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Van Cutsem G, Siewe Fodjo JN, Hadermann A, Amaral LJ, Trevisan C, Pion S, Colebunders R. Onchocerciasis-associated epilepsy: Charting a path forward. Seizure 2024:S1059-1311(24)00123-7. [PMID: 38677953 DOI: 10.1016/j.seizure.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
This narrative review intends to inform neurologists and public health professionals about Onchocerciasis-Associated Epilepsy (OAE), a neglected public health problem in many remote onchocerciasis-endemic areas. For epidemiological purposes, we define OAE as sudden-onset of convulsive and non-convulsive seizure types, including head nodding seizures (nodding syndrome) in a previously healthy child aged 3 to 18 years in the absence of any other obvious cause for epilepsy, all happening within an area with high ongoing Onchocerca volvulus transmission. Several OAE pathophysiological mechanisms have been proposed, but none has been proven yet. Recent population-based studies showed that strengthening onchocerciasis elimination programs was followed by a significant reduction in the incidence of OAE and nodding syndrome. Treating epilepsy in onchocerciasis-endemic regions is challenging. More advocacy is needed to provide uninterrupted, free access to anti-seizure medication to persons with epilepsy in these remote, impoverished areas. It is crucial todevelop policies and increase funding for the prevention and treatment of OAE to reduce the associated burden of disease, notably via the establishment of morbidity management and disability prevention programs (MMDP). Moreover, effective collaboration between onchocerciasis elimination and mental health programs is imperative to alleviate the burden of OAE. This synergy promises reciprocal advantages and underscores the need for a comprehensive approach to address this multifaceted challenge.
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Affiliation(s)
- G Van Cutsem
- Department of Neurology, Centre Hospitalier de Luxembourg, Luxembourg; Faculty of Science, Technology and Medicine, University of Luxembourg, Luxembourg; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - J N Siewe Fodjo
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - A Hadermann
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - L-J Amaral
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - C Trevisan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - S Pion
- Institute of Research for Sustainable Development, Montpelier, France
| | - R Colebunders
- Global Health Institute, University of Antwerp, Antwerp, Belgium.
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Portela CS, Mendes de Araújo CP, Moura Sousa P, Gomes Simão CL, Silva de Oliveira JC, Crainey JL. Filarial disease in the Brazilian Amazon and emerging opportunities for treatment and control. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2023; 5:100168. [PMID: 38283060 PMCID: PMC10821485 DOI: 10.1016/j.crpvbd.2023.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 01/30/2024]
Abstract
Following the successful eradication of Wuchereria bancrofti, there are now just three species of conventional microfilaremic human filarial parasites endemic to the Brazilian Amazon region: Mansonella ozzardi, Mansonella perstans and Onchocerca volvulus. The zoonotic filarial parasite Dirofilaria immitis is also found in the Amazon region as are several sylvatic filarial parasites, some of which have been recorded causing zoonoses and some of which have never been recorded outside the region. Onchocerca volvulus is only found in the Amazonia onchocerciasis focus in the Brazilian state of Roraima where it affects the people of the Yanomami tribe living around the densely forested Venezuela border region. Mansonella ozzardi is by far the most common filarial parasite in Brazil and has a broad but patchy distribution throughout the western Amazon region. Recorded in the Brazilian states of Acre, Roraima, Matto Grosso, and within almost every municipality of Amazonas state, it is believed that pollution of the urban stream and river systems prevents the development of the simuliid vectors of M. ozzardi and explains the parasite's reduced distribution within urban areas and an absence of recent reports from the state capital Manaus. Decades of WHO-led periodic ivermectin treatment of Yanomami tribe's people have resulted in the partial suppression of O. volvulus transmission in this focus and has also probably affected the transmission of M. ozzardi in the region. Mansonella perstans, O. volvulus and very probably M. ozzardi infections can all be treated and most likely cured with a 4-6-week treatment course of doxycycline. The Brazilian Ministry of Health does not, however, presently recommend any treatment for mansonellosis infections and thus parasitic infections outside the Amazonia focus are typically left untreated. While the long treatment courses required for doxycycline-based mansonellosis therapies preclude their use in control programmes, new fast-acting filarial drug treatments are likely to soon become available for the treatment of both onchocerciasis and mansonellosis in the Amazon region. Filarial disease management in the Brazilian Amazon is thus likely to become dramatically more viable at a time when the public health importance of these diseases is increasingly being recognized.
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Affiliation(s)
- Cleudecir Siqueira Portela
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
- Programa de Doutorado em Biologia da Interação Patógeno Hospedeiro, Instituto Leônidas e Maria Deane, Manaus, Amazonas, Brazil
| | - Cláudia Patrícia Mendes de Araújo
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
- Programa de Doutorado em Biologia da Interação Patógeno Hospedeiro, Instituto Leônidas e Maria Deane, Manaus, Amazonas, Brazil
| | - Patrícia Moura Sousa
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
- Programa de Doutorado em Biologia da Interação Patógeno Hospedeiro, Instituto Leônidas e Maria Deane, Manaus, Amazonas, Brazil
| | - Carla Letícia Gomes Simão
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
- Programa de Mestrado em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Manaus, Amazonas, Brazil
| | - João Carlos Silva de Oliveira
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
- Programa de Doutorado em Saúde Pública na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Manaus, Amazonas, Brazil
| | - James Lee Crainey
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
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