UI, 1,858,308–8,190,951) were estimated as economic impact due to T. solium cysticercosis in humans and pigs, of which 40.2% (95% UI, 10.3–75.1) of the total costs were due to NCC-associated epilepsy and 59.8% (95% UI, 24.9–89.7) of the losses due to porcine cysticercosis. The cost per NCC-associated epilepsy case was 72 USD (95% UI, 25–168), representing 30.8% of the GDP per capita in 2020. The probable incident cases and deaths for NCC-associated epilepsy were 9065 (95% UI, 2370–16,716) and 61 (95% UI, 16–114), respectively. More than 2 zDALYs (95% UI, 1.1–3.4) per thousand person-years was estimated, of which an average of 1.3 DALYs [0;0] (95% UI, 0.3–2.6) was due to NCC- associated epilepsy and 0.8 animal loss equivalents (ALEs) (95% UI, 0.3–1.5) due to porcine cysticercosis.

Conclusions

This study provides evidence of a significant burden of T. solium cysticercosis for Burundi’s population. We urge policy makers to use these evidence-based results and put T. solium cysticercosis on the public health agenda of the country. This study recommends urgent action to find solutions for integrated control strategies for T. solium cysticercosis in Burundi.

The prevalence of and contributors to neurocysticercosis in endemic regions

BACKGROUND

Neurocysticercosis is one of the most common causes of acquired epilepsy worldwide. Caused by Taenia solium, the infection uses pigs as an intermediate host and thus is often associated with proximity to and consumption of pigs.

OBJECTIVE

This review explores the epidemiology of neurocysticercosis in endemic regions across Africa, Asia, and Latin America and examines common risk factors in these areas.

METHODS

A literature review was conducted using pubmed to search for articles with key words including neurocysticercosis, Taenia, solium, epidemiology, and the names of countries and continents in the regions of interest.

FINDINGS

Multiple risk factors for neurocysticercosis were identified, including inadequate regulation of pig farms and food safety, poor sanitation, and water contamination. In addition, additional barriers to appropriate diagnosis and management were found, including resource limitations and poor health literacy.

CONCLUSION

Despite its global prevalence, effective limitation of neurocysticercosis is still achievable through projects which address common risk factors.

An exploratory assessment of human and animal health concerns of smallholder farmers in rural communities of Chimborazo, Ecuador

Background

Livestock play important economic and cultural roles in smallholder communities of Ecuador, yet they also serve as potential sources of zoonotic infections. Understanding the animal and human health concerns of smallholder farmers is important in guiding strategies for improvement of the health and livelihoods of these resource-poor farmers. Therefore, the objectives of this study were to: (a) assess the health concerns of smallholder farmers; (b) explore animal and waste management practices; and (c) identify predictors of pediatric and livestock diarrhea on smallholder farms in Ecuador.

Methods

This is a cross-sectional survey of 58 smallholder farmers in three communities of Chimborazo province, Ecuador. Data were collected on household demographics, smallholding characteristics, type of animals owned, human-animal interactions, health concerns, and 30-day occurrence of human as well as animal diarrhea. Summary statistics were computed and logistic models used to investigate predictors of pediatric and animal diarrhea.

Results

All respondents reported keeping animals. Animals kept included cattle, pigs, poultry, dogs, guinea pigs, cats, sheep, horses, rabbits, donkeys, or other livestock. More than half of the respondents named diseases as their greatest personal (55.2%) or family (58.6%) health concern, while an even greater percentage (60.3%) reported physiological stress as the primary health concern for their animals. Occurrence of diarrhea in the 30 days prior to the study was reported by 12.1% of the respondents. Additionally, 15.2% and 55.2% of the households reported diarrhea among children and animals, respectively. The majority (65.5%) of the households had toilets, while the remainder had either latrines (27.6%) or no sanitation facilities (6.9%). However, only 9.1% of the smallholdings had either a toilet (3.6%) or a latrine (5.5%) onsite and yet the farmers tended to spend most of the day at the smallholdings. Potential exposures to gastrointestinal pathogens included food- or water-borne sources (93.5% of children; 91.4% of adults) and blood-borne or fecal sources (80.4% of children; 100% of adults). Although 98.3% of the respondents kept cattle, only 27.6% had animal enclosures and even fewer (15.5%) had animal waste management plans. The odds of animal diarrhea were significantly higher (Odds Ratio [OR] = 8.7; 95% Confidence Interval [1.0–75.0]; p = .049) among households that had animal waste management plans compared to those that did not. None of the variables investigated were significant predictors of pediatric diarrhea.

Conclusions

Ongoing surveillance is needed to develop estimates of diarrhea incidence among smallholder families and their livestock. The impact of different animal management strategies on the potential pathogen exposure of smallholders warrants further investigations. Improving sanitation infrastructure and animal waste management strategies is recommended.

The Interplay Between Neuroinfections, the Immune System and Neurological Disorders: A Focus on Africa

Neurological disorders related to neuroinfections are highly prevalent in Sub-Saharan Africa (SSA), constituting a major cause of disability and economic burden for patients and society. These include epilepsy, dementia, motor neuron diseases, headache disorders, sleep disorders, and peripheral neuropathy. The highest prevalence of human immunodeficiency virus (HIV) is in SSA. Consequently, there is a high prevalence of neurological disorders associated with HIV infection such as HIV-associated neurocognitive disorders, motor disorders, chronic headaches, and peripheral neuropathy in the region. The pathogenesis of these neurological disorders involves the direct role of the virus, some antiretroviral treatments, and the dysregulated immune system. Furthermore, the high prevalence of epilepsy in SSA (mainly due to perinatal causes) is exacerbated by infections such as toxoplasmosis, neurocysticercosis, onchocerciasis, malaria, bacterial meningitis, tuberculosis, and the immune reactions they elicit. Sleep disorders are another common problem in the region and have been associated with infectious diseases such as human African trypanosomiasis and HIV and involve the activation of the immune system. While most headache disorders are due to benign primary headaches, some secondary headaches are caused by infections (meningitis, encephalitis, brain abscess). HIV and neurosyphilis, both common in SSA, can trigger long-standing immune activation in the central nervous system (CNS) potentially resulting in dementia. Despite the progress achieved in preventing diseases from the poliovirus and retroviruses, these microbes may cause motor neuron diseases in SSA. The immune mechanisms involved in these neurological disorders include increased cytokine levels, immune cells infiltration into the CNS, and autoantibodies. This review focuses on the major neurological disorders relevant to Africa and neuroinfections highly prevalent in SSA, describes the interplay between neuroinfections, immune system, neuroinflammation, and neurological disorders, and how understanding this can be exploited for the development of novel diagnostics and therapeutics for improved patient care.

Current Diagnostic Criteria for Neurocysticercosis

Neurocysticercosis (NCC) causes significant neurological morbidity around the world, and is the most common preventable factor for epilepsy in adults. It is endemic in most developing countries, and also diagnosed with some frequency in industrialized countries because of travel and migration. The clinical manifestations of NCC are extremely variable and may include almost any neurological symptom, depending on the number of lesions, location, size and evolutive stage of the infecting parasitic larvae and the immune response of the host. Thus, the diagnosis of NCC relies mostly on neuroimaging and immunological tests. Despite being a disease with a known etiology, the lack of specificity of clinical manifestations and auxiliary examinations makes its diagnosis difficult. In an attempt for developing a standard diagnosis approach, a chart of diagnostic criteria for NCC was initially published in 1996, and revised in 2001 and 2017. This chart of diagnostic criteria systematized the diagnosis of NCC and became widely used worldwide. This manuscript describes the structure of the chart, the principles behind the changes for each revision, as well as the context of its use and potential for improvement.

A Large Case Series of Neurocysticercosis in Kuwait, a Nonendemic Arabian Gulf Country in the Middle East Region

Neurocysticercosis (NCC), a leading global cause of severe progressive headache and epilepsy, in developed or affluent countries is mostly diagnosed among immigrants from poor or developing Taenia solium taeniasis-endemic countries. Taeniasis carriers in Kuwait are routinely screened by insensitive stool microscopy. In this study, enzyme-linked immunoelectrotransfer blot (EITB) was used as a confirmatory test for NCC. Screening was performed on 970 patients referred for suspected NCC on the basis of relevant history and/or ring-enhancing lesions on computed tomography and/or magnetic resonance imaging during a 14-year period in Kuwait. Demographic data and clinical details were retrieved from laboratory or hospital records. EITB was positive in 150 subjects (15.5%), including 98 expatriates mostly originating from taeniasis-endemic countries and, surprisingly, 52 Kuwaiti nationals. The clinical details of 48 of 50 NCC cases diagnosed during 2014–2019 were available. Most common symptoms included seizures, persistent headache with/without fever, and fits or loss of consciousness. Cysticercal lesions were located at various brain regions in 39 of 48 patients. Multiple members of 3 families with NCC were identified; infection was linked to domestic workers from taeniasis-endemic countries and confirmed in at least 1 family. Our data show that NCC is predominantly imported in Kuwait by expatriates originating from taeniasis-endemic countries who transmit the infection to Kuwaiti citizens.

Epilepsy syndromes in Iran: A systematic review

This study aimed to systematically review the literature on the epidemiology of epilepsy in Iran and to provide analytical estimates of the prevalence of various epilepsy syndromes. MEDLINE, Scopus, and Embase from inception to 30 July 2020 were systematically searched. These key words were used: "epilepsy" OR "seizure" AND "Iran." In the second part of the study, the prevalence of various epilepsy syndromes in Iran was estimated based on the data from previous studies. We could identify 17 related articles. Three studies had class 2, and the rest provided class 4 of evidence. Two population-based studies provided the prevalence rate of epilepsy in Iran: 0.8% and 1.2%. In one clinic-based study, 20.2% of the patients were diagnosed as having idiopathic generalized epilepsy (IGE). In another clinic-based study, 5.4% of the patients were diagnosed to have Lennox-Gastaut syndrome. No study has provided data on focal epilepsy syndromes other than temporal lobe epilepsy (TLE) in Iran. While high-quality data from Iran on the epidemiology of epilepsy syndromes are scarce, based on the available data and extrapolations form other data from other world regions, we can estimate that the prevalence of epilepsy in Iran is about 1% and about 840,000 people currently have active epilepsy. From the whole population of people with epilepsy in Iran, about 168,000 people have IGEs, tens of thousands suffer from symptomatic generalized epilepsies, and approximately, 126,000-226,800 people suffer from TLE. There is a need for well-designed population-based epidemiological studies on the topic.

Neuroscience education and research in Cameroon: Current status and future direction

Neurological disorders comprise 20% of hospital admissions in Cameroon. The burden of neurological disorders is increasing, especially in children and the elderly. However, there are very few neurologists, psychiatrists, gerontologists and neuropsychologists trained in the treatment of neurological disorders in Cameroon and there are very few facilities for training in basic and clinical neuroscience. Although non-governmental organizations such as the International Brain Research Organization (IBRO), International Society of Neurochemistry (ISN), and Teaching and Research in Natural Sciences for Development (TReND) in Africa have stepped in to provide short training courses and workshops in neuroscience, these are neither sufficient to train African neuroscientists nor to build the capacity to train neuroscience researchers and clinicians. There has also been little support from universities and the government for such training. While some participants of these schools have managed to form collaborations with foreign researchers and have been invited to study abroad, this does not facilitate the training of neuroscientists in Cameroon. Moreover, the research infrastructure for training in neuroscience remains limited. This is reflected in the low research output from Cameroonian universities in the field. In this review, we describe the burden of neurological disorders in Cameroon and outline the outstanding efforts of local scientists to develop the discipline of neuroscience, which is still an emerging field in Cameroon. We identify key actionable steps towards the improvement of the scientific capacity in neuroscience in Cameroon: (1) develop targeted neuroscience training programs in all major universities in Cameroon; (2) implement a thriving scientific environment supported by international collaborations; (3) focus on the leadership and the mentorship of both local and senior neuroscientists; (4) develop public awareness and information of policy makers to increase governmental funding for neuroscience research.

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Improving scientific capacity to tackle the neurological diseases burden in Cameroon is urgent.

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Neuroscience schools and advocated researchers shape the future of neuroscience in Cameroon.

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Public-private partnerships are required for sustainable country impact of neuroscience schools.

Prevalence and risk assessment of porcine cysticercosis in Ngozi province, Burundi

Cysticercosis is a major zoonotic disease in many developing countries leading to substantial economic and public health impacts on affected communities. Due to a lack of updated data on T. solium cysticercosis in Burundi, the present study was carried out to determine the prevalence of porcine cysticercosis and to identify potential associated risk factors in Ngozi province. This study was conducted in Ngozi and Marangara communes of Ngozi province during January and February 2020. A multistage random sampling strategy was used. Tongue palpation was performed on pigs to diagnose cysticercosis. Randomly selected heads of pig keeping households were interviewed to assess the risk factors for porcine cysticercosis. A logistic regression model was used to analyse the main risk factors associated with porcine cysticercosis. In total, 496 pigs from 321 households distributed in 16 hills, randomly selected in Ngozi and Marangara communes were inspected. The apparent prevalence by tongue palpation in Ngozi province was 15.5% (95% CI: 12.3-18.7%). In Ngozi and in Marangara communes, the prevalence was 22.9% (95% CI: 17.7-28.2%) and 8.1% (95% CI: 4.6-11.4%), respectively. The true prevalence was estimated at 31% for the province, with a prevalence of 45.8% in Ngozi and 16.2% in Marangara commune, respectively. Pig farming systems including free ranging, tethering and penned part of the day (OR = 3.5; 95% CI: 2.1-6.1; p ≤  0.001) and lack of meat inspection at home slaughter (OR = 2.5; 95% CI: 1.1-5.6; p = 0.019) were significant risk factors associated with porcine cysticercosis. The present findings show that porcine cysticercosis is highly endemic in Ngozi province and that pig management systems currently used in the area permit pigs to have access to human stool. Moreover, lack of meat inspection during home slaughter potentially gives the possibility for household and community members to eat infected pork. Total confinement of pigs, improved hygiene and sanitation in households, and improvement of meat inspection through awareness campaigns and overall health education of the community should be implemented to control T. solium infections.

Taenia solium Cysticercosis and Its Impact in Neurological Disease

Taenia solium neurocysticercosis (NCC) is endemic in most of the world and contributes significantly to the burden of epilepsy and other neurological morbidity. Also present in developed countries because of immigration and travel, NCC is one of few diseases targeted for eradication. This paper reviews all aspects of its life cycle (taeniasis, porcine cysticercosis, human cysticercosis), with a focus on recent advances in its diagnosis, management, and control. Diagnosis of taeniasis is limited by poor availability of immunological or molecular assays. Diagnosis of NCC rests on neuroimaging findings, supported by serological assays. The treatment of NCC should be approached in the context of the particular type of infection (intra- or extraparenchymal; number, location, and stage of lesions) and has evolved toward combined symptomatic and antiparasitic management, with particular attention to modulating inflammation. Research on NCC and particularly the use of recently available genome data and animal models of infection should help to elucidate mechanisms of brain inflammation, damage, and epileptogenesis.

Consciring subjects: Q methodology described

BACKGROUND

Despite the availability of Q methodology as a qualitative research alternative that seemingly circumvents the limits of standard qualitative methods across various fields, a recent review of qualitative research literature in leading health-related South African journals indicated that Q methodology is hardly a method of choice in South Africa.

AIM

This article demonstrates the application of Q methodology, a qualitative research option, in psychological research. The methodology is suitably designed to investigate and clarify diverse subjective experiences, attitudes, opinions and/or beliefs held by a group of people on a given topic.

METHODOLOGY

A study on the subjective understandings and perceptions of epilepsy is used to illustrate how Q methodology works. In this particular study, a diverse group of participants, comprising students, traditional healers, doctors, nurses, pastors, high school teachers, laypeople domiciled in rural and urban areas, and speakers of two of the dominant African dialects in the area, was used.

RESULTS

Analysis produced three distinctive factors that are appositely named the scientific, the moderated traditionalist and the community-oriented stances. Each factor, constituted on the basis of close resemblance and statistical association between the rank orderings, represents an identifiable understanding of epilepsy by an exclusive grouping of participants.

CONCLUSION

Concluding remarks about Q methodology are provided.