1
|
Biset G, Abebaw N, Gebeyehu NA, Estifanos N, Birrie E, Tegegne KD. Prevalence, incidence, and trends of epilepsy among children and adolescents in Africa: a systematic review and meta-analysis. BMC Public Health 2024; 24:771. [PMID: 38475724 PMCID: PMC10935902 DOI: 10.1186/s12889-024-18236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Epilepsy contributes to a significant disease burden in children and adolescents worldwide. The incidence of childhood epilepsy is threefold higher in low and middle income countries compared in high-income countries. Epilepsy is a serious neurological condition associated with stigma and discrimination, an impaired quality of life, and other mental health related problems. OBJECTIVE This study is aimed to synthesize existing evidence and estimate the pooled prevalence and incidence of epilepsy in children and adolescents in Africa. METHODS A comprehensive and systematic search of relevant databases was conducted. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale adapted for meta-analysis. Two reviewers screened retrieved articles, conducted critical appraisals, and extracted the data. Heterogeneity between studies was assessed by visual inspection of forest plots and statistically using Cochran's Q statistics and the I2 test. Publication bias was checked by visual inspection of funnel plots as well as statistically using Egger's correlation and Begg's regression tests. Finally, the pooled prevalence and incidence of childhood epilepsy were computed with 95% confidence intervals. RESULT In this review and meta-analysis 42 studies with 56 findings were included to compute the pooled prevalence of childhood epilepsy. On the other hand, 6 studies were included to estimate the combined incidence. The pooled prevalence of cumulative epilepsy was 17.3 per 1000 children. Whereas the pooled prevalence of active and lifetime epilepsy was 6.8 and 18.6 per 1000 children respectively. The pooled incidence of childhood epilepsy was 2.5 per 1000 children. CONCLUSION Nearly 1 in 50 children are suffering from epilepsy in Africa. However, little attention has been paid to the prevention and treatment of childhood epilepsy. Mass epilepsy screening, scaling up treatment coverage, and designing strict treatment follow up and monitoring mechanisms are recommended.
Collapse
Affiliation(s)
- Gebeyaw Biset
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, P.O.BOX: 1145, Ethiopia.
| | - Nigusie Abebaw
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Natan Estifanos
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Endalk Birrie
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, P.O.BOX: 1145, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
2
|
Kariuki SM, Wagner RG, Gunny R, D'Arco F, Kombe M, Ngugi AK, White S, Odhiambo R, Cross JH, Sander JW, Newton CRJC. Magnetic resonance imaging findings in Kenyans and South Africans with active convulsive epilepsy: An observational study. Epilepsia 2024; 65:165-176. [PMID: 37964464 DOI: 10.1111/epi.17829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE Focal epilepsy is common in low- and middle-income countries. The frequency and nature of possible underlying structural brain abnormalities have, however, not been fully assessed. METHODS We evaluated the possible structural causes of epilepsy in 331 people with epilepsy (240 from Kenya and 91 from South Africa) identified from community surveys of active convulsive epilepsy. Magnetic resonance imaging (MRI) scans were acquired on 1.5-Tesla scanners to determine the frequency and nature of any underlying lesions. We estimated the prevalence of these abnormalities using Bayesian priors (from an earlier pilot study) and observed data (from this study). We used a mixed-effect modified Poisson regression approach with the site as a random effect to determine the clinical features associated with neuropathology. RESULTS MRI abnormalities were found in 140 of 240 (modeled prevalence = 59%, 95% confidence interval [CI]: 53%-64%) of people with epilepsy in Kenya, and in 62 of 91 (modeled prevalence = 65%, 95% CI: 57%-73%) in South Africa, with a pooled modeled prevalence of 61% (95% CI: 56%-66%). Abnormalities were common in those with a history of adverse perinatal events (15/23 [65%, 95% CI: 43%-84%]), exposure to parasitic infections (83/120 [69%, 95% CI: 60%-77%]) and focal electroencephalographic features (97/142 [68%, 95% CI: 60%-76%]), but less frequent in individuals with generalized electroencephalographic features (44/99 [44%, 95% CI: 34%-55%]). Most abnormalities were potentially epileptogenic (167/202, 82%), of which mesial temporal sclerosis (43%) and gliosis (34%) were the most frequent. Abnormalities were associated with co-occurrence of generalized non-convulsive seizures (relative risk [RR] = 1.12, 95% CI: 1.04-1.25), lack of family history of seizures (RR = 0.91, 0.86-0.96), convulsive status epilepticus (RR = 1.14, 1.08-1.21), frequent seizures (RR = 1.12, 1.04-1.20), and reported use of anti-seizure medication (RR = 1.22, 1.18-1.26). SIGNIFICANCE MRI identified pathologies are common in people with epilepsy in Kenya and South Africa. Mesial temporal sclerosis, the most common abnormality, may be amenable to surgical correction. MRI may have a diagnostic value in rural Africa, but future longitudinal studies should examine the prognostic role.
Collapse
Affiliation(s)
- Symon M Kariuki
- Neurosciences Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Roxana Gunny
- Department of Neuroradiology, Great Ormond Street Hospital, London, UK
| | - Felice D'Arco
- Department of Neuroradiology, Great Ormond Street Hospital, London, UK
| | - Martha Kombe
- Neurosciences Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Anthony K Ngugi
- Department of Population Health, Medical College, Aga Khan University of East Africa, Nairobi, Kenya
| | | | - Rachael Odhiambo
- Department of Population Health, Medical College, Aga Khan University of East Africa, Nairobi, Kenya
| | - J Helen Cross
- Developmental Neurosciences, UCL, NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
- Department of Neurology, West China Hospital, Chengdu, China
- Institute of Brain Science & Brain-Inspired Technology, Sichuan University, Chengdu, China
| | - Charles R J C Newton
- Neurosciences Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
3
|
Henke K, Ntovas S, Xourgia E, Exadaktylos AK, Klukowska-Rötzler J, Ziaka M. Who Let the Dogs Out? Unmasking the Neglected: A Semi-Systematic Review on the Enduring Impact of Toxocariasis, a Prevalent Zoonotic Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6972. [PMID: 37947530 PMCID: PMC10649795 DOI: 10.3390/ijerph20216972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/28/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
Toxocariasis remains an important neglected parasitic infection representing one of the most common zoonotic infections caused by the parasite Toxocara canis or, less frequently, by Toxocara cati. The epidemiology of the disease is complex due to its transmission route by accidental ingestion of embryonated Toxocara eggs or larvae from tissues from domestic or wild paratenic hosts. Even though the World Health Organization and Centers for Disease Control classified toxocariasis amongst the top six parasitic infections of priority to public health, global epidemiological data regarding the relationship between seropositivity and toxocariasis is limited. Although the vast majority of the infected individuals remain asymptomatic or experience a mild disease, the infection is associated with important health and socioeconomic consequences, particularly in underprivileged, tropical, and subtropical areas. Toxocariasis is a disease with multiple clinical presentations, which are classified into five distinct forms: the classical visceral larva migrans, ocular toxocariasis, common toxocariasis, covert toxocariasis, and cerebral toxocariasis or neurotoxocariasis. Anthelmintic agents, for example, albendazole or mebendazole, are the recommended treatment, whereas a combination with topical or systemic corticosteroids for specific forms is suggested. Prevention strategies include educational programs, behavioral and hygienic changes, enhancement of the role of veterinarians, and anthelmintic regimens to control active infections.
Collapse
Affiliation(s)
- Katrin Henke
- Department of Internal Medicine, Thun Hospital, Krankenhausstrasse 12, 3600 Thun, Switzerland;
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
| | - Sotirios Ntovas
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
- Department of Visceral Surgery and Medicine, lnselspital, University Hospital, University of Bern, 3008 Bern, Switzerland
| | - Eleni Xourgia
- Department of Heart Surgery, lnselspital, University Hospital, University of Bern, 3008 Bern, Switzerland;
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
| | - Mairi Ziaka
- Department of Internal Medicine, Thun Hospital, Krankenhausstrasse 12, 3600 Thun, Switzerland;
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
| |
Collapse
|
4
|
Bhattacharyya S, Vinkeles Melchers NVS, Siewe Fodjo JN, Vutha A, Coffeng LE, Logora MY, Colebunders R, Stolk WA. Onchocerciasis-associated epilepsy in Maridi, South Sudan: Modelling and exploring the impact of control measures against river blindness. PLoS Negl Trop Dis 2023; 17:e0011320. [PMID: 37235598 DOI: 10.1371/journal.pntd.0011320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Onchocerciasis, also known as "river blindness", is caused by the bite of infected female blackflies (genus Simuliidae) that transmit the parasite Onchocerca volvulus. A high onchocerciasis microfarial load increases the risk to develop epilepsy in children between the ages of 3 and 18 years. In resource-limited settings in Africa where onchocerciasis has been poorly controlled, high numbers of onchocerciasis-associated epilepsy (OAE) are reported. We use mathematical modeling to predict the impact of onchocerciasis control strategies on the incidence and prevalence of OAE. METHODOLOGY We developed an OAE model within the well-established mathematical modelling framework ONCHOSIM. Using Latin-Hypercube Sampling (LHS), and grid search technique, we quantified transmission and disease parameters using OAE data from Maridi County, an onchocerciasis endemic area, in southern Republic of South Sudan. Using ONCHOSIM, we predicted the impact of ivermectin mass drug administration (MDA) and vector control on the epidemiology of OAE in Maridi. PRINCIPAL FINDINGS The model estimated an OAE prevalence of 4.1% in Maridi County, close to the 3.7% OAE prevalence reported in field studies. The OAE incidence is expected to rapidly decrease by >50% within the first five years of implementing annual MDA with good coverage (≥70%). With vector control at a high efficacy level (around 80% reduction of blackfly biting rates) as the sole strategy, the reduction is slower, requiring about 10 years to halve the OAE incidence. Increasing the efficacy levels of vector control, and implementing vector control simultaneously with MDA, yielded better results in preventing new cases of OAE. CONCLUSIONS/SIGNIFICANCES Our modeling study demonstrates that intensifying onchocerciasis eradication efforts could substantially reduce OAE incidence and prevalence in endemic foci. Our model may be useful for optimizing OAE control strategies.
Collapse
Affiliation(s)
- Samit Bhattacharyya
- Department of Mathematics, School of Natural Sciences, Shiv Nadar Institution of Eminence, Dadri, Uttar Pradesh, India
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | | | | | - Amit Vutha
- Department of Mathematics, Ohio State University, Columbus, Ohio, United States of America
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Makoy Y Logora
- National Neglected Tropical Disease Programme, Ministry of Health South Sudan, Juba, South Sudan
| | | | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
5
|
Zulu G, Stelzle D, Mwape KE, Welte TM, Strømme H, Mubanga C, Mutale W, Abraham A, Hachangu A, Schmidt V, Sikasunge CS, Phiri IK, Winkler AS. The epidemiology of human Taenia solium infections: A systematic review of the distribution in Eastern and Southern Africa. PLoS Negl Trop Dis 2023; 17:e0011042. [PMID: 37000841 PMCID: PMC10096517 DOI: 10.1371/journal.pntd.0011042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/12/2023] [Accepted: 03/12/2023] [Indexed: 04/03/2023] Open
Abstract
Background
Taenia solium is a tapeworm that causes taeniosis in humans and cysticercosis in humans and pigs. Within Eastern and Southern Africa (ESA), information on the presence of human taeniosis and cysticercosis seems scarce. This systematic review aimed to describe the current information available and gaps in the epidemiology of human T. solium infections in ESA.
Methods/Principle findings
Scientific literature published between 1st January 2000 and 20th June 2022 in international databases [MEDLINE (Ovid), Embase (Ovid), Global Health (Ovid), Scopus (Elsevier), African Index Medicus (via WHO Global Index Medicus), and Open Grey] was systematically reviewed for ESA. The study area included 27 countries that make up the ESA region. Information on either taeniosis, cysticercosis or NCC was available for 16 of 27 countries within the region and a total of 113 reports were retained for the review. Most case reports for cysticercosis and NCC were from South Africa, while Tanzania had the most aggregated cysticercosis reports. Eleven countries reported on NCC with seven countries reporting data on NCC and epilepsy. Unconfirmed human T. solium taeniosis cases were reported in nine countries while two countries (Madagascar and Zambia) reported confirmed T. solium cases. The cysticercosis seroprevalence ranged between 0.7–40.8% on antigen (Ag) ELISA and between 13.1–45.3% on antibody (Ab) ELISA. Based on immunoblot tests the Ab seroprevalence was between 1.7–39.3%, while the proportion of NCC-suggestive lesions on brain CT scans was between 1.0–76% depending on the study population. The human taeniosis prevalence based on microscopy ranged between 0.1–14.7%. Based on Copro Ag-ELISA studies conducted in Kenya, Rwanda, Tanzania, and Zambia, the highest prevalence of 19.7% was reported in Kenya.
Conclusions
Despite the public health and economic impact of T. solium in ESA, there are still large gaps in knowledge about the occurrence of the parasite, and the resulting One Health disease complex, and monitoring of T. solium taeniosis and cysticercosis is mostly not in place.
Collapse
|
6
|
Ngarka L, Siewe Fodjo JN, Ambomatei C, Njamnshi WY, Taryunyu Njamnshi JN, Nfor LN, Mengnjo MK, Njamnshi AK. Epidemiology of epilepsy and relationship with onchocerciasis prevalence in villages of the Ntui Health District of Cameroon. Epilepsy Behav 2023; 142:109184. [PMID: 36972641 PMCID: PMC7614422 DOI: 10.1016/j.yebeh.2023.109184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND A strong association between epilepsy and onchocerciasis endemicity has been reported. We sought to document the epidemiology of epilepsy in onchocerciasis-endemic villages of the Ntui Health District in Cameroon and investigate how this relates to the prevalence of onchocerciasis. METHODS In March 2022, door-to-door epilepsy surveys were conducted in four villages (Essougli, Nachtigal, Ndjame, and Ndowe). Ivermectin intake during the 2021 session of community-directed treatment with ivermectin (CDTI) was investigated in all participating village residents. Persons with epilepsy (PWE) were identified through a two-step approach: administration of a 5-item epilepsy screening questionnaire followed by clinical confirmation by a neurologist. Epilepsy findings were analyzed together with onchocerciasis epidemiological data previously obtained in the study villages. RESULTS We surveyed 1663 persons in the four study villages. The 2021 CDTI coverage for all study sites was 50.9%. Overall, 67 PWE were identified (prevalence of 4.0% (IQR: 3.2-5.1) with one new-onset case during the past 12 months (annual incidence of 60.1 per 100,000 persons). The median age of PWE was 32 years (IQR: 25-40), with 41 (61.2%) being females. The majority (78.3%) of PWE met the previously published criteria for onchocerciasis-associated epilepsy (OAE). Persons with a history of nodding seizures were found in all villages and represented 19.4% of the 67 PWE. Epilepsy prevalence was positively correlated with onchocerciasis prevalence (Spearman Rho = 0.949, p = 0.051). Meanwhile, an inverse relationship was observed between distance from the Sanaga river (blackfly breeding site) and the prevalence of both epilepsy and onchocerciasis. CONCLUSION The high epilepsy prevalence in Ntui appears to be driven by onchocerciasis. It is likely that decades of CDTI have likely contributed to a gradual decrease in epilepsy incidence, as only one new case occurred in the past year. Therefore, more effective elimination measures are urgently needed in such endemic areas to curb the OAE burden.
Collapse
Affiliation(s)
- Leonard Ngarka
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Neurology Department, Central Hospital Yaoundé, Yaoundé, Cameroon; Neuroscience Lab, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon.
| | - Joseph Nelson Siewe Fodjo
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Division of Operational Research in Health, Ministry of Public Health, Yaoundé, Cameroon.
| | | | - Wepnyu Yembe Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Neuroscience Lab, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon; Division of Operational Research in Health, Ministry of Public Health, Yaoundé, Cameroon.
| | | | - Leonard N Nfor
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Neurology Department, Central Hospital Yaoundé, Yaoundé, Cameroon.
| | - Michel K Mengnjo
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Neurology Department, Central Hospital Yaoundé, Yaoundé, Cameroon.
| | - Alfred K Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Neurology Department, Central Hospital Yaoundé, Yaoundé, Cameroon; Neuroscience Lab, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon.
| |
Collapse
|
7
|
Alizadeh Khatir A, Sepidarkish M, Daryabari Y, Taghipour A, Mollalo A, Aghapour S, Rostami A. Malaria infection and the risk of epilepsy: a meta-analysis. Parasitology 2023; 150:1-9. [PMID: 36705577 PMCID: PMC10090621 DOI: 10.1017/s0031182022001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/21/2022] [Accepted: 12/21/2022] [Indexed: 01/28/2023]
Abstract
Epilepsy, a chronic disease of the central nervous system, is highly prevalent in malaria-endemic regions. Therefore, several studies have evaluated the associations between malaria infection and epilepsy development. A meta-analysis of observational studies published from inception to 10 May 2022 has been conducted to synthesize and pool the existing data on this topic. The relevant publications were systematically searched in PubMed/Medline, Scopus, Embase and Web of Science database collections. A random-effects meta-analysis model (REM) was utilized to generate the pooled odds ratio (OR) at 95% confidence intervals (CIs). The between-studies heterogeneity was assessed with I2, as well as several subgroups, meta-regression and sensitivity analysis were performed to identify the source of heterogeneity. Overall, 17 eligible studies containing 6285 cases and 13 909 healthy controls were included. The REM showed a significant positive association between malaria infection and epilepsy development (OR 2.36; 95% CI 1.44–3.88). In subgroup analyses, significant positive associations were observed in studies that: epilepsy was the outcome in the follow-up of patients with cerebral malaria (OR 7.10; 95% CI 3.50–14.38); used blood smear to diagnose malaria (OR 4.80; 95% CI 2.36–9.77); included only children (OR 3.92; 95% CI 1.81–8.50); published before 2010 (OR 6.39; 95% CI 4.25–9.62). Our findings indicated that patients with malaria, especially those with cerebral malaria, are at a high risk of epilepsy development; however, further well-designed and controlled studies are needed to verify the strength of the association.
Collapse
Affiliation(s)
- Ali Alizadeh Khatir
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Yasaman Daryabari
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Taghipour
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Abolfazl Mollalo
- Department of Public Health and Prevention Science, School of Health Sciences, Baldwin Wallace University, Berea, Ohio, USA
| | - Saeed Aghapour
- Department of Neurosurgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
8
|
Langat NK, Kariuki SM, Kamuyu G, Kakooza-Mwesige A, Owusu-Agyei S, Ae-Ngibise K, Wang'ombe A, Ngugi AK, Masaja H, Wagner RG, Newton CR. Exposure to parasitic infections determines features and phenotypes of active convulsive epilepsy in Africa. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17049.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Epilepsy affects 70 million people worldwide, 80% of whom are in low-and-middle income countries (LMICs). Parasitic infections contribute considerably to the burden of epilepsy in LMICs, but the nature and presentation of epilepsy following these infections is not fully understood. We examined if epilepsy outcomes are associated with the exposure to parasitic infections. Methods: This was a case-comparison study nested in a cross-sectional survey of people with active convulsive epilepsy, with cases as those exposed to parasitic infections, and comparison as those unexposed. Associations of exposure to parasites with clinical and electroencephalographic features of epilepsy were done using a modified mixed effects Poisson regression model across five sites in Africa. Multiplicative and additive scale (RERI) interactions were explored to determine the effect of co-infections on epilepsy features. Population attributable fractions (PAF) were calculated to determine the proportion of severe clinical and electroencephalographic features of epilepsy attributable to parasitic infections. Results: A total of 997 participants with active convulsive epilepsy from the five African sites were analyzed, 51% of whom were males. Exposure to parasitic infections was associated with more frequent seizures in adult epilepsy (relative risk (RR)=2.58, 95% confidence interval (95%CI):1.71-3.89). In children, exposure to any parasite was associated with convulsive status epilepticus (RR=4.68, (95%CI: 3.79-5.78), intellectual disabilities (RR=2.13, 95%CI: 1.35-3.34) and neurological deficits (RR=1.92, 95%CI: 1.42-2.61). Toxoplasma gondii and Onchocerca volvulus interacted synergistically to increase the risk of status epilepticus (RERI=0.91, 95%CI=0.48-1.35) in the data pooled across the sites. Exposure to parasitic infections contributed to 30% of severe features of epilepsy as shown by PAF. Conclusions: Parasitic infections may determine features and phenotypes of epilepsy through synergistic or antagonistic interactions, which can be different in children and adults. Interventions to control or manage infections may reduce complications and improve prognosis in people with epilepsy.
Collapse
|
9
|
Diaz MM, Sokhi D, Noh J, Ngugi AK, Minja FJ, Reddi P, Fèvre EM, Meyer ACL. Prevalence of Epilepsy, Human Cysticercosis, and Porcine Cysticercosis in Western Kenya. Am J Trop Med Hyg 2022; 106:1450-1455. [PMID: 38223984 PMCID: PMC9128686 DOI: 10.4269/ajtmh.21-0594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/21/2021] [Indexed: 01/16/2024] Open
Abstract
Cysticercosis is the leading cause of acquired epilepsy worldwide and has been shown to be highly prevalent in pig populations in western Kenya. We conducted a community-based door-to-door survey in a region of western Kenya with a high proportion of pig-keeping households. Persons with epilepsy (PWE) were determined using a screening questionnaire followed by a neurologist evaluation. Cysticercosis serum apDia antigen ELISAs and Western blot for LLGP and rT24h antigen were performed on all PWE and 2% of screen-negative patients. All PWE or people with positive apDia underwent contrast-enhanced brain computed tomography (CT). Of a sample of 810 village residents, 660 (81%) were present in the homestead, of whom 648 (98%) participated. Of these, 17 were confirmed to have lifetime epilepsy, an estimated crude prevalence of 2.6%. No humans with (N = 17) or without (N = 12) epilepsy had serological evidence of cysticercosis infection. Fourteen PWE and one individual with borderline positive apDia antigen ELISA underwent brain CT; none had radiographic findings consistent with neurocysticercosis. Nearly 30% of households kept pigs, with 69% always tethered in both wet and dry seasons. More than 8% (6/72) of pigs had palpable lingual cysts; these pigs all originated from homesteads with latrines, one-third of which were free-ranging at least some of the time. Epilepsy prevalence in our study was greater than the national prevalence, but we found no individuals with epilepsy attributable to cysticercosis. Additional studies are required to identify causes of epilepsy, human and porcine cysticercosis, the role of spatial clustering, and protective factors like host-pathogen immunity.
Collapse
Affiliation(s)
- Monica M. Diaz
- Yale University, New Haven, Connecticut
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dilraj Sokhi
- International Livestock Research Institute, Nairobi, Kenya
| | - John Noh
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Prabhakhar Reddi
- Aga Khan University East Africa, Nairobi, Kenya
- Aga Khan Hospital, Kisumu, Kenya
| | - Eric M. Fèvre
- International Livestock Research Institute, Nairobi, Kenya
- University of Liverpool, Liverpool, United Kingdom
| | - Ana-Claire L. Meyer
- Yale University, New Haven, Connecticut
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
10
|
Abstract
Purpose of the review Neurocysticercosis (NCC) has been well recognized as a leading cause of epilepsy. More recently, studies of other parasitic diseases such as cerebral malaria (CM) and onchocerciasis are yielding novel insights into the pathogenesis of parasite-associated epilepsy. We compare the clinical and electrophysiological findings in epilepsy associated with these highly prevalent parasites and discuss the mechanisms involved in epileptogenesis. Recent Findings Electrophysiological and imaging biomarkers continue to emerge, and individuals who are at-risk of developing parasite-associated epilepsies are being identified with greater reliability. While both Taenia solium and Plasmodium falciparum directly affect the brain parenchyma, Onchocerca volvulus is not known to invade the central nervous system. Thus, the causal association between O. volvulus and epilepsy remains controversial. Summary Both NCC and CM have a well-defined acute phase when the parasites directly or indirectly invade the brain parenchyma and lead to local inflammatory changes. This is followed by a chronic phase marked by recurrent seizures. However, these stages of epileptogenic process have not been identified in the case of O. volvulus.
Collapse
Affiliation(s)
- Rajarshi Mazumder
- Department of Neurology, David Geffen School of Medicine, University of California, 710 Westwood Plaza, C109, Los Angeles, CA, 90095, USA.
| | - John K Lee
- Department of Neurology, David Geffen School of Medicine, University of California, 710 Westwood Plaza, C109, Los Angeles, CA, 90095, USA
| |
Collapse
|
11
|
Community knowledge, attitudes, and practices regarding epilepsy in Mahenge, Tanzania: A socio-anthropological study in an onchocerciasis-endemic area with a high prevalence of epilepsy. Epilepsy Behav 2022; 128:108568. [PMID: 35101841 DOI: 10.1016/j.yebeh.2022.108568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/09/2022] [Accepted: 01/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Throughout Africa, epilepsy is a highly stigmatized condition. It is often considered to be contagious. This study aimed to assess community knowledge, attitude, and practices toward epilepsy in four villages namely Mdindo, Msogezi, Mzelezi, and Sali within Mahenge division, in Morogoro region, Tanzania. These villages are located in an onchocerciasis-endemic area with a high prevalence of epilepsy. METHODS A qualitative cross-sectional study was conducted between June and July 2019 within the framework of a multi-disciplinary research project investigating the association between onchocerciasis and epilepsy. Focus group discussions (FGDs) and in-depth interviews (IDIs) were held with persons with epilepsy (PWE) and their caretakers, community resource persons, and program coordinators of the neglected tropical diseases program. RESULTS The main symptoms of epilepsy were well described by all participants in all villages. PWE and caretakers in all villages considered epilepsy to be a major health problem and some participants ranked it second in importance after malaria. The reported perceived causes of epilepsy included febrile seizures during childhood (locally known as degedege), heredity, evil spirits, and inhaling flatus or touching secretions from PWE, especially during seizures. Knowledge about the association between epilepsy and onchocerciasis was low. People with epilepsy are disregarded, stigmatized, and marginalized from various opportunities such as conjugal rights, schooling, leadership roles, and property inheritance. Traditional healers are often the first contact when seeking care after a person develops epilepsy. CONCLUSION Epilepsy is a major health burden and public health concern in the Mahenge area. The negative attitudes toward PWE and misconceptions about the causes of epilepsy contribute to delays in seeking care at health facilities. Findings from this study will be used to optimize the comprehensive community-based epilepsy treatment program that was recently initiated in the area.
Collapse
|
12
|
Ngarka L, Siewe Fodjo JN, Aly E, Masocha W, Njamnshi AK. The Interplay Between Neuroinfections, the Immune System and Neurological Disorders: A Focus on Africa. Front Immunol 2022; 12:803475. [PMID: 35095888 PMCID: PMC8792387 DOI: 10.3389/fimmu.2021.803475] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/13/2021] [Indexed: 12/31/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Leonard Ngarka
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
- Neuroscience Lab, Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Joseph Nelson Siewe Fodjo
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Esraa Aly
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
| | - Willias Masocha
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
| | - Alfred K. Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
- Neuroscience Lab, Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
| |
Collapse
|
13
|
Two trichinellosis outbreaks in Serbia – challenging diagnosis due to a potential co-infection with Toxocara spp. J Helminthol 2022; 96:e83. [DOI: 10.1017/s0022149x22000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
In Serbia, in most cases, small family outbreaks of trichinellosis occur due to the consumption of untested infected meat from domestic pigs that are raised and slaughtered in the backyards of small individual farms. The aim of this study is to present data regarding 24 patients involved in two outbreaks that occurred in two neighbouring districts in Serbia during a closely related period of time in August 2014. The source of infection in the first outbreak was undercooked pork, while raw pork sausages caused the second outbreak. Meat samples and sausages were Trichinella spp. positive by artificial digestion. With the aim to obtain a second opinion and validate the serological findings discovered at the Public Health Institute Nis, all samples were sent to the National Reference Laboratory for Trichinellosis, INEP. Serodiagnosis showed that 21 persons were positive (87.5%) and three (12.5%) were negative for anti-Trichinella antibodies, while 15 patients fulfilled the trichinellosis case definition. Western blot analysis (using an epitope unique for the muscle larvae stage of the Trichinella genus) confirmed the diagnosis of trichinellosis in five patients. Six patients also had specific antibodies against Toxocara canis (T. canis). Due to the fact that in endemic foci in Serbia there is the presence of Trichinella spiralis and T. canis and that these two infections could be asymptomatic, we consider that trichinellosis cases were irrefutably proven. The dilemma about the existence of co-infection with T. canis remained open due to the lack of clinical findings.
Collapse
|
14
|
Alizadeh Khatir A, Moghaddam SA, Almukhtar M, Ghorbani H, Babazadeh A, Mehravar S, Rostami A. Toxoplasma infection and risk of epilepsy: A case-control study of incident patients. Microb Pathog 2021; 161:105302. [PMID: 34808274 DOI: 10.1016/j.micpath.2021.105302] [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: 09/11/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
We performed an age matched case-control study of incident epileptic patients to assess the relationship between Toxoplasma gondii seropositivity and epilepsy. Cases were 94 newly diagnosed patients (mean age, 36.7 ± 15.9) with unprovoked convulsive epilepsy of unknown etiology and controls were 88 healthy individuals (mean age, 37.5 ± 17.1) with no history of epilepsy or neurological disorders. Sera of all subjects were examined for anti-Toxoplasma IgG antibodies using commercially enzyme-linked immunoassays. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using univariate analysis and logistic regression, adjusted for potential confounders. The prevalence of anti-Toxoplasma IgG antibodies in epileptic patients (68.1%; 95%CI, 57.6-77.3%) was significantly higher than healthy controls (47.7%; 95%CI, 36.9-58.6%), indicating a significant relationship between Toxoplasma infection seropositivity and epilepsy (adjusted OR, 2.58; 95%CI, 1.16-5.72; P value < 0.05). The univariate analyses showed more than two-fold higher Toxoplasma seropositivity in patients with focal (OR, 2.31; 95%CI, 0.94-5.67) and generalized (OR, 2.35; 95%CI, 1.215-4.57) seizures versus healthy controls. Our findings support hypothesis that Toxoplasma infection/exposure may play an important role in development of epilepsy. Preventive measures to control of Toxoplasma infection especially in north of Iran and early treatment might be effective to reduce the occurrence of epilepsy in this region.
Collapse
Affiliation(s)
- Ali Alizadeh Khatir
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | | | - Hossein Ghorbani
- Department of Pathology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Saeed Mehravar
- Department of Epidemiology and Statistics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| |
Collapse
|
15
|
Egesa IJ, Newton CRJC, Kariuki SM. Evaluation of the International League Against Epilepsy 1981, 1989, and 2017 classifications of seizure semiology and etiology in a population-based cohort of children and adults with epilepsy. Epilepsia Open 2021; 7:98-109. [PMID: 34792291 PMCID: PMC8886073 DOI: 10.1002/epi4.12562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/16/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
Objective The International League Against Epilepsy (ILAE) has revised the classification of epilepsies and seizures on several occasions since the original classification published in 1964. It is unclear if these changes have impacted the characterization of epilepsy, including the clinical validity of seizure semiology or epilepsy outcomes in resource‐poor areas. We aim to address this important knowledge gap. Methods We reviewed the clinical seizure semiology and etiological data of 483 persons with epilepsy identified from a population‐based survey in rural Kenya. The seizure semiology and etiological data were classified using the 1981 (for seizures) and 1989 (for epilepsy) ILAE criteria and then reclassified according to the ILAE‐2017 criteria. Logistic regression models adjusted for potential confounders were used to measure the associations between the seizure semiology and different clinical and electroencephalographic features of epilepsy. Results Focal (formerly localization‐related) and generalized epilepsies were lower in ILAE‐2017 (56% and 29%) than that of ILAE‐1989 (61% and 34%), P < .001 and P < .001. Combined focal and generalized epilepsy type in ILAE‐2017 accounted for 11% of epilepsies. Individual seizure types were statistically similar in both ILAE‐1981 and 2017. New classification categories in ILAE‐2017 such as unknown seizures and epilepsies were identified, and the proportions were similar to the unclassified category in ILAE‐1989, 6% and 5%, respectively. The most common causes of epilepsy were symptomatic (76%) in the ILAE‐1989 criteria, with infectious (45%) and structural (36%) causes were highest in the ILAE‐2017 criteria. Significance Our study confirms that the two ILAE classification schemes are broadly consistent, but the introduction of the combined onset seizure category in ILAE‐2017 significantly reduces the proportion of mutually exclusive focal and generalized seizures. The comprehensive classification of etiology categories in ILAE‐2017 will facilitate appropriate treatment and improve prognosis.
Collapse
Affiliation(s)
- Isaac J Egesa
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya
| | - Charles R J C Newton
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Symon M Kariuki
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
16
|
Langat NK, Kariuki SM, Kamuyu G, Kakooza-Mwesige A, Owusu-Agyei S, Ae-Ngibise K, Wang'ombe A, Ngugi AK, Masaja H, Wagner RG, Newton CR. Exposure to parasitic infections determines features and phenotypes of active convulsive epilepsy in Africa. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17049.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Epilepsy affects 70 million people worldwide, 80% of whom are in low-and-middle income countries (LMICs). Infections of the central nervous system (CNS) contribute considerably to the burden of epilepsy in LMICs, but the nature and presentation of epilepsy following these infections is not fully understood. We examined if epilepsy foutcomes are associated with the exposure to parasitic infections. Methods: This was a case-comparison study nested in a cross-sectional survey of people with active convulsive epilepsy, with cases as those exposed to parasitic infections, and comparison as those unexposed. Associations of exposure to parasites with clinical and electroencephalographic features of epilepsy were done using a modified mixed effects Poisson regression model across five sites in Africa. Multiplicative and additive scale (RERI) interactions were explored to determine the effect of co-infections on epilepsy features. Population attributable fractions (PAF) were calculated to determine the proportion of severe clinical and electroencephalographic features of epilepsy attributable to CNS infections. Results: A total of 997 participants with active convulsive epilepsy from the five African sites were analyzed, 51% of whom were males. Exposure to parasitic infections was associated with more frequent seizures in adult epilepsy (relative risk (RR)=2.58, 95% confidence interval (95%CI):1.71-3.89). In children, exposure to any parasite was associated with convulsive status epilepticus (RR=4.68, (95%CI: 3.79-5.78), intellectual disabilities (RR=2.13, 95%CI: 1.35-3.34) and neurological deficits (RR=1.92, 95%CI: 1.42-2.61). Toxoplasma gondii and Onchocerca volvulus interacted synergistically to increase the risk of status epilepticus (RERI=0.91, 95%CI=0.48-1.35) in the data pooled across the sites. Exposure to parasitic infections contributed to 30% of severe features of epilepsy as shown by PAF. Conclusions: Parasitic infections may determine features and phenotypes of epilepsy through synergistic or antagonistic interactions, which can be different in children and adults. Interventions to control or manage infections may reduce complications and improve prognosis in epilepsy.
Collapse
|
17
|
Watila MM, Balarabe SA, Komolafe MA, Igwe SC, Fawale MB, Otte WM, van Diessen E, Okunoye O, Mshelia AA, Abdullahi I, Musa J, Hedima EW, Nyandaiti YW, Singh G, Winkler AS, Sander JW. Epidemiology of Epilepsy in Nigeria: A Community-Based Study From 3 Sites. Neurology 2021; 97:e728-e738. [PMID: 34253632 DOI: 10.1212/wnl.0000000000012416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We determined the prevalence, incidence, and risk factors for epilepsy in Nigeria. METHODS We conducted a door-to-door survey to identify cases of epilepsy in 3 regions. We estimated age-standardized prevalence adjusted for nonresponse and sensitivity and the 1-year retrospective incidence for active epilepsy. To assess potential risk factors, we conducted a case-control study by collecting sociodemographic and risk factor data. We estimated odds ratios using logistic regression analysis and corresponding population attributable fractions (PAFs). RESULTS We screened 42,427 persons (age ≥6 years), of whom 254 had confirmed active epilepsy. The pooled prevalence of active epilepsy per 1,000 was 9.8 (95% confidence interval [CI] 8.6-11.1), 17.7 (14.2-20.6) in Gwandu, 4.8 (3.4-6.6) in Afikpo, and 3.3 (2.0-5.1) in Ijebu-Jesa. The pooled incidence per 100,000 was 101.3 (95% CI 57.9-167.6), 201.2 (105.0-358.9) in Gwandu, 27.6 (3.3-128.0) in Afikpo, and 23.9 (3.2-157.0) in Ijebu-Jesa. Children's significant risk factors included febrile seizures, meningitis, poor perinatal care, open defecation, measles, and family history in first-degree relatives. In adults, head injury, poor perinatal care, febrile seizures, family history in second-degree relatives, and consanguinity were significant. Gwandu had more significant risk factors. The PAF for the important factors in children was 74.0% (71.0%-76.0%) and in adults was 79.0% (75.0%-81.0%). CONCLUSION This work suggests varied epidemiologic numbers, which may be explained by differences in risk factors and population structure in the different regions. These variations should differentially determine and drive prevention and health care responses.
Collapse
Affiliation(s)
- Musa M Watila
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Salisu A Balarabe
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Morenikeji A Komolafe
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Stanley C Igwe
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Michael B Fawale
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Willem M Otte
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Eric van Diessen
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Olaitan Okunoye
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Anthony A Mshelia
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Ibrahim Abdullahi
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Joseph Musa
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Erick W Hedima
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Yakub W Nyandaiti
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Gagandeep Singh
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Andrea S Winkler
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands
| | - Josemir W Sander
- From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands.
| |
Collapse
|
18
|
Ogwang R, Ningwa A, Akun P, Bangirana P, Anguzu R, Mazumder R, Salamon N, Henning OJ, Newton CR, Abbo C, Mwaka AD, Marsh K, Idro R. Epilepsy in Onchocerca volvulus Sero-Positive Patients From Northern Uganda-Clinical, EEG and Brain Imaging Features. Front Neurol 2021; 12:687281. [PMID: 34149607 PMCID: PMC8209377 DOI: 10.3389/fneur.2021.687281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023] Open
Abstract
Globally, epilepsy is the most common chronic neurological disorder. The incidence in sub-Saharan Africa is 2-3 times higher than that in high income countries. Infection by Onchocerca volvulus may be an underlying risk factor for the high burden and based upon epidemiological associations, has been proposed to cause a group of disorders—Onchocerca associated epilepsies (OAE) like nodding syndrome (NS). To improve our understanding of the disease spectrum, we described the clinical, electroencephalographic (EEG) and magnetic resonance imaging (MRI) features of children with epilepsy and sero-positive for Onchocerca volvulus (possible OAEs other than nodding syndrome). Twenty-nine children and adolescents with non-nodding syndrome OAE in northern Uganda were enrolled. A diagnosis of OAE was made in patients with epilepsy and seizure onset after age 3 years, no reported exposure to perinatal severe febrile illness or traumatic brain injury, no syndromic epilepsy diagnosis and a positive Ov-16 ELISA test. Detailed clinical evaluation including psychiatric, diagnostic EEG, a diagnostic brain MRI (in 10 patients) and laboratory testing were performed. Twenty participants (69%) were male. The mean age was 15.9 (standard deviation [SD] 1.9) years while the mean age at seizure onset was 9.8 (SD 2.9) years. All reported normal early childhood development. The most common clinical presentation was a tonic-clonic seizure. The median number of seizures was 2 (IQR 1–4) in the previous month. No specific musculoskeletal changes, or cranial nerve palsies were reported, neither were any vision, hearing and speech difficulties observed. The interictal EEG was abnormal in the majority with slow wave background activity in 52% (15/29) while 41% (12/29) had focal epileptiform activity. The brain MRI showed mild to moderate cerebellar atrophy and varying degrees of atrophy of the frontal, parietal and occipital lobes. The clinical spectrum of epilepsies associated with Onchocerca may be broader than previously described. In addition, focal onset tonic-clonic seizures, cortical and cerebellar atrophy may be important brain imaging and clinical features.
Collapse
Affiliation(s)
- Rodney Ogwang
- College of Health Sciences, Makerere University, Kampala, Uganda.,KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Coast, Kilifi, Kenya.,Centre of Tropical Neuroscience, Kitgum, Uganda
| | - Albert Ningwa
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda
| | - Pamela Akun
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda
| | - Paul Bangirana
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Anguzu
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda.,Division of Epidemiology, Medical College of Wisconsin, Institute for Health and Equity, Milwaukee, WI, United States
| | - Rajarshi Mazumder
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Oliver Johannes Henning
- Division of Clinical Neuroscience, The National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Charles R Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Coast, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Catherine Abbo
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Kevin Marsh
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Richard Idro
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
19
|
Prevalence and mortality of epilepsies with convulsive and non-convulsive seizures in Kilifi, Kenya. Seizure 2021; 89:51-55. [PMID: 34000517 PMCID: PMC7611274 DOI: 10.1016/j.seizure.2021.04.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives The prevalence of all epilepsies (both convulsive and non-convulsive seizures) in Low- and Middle-Income Countries (LMIC), particularly sub-Saharan Africa is unknown. Under estimation of non-convulsive epilepsies in data from these countries may lead to inadequate and sub-optimal allocation of resources to control and prevent epilepsy. We determined the prevalence of all types of epilepsies and compared the mortality between convulsive seizures and non-convulsive seizures in a resource limited rural area in Kenya. Methods Trained clinicians identified cases of epilepsy in a randomly selected sample of 4,441 residents in the Kilifi Health and Demographic Surveillance System site using a cross-sectional survey design. Seizure types were classified by epileptologists using the current guidelines of the International League Against Epilepsy (ILAE). We estimated prevalence for epilepsy with convulsive seizures and non-convulsive seizures and for epilepsy with non-convulsive seizures only and compared premature mortality between these groups of seizures. Results Of the 4441 people visited, 141 had lifetime epilepsy and 96 active epilepsy, which is a crude prevalence of 31.7/1,000 persons (95% CI: 26.6-36.9) and 21.6/1,000 (95% CI: 17.3-25.9), respectively. Both convulsive and non-convulsive seizures occurred in 7% people with epilepsy (PWE), only convulsive seizures in 52% and only non-convulsive seizures in 35% PWE; there was insufficient information to classify epilepsy in the remainder 6%. The age- and sex-adjusted prevalence of lifetime people was 23.5/1,000 (95% CI: 11.0-36.0), with the adjusted prevalence of epilepsy with non-convulsive seizures only estimated at 8.2/1,000 (95%CI:3.9-12.6). The mortality rate in PWE was 6.3/1,000 (95%CI: 3.4-11.8), compared to 2.8/1,000 (2.3-3.3) in those without epilepsy; hazard ratio (HR) =2.31 (1.22-4.39; p=0.011). The annual mortality rate was 11.2/1,000 (95%CI: 5.3-23.4) in PWE with convulsive and non-convulsive seizures and none died in PWE with non-convulsive seizures alone. Conclusions Our study shows that epilepsy with non-convulsive seizures is common and adds to the prevalence of previously reported estimates of active convulsive epilepsy. Both epilepsy with convulsive seizures and that with non-convulsive seizures should be identified for optimising treatment and for planning resource allocation.
Collapse
|
20
|
Devi KR, Borbora D, Upadhyay N, Goswami D, Rajguru SK, Narain K. Neurocysticercosis in patients with active epilepsy in the tea garden community of Assam, Northeast India. Sci Rep 2021; 11:7433. [PMID: 33795818 PMCID: PMC8016991 DOI: 10.1038/s41598-021-86823-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/19/2021] [Indexed: 11/09/2022] Open
Abstract
Neurocysticercosis is a significant cause of epilepsy in the tropics. The present cross-sectional survey was conducted in the socioeconomically backward tea garden community of Assam to gauge the prevalence of neurocysticercosis in patients with active epilepsy and to determine the associated risk factors. In a door to door survey, a total of 1028 individuals from every fifth household of the study Teagarden were enrolled to identify self-reported seizure cases, followed by a neurological examination to confirm the diagnosis of active epilepsy. Patients with active epilepsy underwent clinical, epidemiological, neuroimaging (contrast-enhanced computerized tomography) and immunological evaluations to establish the diagnosis of neurocysticercosis. Clinically confirmed 53 (5.16%) active epilepsy were identified; 45 agreed to further assessment for neurocysticercosis and 19 (42.2%) cases fulfilled either definitive or probable diagnostic criteria for neurocysticercosis. Patients with epilepsy due to neurocysticercosis were more likely to suffer from taeniasis (20.0% vs 0.0%), rear pigs (57.9% vs 15.4%) or have pigs in their neighbourhood (78.9% vs 53.8%) relative to epileptic patients without neurocysticercosis. Rearing pigs (aOR 14.35, 95% CI: 3.98–51.75) or having pigs in the neighbourhood (aOR 12.34, 95% CI: 2.53–60.31) were independent risk factors of neurocysticercosis. In this community, the prevalence of taeniasis (adult worm infection) was 6.6% based on microscopy. The study reports a high prevalence of active epilepsy in the tea garden community of Assam and neurocysticercosis as its primary cause. The high prevalence of taeniasis is also a significant concern.
Collapse
Affiliation(s)
- K Rekha Devi
- ICMR-Regional Medical Research Centre, N. E. Region, Dibrugarh, Assam, 786001, India
| | - Debasish Borbora
- ICMR-Regional Medical Research Centre, N. E. Region, Dibrugarh, Assam, 786001, India.,Department of Biotechnology, Gauhati University, Guwahati, Assam, 781014, India
| | - Narayan Upadhyay
- Department of Neurology, Assam Medical College and Hospital, Dibrugarh, Assam, 786002, India
| | - Dibyajyoti Goswami
- ICMR-Regional Medical Research Centre, N. E. Region, Dibrugarh, Assam, 786001, India
| | - S K Rajguru
- ICMR-Regional Medical Research Centre, N. E. Region, Dibrugarh, Assam, 786001, India
| | - Kanwar Narain
- ICMR-Regional Medical Research Centre, N. E. Region, Dibrugarh, Assam, 786001, India.
| |
Collapse
|
21
|
Potential Parasitic Causes of Epilepsy in an Onchocerciasis Endemic Area in the Ituri Province, Democratic Republic of Congo. Pathogens 2021; 10:pathogens10030359. [PMID: 33803565 PMCID: PMC8002919 DOI: 10.3390/pathogens10030359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
A high burden of epilepsy is observed in Africa where parasitological infections are endemic. In 2016, in an Onchocerciasis endemic area in the Logo health zone, in Ituri province in the Democratic Republic of Congo, a door-to-door study showed an epilepsy prevalence of 4.6%, and 50.6% of persons with epilepsy were infected with Onchocerca volvulus. In the current study, the serum of 195 people infected with O. volvulus persons with epilepsy were tested to determine the proportion of co-infections with Taenia solium, Toxocara canis and Strongyloides. These proportions were, respectively, 8.2, 18.5 and 12.8%. Persons with a T. solium co-infection were older than those without co-infection (p = 0.021). In six (37.5%) of the T. solium co-infected persons, the first seizures appeared after the age of 30 years compared to three (2.1%) persons without a co-infection (p < 0.0001). Our study suggests that an O. volvulus infection is the main parasitic cause of epilepsy in the Ituri province, but in some persons, mainly in those with late onset epilepsy and with focal seizures, the epilepsy may be caused by neurocysticercosis. As the population in the area rears pigs, activities to limit T. solium transmission should be implemented.
Collapse
|
22
|
Colebunders R, Njamnshi AK, Menon S, Newton CR, Hotterbeekx A, Preux PM, Hopkins A, Vaillant M, Siewe Fodjo JN. Onchocerca volvulus and epilepsy: A comprehensive review using the Bradford Hill criteria for causation. PLoS Negl Trop Dis 2021; 15:e0008965. [PMID: 33411705 PMCID: PMC7790236 DOI: 10.1371/journal.pntd.0008965] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The possibility that onchocerciasis may cause epilepsy has been suggested for a long time, but thus far, an etiological link has not been universally accepted. The objective of this review is to critically appraise the relationship between Onchocerca volvulus and epilepsy and subsequently apply the Bradford Hill criteria to further evaluate the likelihood of a causal association. METHODS PubMed and gray literature published until September 15, 2020, were searched and findings from original research were synthesized. Adherence to the 9 Bradford Hill criteria in the context of onchocerciasis and epilepsy was determined to assess whether the criteria are met to strengthen the evidence base for a causal link between infection with O. volvulus and epilepsy, including the nodding syndrome. RESULTS Onchocerciasis as a risk factor for epilepsy meets the following Bradford Hill criteria for causality: strength of the association, consistency, temporality, and biological gradient. There is weaker evidence supporting causality based on the specificity, plausibility, coherence, and analogy criteria. There is little experimental evidence. Considering the Bradford Hill criteria, available data suggest that under certain conditions (high microfilarial load, timing of infection, and perhaps genetic predisposition), onchocerciasis is likely to cause epilepsy including nodding and Nakalanga syndromes. CONCLUSION Applying the Bradford Hill criteria suggests consistent epidemiological evidence that O. volvulus infection is a trigger of epilepsy. However, the pathophysiological mechanisms responsible for seizure induction still need to be elucidated.
Collapse
Affiliation(s)
- Robert Colebunders
- Global Health Institute, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Alfred K. Njamnshi
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé Cameroon
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Sonia Menon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Charles R. Newton
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - An Hotterbeekx
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre-Marie Preux
- Institute of Epidemiology and Tropical Neurology, INSERM UMR1094, University of Limoges, Limoges, France
| | - Adrian Hopkins
- Neglected and Disabling Diseases of Poverty Consultant, Kent, United Kingdom
| | - Michel Vaillant
- Competence Center in Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | | |
Collapse
|
23
|
Manuel L, Santos-Gomes G, Noormahomed EV. Human toxoplasmosis in Mozambique: gaps in knowledge and research opportunities. Parasit Vectors 2020; 13:571. [PMID: 33176884 PMCID: PMC7659051 DOI: 10.1186/s13071-020-04441-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/30/2020] [Indexed: 01/01/2023] Open
Abstract
Toxoplasmosis is a parasitic zoonotic disease caused by Toxoplasma gondii that afflicts humans worldwide and wild and domestic warm-blooded animals. In immunocompetent individuals, the acute phase of infection presents transient low or mild symptoms that remain unnoticed. In immunocompromised patients, T. gondii is a life-threatening opportunistic infection, which can result from the reactivation of latent infection or primary infection. Moreover, congenital toxoplasmosis, which results from the transplacental passage of tachyzoites into the fetus during a pregnant primary infection, can lead to miscarriage, stillbirth, or ocular and neurologic disease, and neurocognitive deficits in the newborns. Thus, the present review aims to address the current knowledge of T. gondii infection and toxoplasmosis in Africa and especially in Mozambique, stressing the importance of identifying risk factors and promote awareness among the health care providers and population, assessing the gaps in knowledge and define research priorities. In Mozambique, and in general in southern African countries, clinical disease and epidemiological data have not yet been entirely addressed in addition to the implications of T. gondii infection in immunocompetent individuals, in pregnant women, and its relation with neuropsychiatric disorders. The main gaps in knowledge in Mozambique include lack of awareness of the disease, lack of diagnostic methods in health facilities, lack of genetic data, and lack of control strategies.![]()
Collapse
Affiliation(s)
- Leonardo Manuel
- Faculty of Health Sciences, Universidade Lurio, Nampula, Mozambique
| | - Gabriela Santos-Gomes
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Emilia V Noormahomed
- Department of Microbiology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique. .,Department of Medicine, Infectious Disease Division, University of California, San Diego, USA. .,Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique.
| |
Collapse
|
24
|
Toxoplasma gondii: AnUnderestimated Threat? Trends Parasitol 2020; 36:959-969. [PMID: 33012669 DOI: 10.1016/j.pt.2020.08.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 02/08/2023]
Abstract
Traditionally, the protozoan parasite Toxoplasma gondii has been thought of as relevant to public health primarily within the context of congenital toxoplasmosis or postnatally acquired disease in immunocompromised patients. However, latent T.gondii infection has been increasingly associated with a wide variety of neuropsychiatric disorders and, more recently, causal frameworks for these epidemiological associations have been proposed. We present assimilated evidence on the associations between T.gondii and various human neuropsychiatric disorders and outline how these may be explained within a unifying causal framework. We argue that the occult effects of latent T.gondii infection likely outweigh the recognised overt morbidity caused by toxoplasmosis, substantially raising the public health importance of this parasite.
Collapse
|
25
|
Sadeghi M, Riahi SM, Mohammadi M, Saber V, Aghamolaie S, Moghaddam SA, Aghaei S, Javanian M, Gamble HR, Rostami A. An updated meta-analysis of the association between Toxoplasma gondii infection and risk of epilepsy. Trans R Soc Trop Med Hyg 2020; 113:453-462. [PMID: 31034025 DOI: 10.1093/trstmh/trz025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/08/2019] [Accepted: 03/26/2019] [Indexed: 12/19/2022] Open
Abstract
Toxoplasma gondii is a neurotropic pathogen with worldwide distribution. To evaluate the association between Toxoplasma infection and the risk of epilepsy by meta-analysis, observational peer-reviewed studies were retrieved from PubMed, Embase, Web of Science, Scopus and Google Scholar (up to 10 October 2018) and by reference review. Pooled risk estimates were calculated using a random effects model. Heterogeneity was assessed using Cochrane's Q-test and I2. In total, 16 eligible studies involving 19 data sets were included for the final analysis. A total 7897 participants (3771 epileptic patients, 4026 healthy controls) were included. The pooled odds ratio (OR) for Toxoplasma infection was increased to 1.72 (95% confidence interval [CI] 1.37 to 2.16) among patients with epilepsy. There was moderate heterogeneity among the studies (χ2=39.8, I2=62.3%, p=0.001). The ORs from subgroup analyses showed that both cryptogenic epilepsy (OR 2.65 [95% CI 1.91 to 3.68]) and active convulsive epilepsy (OR 1.37 [95% CI 1.09 to 1.72]) were significantly associated with Toxoplasma infection. Another subgroup analyses according to age showed a significant positive association in children (OR 1.33), adults (OR 1.57) and in all ages (OR 1.89). Our findings support the association between Toxoplasma infection and epilepsy. More prospective studies with larger sample sizes and more experimental studies are recommended to elucidate a causative relationship.
Collapse
Affiliation(s)
- Maryam Sadeghi
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Riahi
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Mohammadi
- Clinical Parasitology Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Vafa Saber
- Department of Microbiology, Islamic Azad University, Varamin Pishva Branch, Tehran, Iran
| | - Somayeh Aghamolaie
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shima Aghaei
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mostafa Javanian
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - H Ray Gamble
- National Academy of Sciences, Washington, DC, USA
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Immunoregulation Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
26
|
Romo ML. Novel evidence to motivate onchocerciasis elimination. THE LANCET. INFECTIOUS DISEASES 2020; 20:1223-1224. [PMID: 32598870 DOI: 10.1016/s1473-3099(20)30284-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/03/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Matthew L Romo
- Institute for Implementation Science in Population Health and Graduate School of Public Health and Health Policy, City University of New York, NY 10027, USA; Program in Global Health and Development, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| |
Collapse
|
27
|
Gumisiriza N, Kaiser C, Asaba G, Onen H, Mubiru F, Kisembo D, Siewe Fodjo JN, Colebunders R. Changes in epilepsy burden after onchocerciasis elimination in a hyperendemic focus of western Uganda: a comparison of two population-based, cross-sectional studies. THE LANCET. INFECTIOUS DISEASES 2020; 20:1315-1323. [PMID: 32598869 DOI: 10.1016/s1473-3099(20)30122-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 01/13/2020] [Accepted: 02/13/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In 1994, prevalence and incidence of epilepsy were high in the Itwara onchocerciasis focus (western Uganda), and cases of nodding and Nakalanga syndrome were documented. Onchocerciasis transmission was interrupted successfully in 2001. 17 years later, we re-investigated the epilepsy burden in this area. METHODS From Dec 11 to Dec 15, 2018, a door-to-door survey was done in the three villages (Kabende Centre, Masongora South, and Rwesenene) with the highest epilepsy rates in 1994 to identify people with suspected epilepsy. Epilepsy diagnoses were confirmed by an interview and physical examination by a study clinician. The prevalence and incidence of epilepsy were measured using methods consistent with those used in 1994. Results from 2018 were compared with those from 1994. FINDINGS The overall crude prevalence of epilepsy in the study villages decreased from 3·0% (35 of 1169) in 1994 to 1·2% (27 of 2325) in 2018 (p=0·0002), with a concomitant decrease in the proportion of people with epilepsy with unknown cause (p=0·037). Between 1994 and 2018, the overall incidence of epilepsy decreased from 418 cases per 100 000 person-years (95% CI 265-626) to 73 new cases per 100 000 person-years (32-114; p<0·0001); this reduction was more pronounced for cases having the first seizure between ages 3 years and 18 years (p<0·0001). No new case of nodding or Nakalanga syndromes had occurred since the interruption of onchocerciasis transmission. INTERPRETATION Our findings support the existence of a negative association between onchocerciasis elimination and epilepsy burden in previously hyperendemic areas. Therefore, onchocerciasis elimination efforts should be intensified in endemic regions with a high prevalence of epilepsy, which might reduce the burden of epilepsy. FUNDING Flemish University Development Cooperation and the European Research Council.
Collapse
Affiliation(s)
| | | | - George Asaba
- Department of Pediatrics, Regional Referral Hospital, Fort Portal, Uganda
| | - Henry Onen
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Frank Mubiru
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | | | | | | |
Collapse
|
28
|
Chesnais CB, Bizet C, Campillo JT, Njamnshi WY, Bopda J, Nwane P, Pion SD, Njamnshi AK, Boussinesq M. A Second Population-Based Cohort Study in Cameroon Confirms the Temporal Relationship Between Onchocerciasis and Epilepsy. Open Forum Infect Dis 2020; 7:ofaa206. [PMID: 32587878 PMCID: PMC7304933 DOI: 10.1093/ofid/ofaa206] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/28/2020] [Indexed: 11/13/2022] Open
Abstract
To confirm our earlier evidence of a temporal and dose–response relationship between onchocerciasis and epilepsy, we conducted another cohort study in a different setting in Cameroon. Individuals whose Onchocerca volvulus microfilarial density (Ov-MFD) was measured in 1992–1994 when they were children were revisited in 2019 to determine if they acquired epilepsy. With reference to individuals with no microfilariae in 1992–1994, the relative risks of acquiring epilepsy were 0.96, 2.76, 3.67, and 11.87 in subjects with initial Ov-MFD of 1–7, 8–70, 71–200, and > 200 microfilariae per skin snip, respectively. This study further demonstrates reproducibility using the Bradford Hill’s criteria for causality.
Collapse
Affiliation(s)
- Cédric B Chesnais
- UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier, INSERM Unité 1175, Montpellier, France
| | - Charlotte Bizet
- UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier, INSERM Unité 1175, Montpellier, France.,Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Jérémy T Campillo
- UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier, INSERM Unité 1175, Montpellier, France
| | - Wepnyu Y Njamnshi
- Neurology Department, Central Hospital/Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, (FMBS-UYI), Yaoundé, Cameroon.,Brain Research Africa Initiative, BRAIN, Geneva, Switzerland/Yaoundé, Cameroon
| | - Jean Bopda
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Philippe Nwane
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Sébastien D Pion
- UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier, INSERM Unité 1175, Montpellier, France
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital/Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, (FMBS-UYI), Yaoundé, Cameroon.,Brain Research Africa Initiative, BRAIN, Geneva, Switzerland/Yaoundé, Cameroon
| | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier, INSERM Unité 1175, Montpellier, France
| |
Collapse
|
29
|
Muhigwa A, Preux PM, Gérard D, Marin B, Boumediène F, Ntamwira C, Tsai CH. Comorbidities of epilepsy in low and middle-income countries: systematic review and meta-analysis. Sci Rep 2020; 10:9015. [PMID: 32488109 PMCID: PMC7265529 DOI: 10.1038/s41598-020-65768-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/06/2020] [Indexed: 01/30/2023] Open
Abstract
Epilepsy is a major public health concern in low and middle-income countries (LMICs) and comorbidities aggravate the burden associated with the disease. The epidemiology of these comorbidities has not been well described, although, identifying the main comorbidities of epilepsy, and their relative importance, is crucial for improving the quality of care. Comorbidities were defined as disorders coexisting with or preceding epilepsy, or else compounded or directly attributed to epilepsy or to its treatment. A meta-analysis of the proportion of main comorbidities by subcontinent as well as overall was also conducted. Out of the 2,300 papers identified, 109 from 39 countries were included in this systematic review. Four groups of comorbidities were identified: parasitic and infectious diseases (44% of comorbid conditions), somatic comorbidities (37%), psychosocial (11%), as well as psychiatric comorbidities (8%). Heterogeneity was statistically significant for most variables then random effect models were used. The most frequently studied comorbidities were: neurocysticercosis (comorbid proportion: 23%, 95% CI: 18-29), head trauma (comorbid proportion: 9%, 95% CI: 5-15) malnutrition (comorbid proportion: 16%, 95% CI: 28-40), stroke (comorbid proportion: 1.3%, 95% CI: 0.2-7.0), and discrimination for education (comorbid proportion: 34%, 95% CI: 28-40). Many comorbidities of epilepsy were identified in LMICs, most of them being infectious.
Collapse
Affiliation(s)
- Aline Muhigwa
- INSERM, IRD associated unit, U1094, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, CHU Limoges, GEIST, 87000, Limoges, France
- Faculté de médecine, Université officielle de Bukavu/1, Avenue Kasongo, Commune d'Ibanda, B.P. 570, Bukavu, Democratic Republic of the Congo
| | - Pierre-Marie Preux
- INSERM, IRD associated unit, U1094, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, CHU Limoges, GEIST, 87000, Limoges, France.
| | - Daniel Gérard
- INSERM, IRD associated unit, U1094, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, CHU Limoges, GEIST, 87000, Limoges, France
| | - Benoit Marin
- INSERM, IRD associated unit, U1094, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, CHU Limoges, GEIST, 87000, Limoges, France
| | - Farid Boumediène
- INSERM, IRD associated unit, U1094, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, CHU Limoges, GEIST, 87000, Limoges, France
| | - Charles Ntamwira
- Faculté de médecine, Université officielle de Bukavu/1, Avenue Kasongo, Commune d'Ibanda, B.P. 570, Bukavu, Democratic Republic of the Congo
| | - Chung-Huang Tsai
- Department of family medicine, Chung-Kang Branch, Cheng Ching hospital, Taiwan No.966.sec. 4, Taiwan Blvd. Xitun Dist., Taichung, Taiwan, ROC
| |
Collapse
|
30
|
Zoonotic and vector-borne parasites and epilepsy in low-income and middle-income countries. Nat Rev Neurol 2020; 16:333-345. [PMID: 32427939 DOI: 10.1038/s41582-020-0361-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 12/22/2022]
Abstract
Zoonotic and vector-borne parasites are important preventable risk factors for epilepsy. Three parasitic infections - cerebral malaria, Taenia solium cysticercosis and onchocerciasis - have an established association with epilepsy. Parasitoses are widely prevalent in low-income and middle-income countries, which are home to 80% of the people with epilepsy in the world. Once a parasitic infection has taken hold in the brain, therapeutic measures do not seem to influence the development of epilepsy in the long term. Consequently, strategies to control, eliminate and eradicate parasites represent the most feasible way to reduce the epilepsy burden at present. The elucidation of immune mechanisms underpinning the parasitic infections, some of which are parasite-specific, opens up new therapeutic possibilities. In this Review, we explore the pathophysiological basis of the link between parasitic infections and epilepsy, and we consider preventive and therapeutic approaches to reduce the burden of epilepsy attributable to parasitic disorders. We conclude that a concerted approach involving medical, veterinary, parasitological and ecological experts, backed by robust political support and sustainable funding, is the key to reducing this burden.
Collapse
|
31
|
Spencer PS, Mazumder R, Palmer VS, Valdes Angues R, Pollanen MS. The etiology of nodding syndrome phenotypes remains unknown §,§§. Rev Neurol (Paris) 2020; 177:141-143. [PMID: 32359948 DOI: 10.1016/j.neurol.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/01/2022]
Affiliation(s)
- P S Spencer
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
| | - R Mazumder
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - V S Palmer
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - R Valdes Angues
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - M S Pollanen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| |
Collapse
|
32
|
Abstract
Toxocara canis and T. cati are among the most widely distributed helminthic species in the world with a high zoonotic impact. Millions of people are infecteda and hundreds of thousands are suffering from toxocarosis, a disease encompassing four different entities: larva migrans visceralis (VLM) syndrome, ocular larva migrans (OLM) syndrome, covert toxocarosis (covT), common toxocarosis (comT) and neurotoxocarosis (NT). Toxocara infections in humans may remain clinically inapparent but may also induce severe diseases. This contribution gives a synoptic overview of the most important historical, clinical, diagnostic and therapeutical aspects of toxocarosis in humans.
Collapse
|
33
|
Strube C, Waindok P, Raulf MK, Springer A. Toxocara-induced neural larva migrans (neurotoxocarosis) in rodent model hosts. ADVANCES IN PARASITOLOGY 2020; 109:189-218. [PMID: 32381198 DOI: 10.1016/bs.apar.2020.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Neural larva migrans (NLM), or neurotoxocarosis, induced by Toxocara canis or Toxocara cati results from migrating and persisting larvae in the central nervous system of paratenic hosts, including humans. As the diagnosis of NLM in humans is not straightforward, most knowledge on the disease is derived from only a few published clinical cases. To improve our understanding of human NLM, studies on the pathogenesis and clinical symptoms in laboratory animal model systems are indispensable, and rodents have been accepted as the most appropriate model organisms for NLM. As research has mostly focused on neuroinvasive T. canis-larvae, information regarding the pathogenesis of T. cati-induced NLM remains scarce. This review summarises the current state of knowledge on neuroinvasion by both T. canis and T. cati in different rodent model hosts, the resulting behavioural changes, and histopathological alterations during the course of NLM as well as the potential molecular pathogenic mechanisms.
Collapse
Affiliation(s)
- Christina Strube
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Hanover, Germany.
| | - Patrick Waindok
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Marie-Kristin Raulf
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Hanover, Germany; Immunology Unit & Research Centre for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Andrea Springer
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Hanover, Germany
| |
Collapse
|
34
|
Fan CK. Pathogenesis of cerebral toxocariasis and neurodegenerative diseases. ADVANCES IN PARASITOLOGY 2020; 109:233-259. [PMID: 32381200 DOI: 10.1016/bs.apar.2020.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Toxocara canis belongs to one of zoonotic parasites that commonly infects canines worldwide, and its eggs in host faeces may contaminate the food, water, soil and their fur as well as the larvae entrapped in the granuloma can infect paratenic hosts including mice and humans. Survivability of T. canis embryonated eggs under moist, cool conditions may be as long as 2-4 years or more. In paratenic hosts such as mice and humans, T. canis L3 larvae neither moult, grow, nor replicate and will wander through a number of internal organs in humans so as to cause Th2-dominant pathology in various internal organs as leading to neurotoxocariasis (NT), ocular toxocariasis (OT), or visceral larva migrans (VLM). Although the systemic immune response to T. canis has been widely reported, the immune response in the brain has received little attention. Differential cytokine expression and other brain injury-associated biomarkers or neurodegeneration-associated factors have been observed in infected versus uninfected outbred and inbred mice. Preliminary data have also suggested a possible link between significant memory impairment and cytokine production associated with T. canis infection in the hippocampus which has been long recognised as being responsible for learning and memory functions. Notably, it remains an enigma concerning cerebral invasion by T. canis larvae rarely induces a recognisable neurological syndrome or its involvement in neuropathological disorders in humans. Exploration of the relationship between host and parasite in the brain may elucidate the cryptic symptoms of human cerebral toxocariasis, with patients presenting with mental retardation, epilepsy, neurodegeneration and other central nervous system (CNS) disorders.
Collapse
Affiliation(s)
- Chia-Kwung Fan
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Research Center of International Tropical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Tropical Medicine Division, International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
35
|
Schmidt V, O’Hara MC, Ngowi B, Herbinger KH, Noh J, Wilkins PP, Richter V, Kositz C, Matuja W, Winkler AS. Taenia solium cysticercosis and taeniasis in urban settings: Epidemiological evidence from a health-center based study among people with epilepsy in Dar es Salaam, Tanzania. PLoS Negl Trop Dis 2019; 13:e0007751. [PMID: 31809501 PMCID: PMC6897529 DOI: 10.1371/journal.pntd.0007751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/05/2019] [Indexed: 01/11/2023] Open
Abstract
In Africa, urbanization is happening faster than ever before which results in new implications for transmission of infectious diseases. For the zoonotic parasite Taenia solium, a major cause of acquired epilepsy in endemic countries, the prevalence in urban settings is unknown. The present study investigated epidemiological, neurological, and radiological characteristics of T. solium cysticercosis and taeniasis (TSCT) in people with epilepsy (PWE) living in Dar es Salaam, Tanzania, one of the fastest growing cities worldwide. A total of 302 PWE were recruited from six health centers in the Kinondoni district of Dar es Salaam. Serological testing for T. solium cysticercosis-antigen (Ag) and -antibodies (Abs) and for T. solium taeniasis-Abs was performed in all PWE. In addition, clinical and radiological examinations that included cranial computed tomography (CT) were performed. With questionnaires, demographic data from study populations were collected, and factors associated with TSCT were assessed. Follow-up examinations were conducted in PWE with TSCT. T. solium cysticercosis-Ag was detected in three (0.99%; 95% CI: 0–2.11%), -Abs in eight (2.65%; 95% CI: 0.84–4.46%), and taeniasis-Abs in five (1.66%; 95% CI: 0.22–3.09%) of 302 PWE. Six PWE (1.99%; 95% CI: 0.41–3.56%) were diagnosed with neurocysticercosis (NCC). This study demonstrates the presence of TSCT in Dar es Salaam, however, NCC was only associated with a few cases of epilepsy. The small fraction of PWE with cysticercosis- and taeniasis-Abs may suggest that active transmission of T. solium plays only a minor role in Dar es Salaam. A sufficiently powered risk analysis was hampered by the small number of PWE with TSCT; therefore, further studies are required to determine the exact routes of infection and risk behavior of affected individuals. Taenia solium cysticercosis and taeniasis is a zoonotic disease complex which affects thousands of people in sub-Saharan Africa. This parasite has a human-pig life cycle and has been considered a public health problem mainly in rural areas. As African towns and suburbs grow rapidly and disproportionally, adequate infrastructure such as sewage systems and clean water often lack while population density, trade, and travel increase. This may lead to the appearance of parasitic diseases formerly considered `rural´ in urban settings. In this study, we searched for evidence of T. solium infections in the Kinondoni district of Dar es Salaam, Tanzania. We focused on people with epilepsy (PWE) since epilepsy is one of the most common and severe disorders associated with T. solium neurocysticercosis and tested all of them serologically for T. solium cysticercosis and taeniasis. We further investigated neurological and radiological characteristics. Our findings show that in our study area in Dar es Salaam 2.65% of PWE had contracted T. solium infection at some stage. Neurocysticercosis, as confirmed by neuroimaging, was found only in 1.99% of PWE. This, in combination with the relatively small number of PWE detected with taeniasis antibodies (1.66%), points towards the fact that active transmission of T. solium seems to play only a minor role in this urban setting, suggesting that infections may mainly be contracted in rural areas. Further large-scale studies are required to investigate the infection pathways and risk behavior related to T. solium infections within urban areas of sub-Saharan Africa.
Collapse
Affiliation(s)
- Veronika Schmidt
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- * E-mail:
| | - Marie-Claire O’Hara
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Neurology, Elbe Klinikum Stade, Stade, Germany
| | - Bernard Ngowi
- Muhimbili Medical Research Centre, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
- College of Health and Allied Sciences, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - John Noh
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Patricia Procell Wilkins
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Vivien Richter
- Department of Neurology and Epileptology, Evangelical Hospital Alsterdorf, Hamburg, Germany
| | - Christian Kositz
- Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Schwitzerland
| | - William Matuja
- Department of Neurology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea Sylvia Winkler
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
36
|
Ngowi HA, Winkler AS, Braae UC, Mdegela RH, Mkupasi EM, Kabululu ML, Lekule FP, Johansen MV. Taenia solium taeniosis and cysticercosis literature in Tanzania provides research evidence justification for control: A systematic scoping review. PLoS One 2019; 14:e0217420. [PMID: 31166983 PMCID: PMC6550401 DOI: 10.1371/journal.pone.0217420] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 05/11/2019] [Indexed: 11/19/2022] Open
Abstract
Background Despite Taenia solium taeniosis/cysticercosis (TSTC) having been put high on the global agenda of neglected tropical diseases (NTDs), which over the last years has received a lot of attention, there has been no control programmes in place in sub-Saharan Africa, a highly endemic region. This could be attributed to lack of awareness of many stakeholders on the burden and impact of T. solium. This information is essential in guiding TSTC policies, practices and research agendas as well as encouraging cross-sectoral collaboration in the control of this important zoonotic parasite using a One Health approach. National elimination of the parasite is the foundation for global eradication. This will require that substantial country-level information is provided to all key stakeholders. We have mapped out TSTC research evidence in Tanzania to inform on disease burden and potential for integrated control measures. Methodology/Principal findings A scoping review of all TSTC studies undertaken in Tanzania and published up to December 2018 was conducted. The articles were searched from PUBMED, AJOL, Google Scholar and Google in general. Fifty-one (51) articles met the inclusion criteria and were reviewed. Prevalence of taeniosis of 2.3% - 5.2% was estimated based on copro-antigen ELISA while human cysticercosis of >16% was estimated based on serum antigen ELISA (Ag-ELISA) or IgG Western Blot. Neurocysticercosis (NCC) contributed significantly to epilepsy in adults. Farm prevalence of porcine cysticercosis were 6.0% - 17.4% (lingual examination) and 1.5% - 33.3% (Ag-ELISA). Slaughter-slab prevalence were 0% - 18.2% (routine meat inspection). Lacking latrines, watering pigs with river or pond water, and feeding pigs with potato peels were associated with porcine cysticercosis prevalence. Washing hands by dipping method increased the risk of human cysticercosis. In 2012, the number of DALYs/1000 person-years for NCC-associated epilepsy was 0.7 (95% UI, 0.2–1.6), around 5 million USD (95% UI, 797,535–16,933,477) were spent due to NCC-associated epilepsy and nearly 3 million USD (95% UI, 1,095,960–5,366,038) were potentially lost due to porcine cysticercosis. Three rounds of annual treatment of school-age children with praziquantel significantly reduced prevalence of taeniosis and porcine cysticercosis. Health education was efficacious in improving knowledge and attitudes favourable for control of TSTC while a single dose of oxfendazole 30 mg/kg body weight was efficacious in eliminating T. solium cysticerci from pig musculature. Conclusions/Significance The observed high burden of TSTC and the significant contribution of NCC to epilepsy in Tanzania warrant urgent interventions. Evaluation of best control options should make use of disease transmission dynamics models such as cystiSim, taking into account findings from the field based intervention studies. In addition, locally adapted management guidelines for people suffering from NCC are urgently needed.
Collapse
Affiliation(s)
- Helena Aminiel Ngowi
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
- * E-mail:
| | - Andrea Sylvia Winkler
- Center for Global Health, Department of Neurology, Technical University of Munich, Munich, Germany
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Uffe Christian Braae
- One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | | | - Ernatus Martin Mkupasi
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | | | - Faustin Peter Lekule
- Department of Animal Science and Production, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Maria Vang Johansen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
37
|
Boullé C, Njamnshi AK, Dema F, Mengnjo MK, Siewe Fodjo JN, Bissek ACZK, Suykerbuyk P, Lenou-Nanga CG, Nana-Djeunga HC, Kamgno J, Chesnais CB, Boussinesq M, Colebunders R. Impact of 19 years of mass drug administration with ivermectin on epilepsy burden in a hyperendemic onchocerciasis area in Cameroon. Parasit Vectors 2019; 12:114. [PMID: 30890155 PMCID: PMC6423875 DOI: 10.1186/s13071-019-3345-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/26/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Surveys conducted in 1991-1992 in the Mbam Valley (Cameroon) revealed that onchocerciasis was highly endemic, with community microfilarial loads (CMFL) > 100 microfilariae/snip in some villages. Also in 1991-1992, a survey of suspected cases of epilepsy (SCE) found 746 SCE using a questionnaire administered to individuals identified by key informants, with prevalences reaching 13.6% in some communities. From 1998, annual community-directed treatment with ivermectin (CDTI) was implemented to control onchocerciasis. In 2017, a door-to-door household survey was conducted in three of the villages visited in 1991-1992, using a standardized 5-item epilepsy screening questionnaire. RESULTS In 2017, a total of 2286 individuals living in 324 households were screened (582 in Bayomen, 553 in Ngongol and 1151 in Nyamongo) and 112 SCE were identified (4.9%). Neurologists examined 92 of these SCE and confirmed the diagnosis of epilepsy for 81 of them (3.5%). Between the surveys in 1991-1992 and 2017, the prevalence of SCE decreased from 13.6% to 2.5% in Bayomen (P = 0.001), from 8.7% to 6.6% in Ngongol (P = 0.205) and from 6.4% to 5.4% in Nyamongo (P = 0.282). The median age of SCE shifted from 20 (IQR: 12-23) to 29 years (IQR: 18-33; P = 0.018) in Bayomen, from 16 (IQR: 12-21) to 26 years (IQR: 21-39; P < 0.001) in Ngongol and from 16 (IQR: 13-19) to 24 years (IQR: 19-32; P < 0.001) in Nyamongo. The proportions of SCE aged < 10, 10-19, 20-29 and ≥ 30 years shifted from 9.5, 58.3, 25.0 and 7.1% in 1991-1992 to 2.7, 20.5, 39.3 and 37.5% in 2017, respectively. CONCLUSIONS SCE prevalence decreased overall between 1991-1992 and 2017. The age shift observed is probably due to a decrease in the number of new cases of epilepsy resulting from the dramatic reduction of Onchocerca volvulus transmission after 19 years of CDTI.
Collapse
Affiliation(s)
- Charlotte Boullé
- TransVIHMI, University of Montpellier, Inserm, IRD, Montpellier, France
- Infectious and Tropical Diseases Department, University Hospital, Nîmes, France
| | - Alfred K. Njamnshi
- Neurology Department, Central Hospital of Yaoundé, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | | | - Michel K. Mengnjo
- Neurology Department, Central Hospital of Yaoundé, Yaoundé, Cameroon
| | - Joseph Nelson Siewe Fodjo
- Subdivisonal hospital of Mbangassina, Mbangassina, Cameroon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Anne-Cécile Zoung-Kanyi Bissek
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Ministry of Public Health, Yaoundé, Cameroon
- Dermatology Department, Chantal Biya Mother-Child Center, Yaoundé, Cameroon
| | | | | | | | - Joseph Kamgno
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
| | | | - Michel Boussinesq
- TransVIHMI, University of Montpellier, Inserm, IRD, Montpellier, France
| | | |
Collapse
|
38
|
Angwafor SA, Bell GS, Njamnshi AK, Singh G, Sander JW. Parasites and epilepsy: Understanding the determinants of epileptogenesis. Epilepsy Behav 2019; 92:235-244. [PMID: 30711777 DOI: 10.1016/j.yebeh.2018.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/25/2018] [Accepted: 11/26/2018] [Indexed: 12/25/2022]
Abstract
There is a large body of evidence suggesting that parasites could be a major preventable risk factor for epilepsy in low- and middle-income countries. We review potentially important substrates for epileptogenesis in parasitic diseases. Taenia solium is the most widely known parasite associated with epilepsy, and the risk seems determined mainly by the extent of cortical involvement and the evolution of the primary cortical lesion to gliosis or to a calcified granuloma. For most parasites, however, epileptogenesis is more complex, and other favorable host genetic factors and parasite-specific characteristics may be critical. In situations where cortical involvement by the parasite is either absent or minimal, parasite-induced epileptogenesis through an autoimmune process seems plausible. Further research to identify important markers of epileptogenesis in parasitic diseases will have huge implications for the development of trials to halt or delay onset of epilepsy.
Collapse
Affiliation(s)
- Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom
| | - Gail S Bell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé 1, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Gagandeep Singh
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom; Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), the Netherlands.
| |
Collapse
|
39
|
Siewe JNF, Ukaga CN, Nwazor EO, Nwoke MO, Nwokeji MC, Onuoha BC, Nwanjor SO, Okeke J, Osahor K, Chimechefulam L, Ogomaka AI, Amaechi AA, Ezenwa CI, Ezike MN, Ikpeama C, Nwachukwu O, Eriama-Joseph AI, Nwoke BEB, Colebunders R. Low prevalence of epilepsy and onchocerciasis after more than 20 years of ivermectin treatment in the Imo River Basin in Nigeria. Infect Dis Poverty 2019; 8:8. [PMID: 30670093 PMCID: PMC6343278 DOI: 10.1186/s40249-019-0517-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/06/2019] [Indexed: 12/02/2022] Open
Abstract
Background High epilepsy prevalence and incidence have been reported in areas with high onchocerciasis transmission. Recent findings suggest that proper community-directed treatment with ivermectin (CDTI) is potentially able to prevent onchocerciasis-associated epilepsy (OAE). We assessed the epilepsy prevalence and onchocerciasis transmission in two Nigerian villages following more than 20 years of CDTI. Methods A cross-sectional door-to-door survey was performed in two villages in the Imo River Basin reported to be mesoendomic for onchocerciasis (Umuoparaodu and Umuezeala). Individuals were screened for epilepsy using a validated 5-item questionnaire. Persons suspected to have epilepsy were examined by a neurologist or a physician with training in epilepsy for confirmation. Onchocerciasis was investigated via skin snip microscopy and rapid diagnostic tests for Ov16 antibodies. Results were compared with previous findings from the Imo river basin. Results A total of 843 individuals from 257 households in the two villages were encountered. We detected four persons with epilepsy (PWE) giving a crude epilepsy prevalence of 0.5%. This finding differs from observations reported 14 years ago which showed an epilepsy prevalence of 2.8% in the neighbouring village of Umulolo (P = 0.0001), and 1.2% from 13 villages in the Imo river basin (P = 0.07). The seroprevalence of Ov16 antibodies was found to be 0%. Only 4.6% of skin snips were positive compared to 26.8% in previous surveys (P < 0.0001). Ivermectin mass distribution coverage in the study sites in 2017 was 79.7%. Conclusions A low epilepsy and onchocerciasis prevalence was observed following more than 20 years of CDTI in the Imo River Basin. Absence of Ov16 antibodies indicates minimal transmission of onchocerciasis. These results contrast with observations from areas of high onchocerciasis transmission, where epilepsy prevalence and incidence remain high. Findings from this study suggest that sustained efforts could eventually achieve elimination of onchocerciasis in these villages. Electronic supplementary material The online version of this article (10.1186/s40249-019-0517-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Joseph N F Siewe
- Global Health Institute, University of Antwerp, Campus Drie Eiken, Doornstraat 331, 2610 Wilrijk, Antwerp, Belgium.
| | | | - Ernest O Nwazor
- Federal Medical Centre, Owerri, Nigeria.,Madonna University Teaching Hospital, Elele, Nigeria
| | | | | | | | | | - Joel Okeke
- Imo State Ministry of Health, Owerri, Nigeria
| | | | | | | | | | | | | | | | | | | | | | - Robert Colebunders
- Global Health Institute, University of Antwerp, Campus Drie Eiken, Doornstraat 331, 2610 Wilrijk, Antwerp, Belgium
| |
Collapse
|
40
|
Bouscaren N, Pilleron S, Mbelesso P, Ndamba-Bandzouzi B, Dartigues JF, Clément JP, Preux PM, Dardé ML, Guerchet M. Prevalence of toxoplasmosis and its association with dementia in older adults in Central Africa: a result from the EPIDEMCA programme. Trop Med Int Health 2018; 23:1304-1313. [PMID: 30284355 DOI: 10.1111/tmi.13151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed at estimating the seroprevalence of Toxoplasma gondii (T. gondii) infection in older adults living in Central Africa and investigating its association with dementia using data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) programme. METHODS A cross-sectional multicentre population-based study was carried out among participants aged 73 (±7) years on average, living in rural and urban areas of the Central African Republic and the Republic of Congo between November 2011 and December 2012. Blood samples were collected from each consenting participant. The detection of anti-T. gondii immunoglobulin G antibodies was performed in 2014 in France using a commercially available ELISA kit. Participants were interviewed using a standardised questionnaire including sociodemographic characteristics. DSM-IV criteria were required for a diagnosis of dementia. Multivariate binary logistic regression models were used to assess the association between toxoplasmosis infection and dementia. RESULTS Among 1662 participants, the seroprevalence of toxoplasmosis was 63.0% (95% confidence interval (CI): 60.7-65.3) overall, 66.6% (95%CI: 63.4-69.8) in Central African Republic and 59.4% (95%CI: 56.1-62.7) in the Republic of Congo. In multivariate analyses, toxoplasmosis status was significantly associated with increasing age (P = 0.006), Republic of Congo (P = 0.002), urban area (P = 0.001) and previous occupation (P = 0.002). No associations between dementia and toxoplasmosis status or anti-T. gondii IgG titres were found. CONCLUSION Toxoplasma gondii infection was not associated with dementia among older adults in Central Africa. Our findings are consistent with previous studies and add to the knowledge on the relationship between T. gondii infection and neurological disorders.
Collapse
Affiliation(s)
- Nathalie Bouscaren
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France.,Faculty of Medicine, University Hospital of Limoges, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
| | - Sophie Pilleron
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France.,Faculty of Medicine, University Hospital of Limoges, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
| | - Pascal Mbelesso
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France.,Faculty of Medicine, University Hospital of Limoges, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,Department of Neurology, Amitié Hospital, Bangui, Central African Republic
| | | | | | - Jean-Pierre Clément
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France.,Faculty of Medicine, University Hospital of Limoges, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,Hospital and University Federation of Adult and Geriatric Psychiatry, Limoges, France
| | - Pierre-Marie Preux
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France.,Faculty of Medicine, University Hospital of Limoges, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,Centre of Epidemiology, Biostatistic, and Research Methodology, University Hospital of Limoges, CEBIMER, Limoges, France
| | - Marie-Laure Dardé
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France.,Faculty of Medicine, University Hospital of Limoges, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,Department of Parasitology and Biological Resource Centre for Toxoplasma, CHU Limoges, Limoges, France
| | - Maëlenn Guerchet
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France.,Faculty of Medicine, University Hospital of Limoges, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | |
Collapse
|
41
|
Chesnais CB, Nana-Djeunga HC, Njamnshi AK, Lenou-Nanga CG, Boullé C, Bissek ACZK, Kamgno J, Colebunders R, Boussinesq M. The temporal relationship between onchocerciasis and epilepsy: a population-based cohort study. THE LANCET. INFECTIOUS DISEASES 2018; 18:1278-1286. [PMID: 30268645 DOI: 10.1016/s1473-3099(18)30425-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/13/2018] [Accepted: 07/04/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Many studies have suggested that onchocerciasis might be associated with epilepsy. Therefore, we did a cohort study to assess the incidence of epilepsy relative to Onchocerca volvulus skin microfilarial density (MFD) measured during childhood and to assess the possibility of a temporal relationship. METHODS During onchocerciasis surveys undertaken in 25 villages in Cameroon during 1991-93, we measured MFD in individuals aged 5 years or older. In 2017, we revisited seven of these villages. With a standardised five-item questionnaire, we collected information on the occurrence of epilepsy in 856 individuals who were aged 5-10 years in 1991-93, and had MFD determined during the original surveys. We did multivariable analyses to assess the overall incidence and incidence ratios taking into account age, sex, individual MFD in 1991-93, and onchocerciasis endemicity level in the village. FINDINGS In 2017, we obtained data on the history of epilepsy for 85% (729 of 856) of individuals. Among these individuals, we classified 60 as being suspected cases of epilepsy. The overall incidence of epilepsy was 350 per 100 000 person-years (95% CI 270-450). The adjusted incidence ratio for developing epilepsy was 7·07 (95% CI 0·98-51·26; p=0·0530) in individuals with initial MFD of one to five microfilariae per skin snip (mf per snip), 11·26 (2·73-46·43) in individuals with six to 20 mf per snip, 12·90 (4·40-37·83) in individuals with 21-50 mf per snip, 20·00 (3·71-108·00) in individuals with 51-100 mf per snip, 22·58 (3·21-158·56) in individuals with 101-200 mf per snip, and 28·50 (95% CI 3·84-211·27; p=0·0010) in individuals with more than 200 mf per snip, compared with that of individuals without detectable densities of skin microfilariae. INTERPRETATION Individual O volvulus MFD in childhood was associated with the risk of either seizures or epilepsy in an onchocerciasis focus in Cameroon. This temporal relationship suggests a potential causal link between onchocerciasis and epilepsy. FUNDING European Research Council, NSETHIO Project.
Collapse
Affiliation(s)
- Cédric B Chesnais
- UMI 233, Institut de Recherche pour le Développement, Montpellier, France; Université Montpellier, Montpellier, France; INSERM Unité 1175, Montpellier, France
| | | | - Alfred K Njamnshi
- Neurology Department, University of Yaoundé I, Yaounde, Cameroon; Brain Research Africa Initiative, Yaounde, Cameroon
| | - Cédric G Lenou-Nanga
- Centre for Research on Filariasis and other Tropical Diseases, Yaounde, Cameroon
| | - Charlotte Boullé
- UMI 233, Institut de Recherche pour le Développement, Montpellier, France; Université Montpellier, Montpellier, France; INSERM Unité 1175, Montpellier, France; Centre Hospitalier Universitaire Nîmes, Nîmes, France
| | - Anne-Cécile Zoung-Kanyi Bissek
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon; Division of Health Operations Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases, Yaounde, Cameroon; Public Health Department, University of Yaoundé I, Yaounde, Cameroon
| | | | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement, Montpellier, France; Université Montpellier, Montpellier, France; INSERM Unité 1175, Montpellier, France.
| |
Collapse
|
42
|
Vinkeles Melchers NVS, Mollenkopf S, Colebunders R, Edlinger M, Coffeng LE, Irani J, Zola T, Siewe JN, de Vlas SJ, Winkler AS, Stolk WA. Burden of onchocerciasis-associated epilepsy: first estimates and research priorities. Infect Dis Poverty 2018; 7:101. [PMID: 30253788 PMCID: PMC6156959 DOI: 10.1186/s40249-018-0481-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 08/30/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Since the 1990s, evidence has accumulated of an increased prevalence of epilepsy in onchocerciasis-endemic areas in Africa as compared to onchocerciasis-free areas. Although the causal relationship between onchocerciasis and epilepsy has yet to be proven, there is likely an association. Here we discuss the need for disease burden estimates of onchocerciasis-associated epilepsy (OAE), provide them, detail how such estimates should be refined, and discuss the socioeconomic impact of OAE, including a cost-estimate for anti-epileptic drugs. MAIN BODY Providing OAE burden estimates may aid prevention of epilepsy in onchocerciasis- endemic areas by inciting and informing collaboration between onchocerciasis control programmes and mental health services. Epilepsy not only massively impacts the health of those affected, but it also carries a high socioeconomic burden for the households and communities involved. We used previously published geospatial estimates of onchocerciasis in Africa and a separately published logistic regression model quantifying the association between onchocerciasis and epilepsy to estimate the number of OAE cases. We then applied disability weights for epilepsy to quantify the burden in terms of years of life lived with disability (YLD) and estimate the cost of treatment. We estimate that in 2015 roughly 117 000 people were affected by OAE across onchocerciasis-endemic areas previously under the African Programme for Onchocerciases control (APOC) mandate where OAE has ever been reported or suspected, and another 264 000 persons in onchocerciasis-endemic areas where OAE has never been investigated before. The total number of YLDs due to OAE was 39 300 and 88 700 in these areas respectively, based on a weighted mean disability weight of 0.336. The burden of OAE is approximately 13% of the total YLDs attributable to onchocerciasis and 10% of total YLDs attributable to epilepsy. We estimated that by 2015 the total costs of treatment with anti-epileptic drug for OAE cases would have been a minimum of 12.4 million US$. CONCLUSIONS These estimates suggest a considerable health, social and economic burden of OAE in Africa. The treatment and care for people with epilepsy, especially in hyperendemic onchocerciasis areas with high epilepsy prevalence thus requires more financial and human resources.
Collapse
Affiliation(s)
- Natalie V S Vinkeles Melchers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Sarah Mollenkopf
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA, 98121, USA
| | | | - Michael Edlinger
- Department of Medical Statistics, Informatics, and Health Economics, Medical University Innsbruck, Vienna, Austria
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Julia Irani
- Department of Public Health, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Trésor Zola
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joseph N Siewe
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Andrea S Winkler
- Centre for Global Health, Institute for Health and Society, Oslo, Norway.,Center for Global Health, Department of Neurology, Technical University of Munich, Munich, Germany
| | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. box 2040, 3000, CA, Rotterdam, The Netherlands
| |
Collapse
|
43
|
Updated evidence of the association between toxocariasis and epilepsy: Systematic review and meta-analysis. PLoS Negl Trop Dis 2018; 12:e0006665. [PMID: 30028858 PMCID: PMC6070292 DOI: 10.1371/journal.pntd.0006665] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/01/2018] [Accepted: 07/05/2018] [Indexed: 01/07/2023] Open
Abstract
Objective To gain further insight on the association between human toxocariasis and epilepsy in light of the new evidence in the last years. Methods A systematic review was conducted without date and language restriction in the following electronic databases: MEDLINE (PubMed), Ingenta Connect, Science Direct (Elsevier), RefDoc, Scopus, HighWire, Scielo and the database of the Institute of Neuroepidemiology and Tropical Neurology of the Limoges University (IENT). Two investigators independently conducted the search up to November 2017. A pooled odds ratio (OR) was estimated using a random effects model. Meta-regression was conducted to investigate potential sources of heterogeneity. Results Database search produced 204 publications. Eleven case-control studies were included that were carried out in 13 countries worldwide. A total number of 4740 subjects were considered (2159 people with epilepsy and 2581 people without epilepsy). The overall pooled OR was 1.69 (95% CI 1.42–2.01) for the association between epilepsy and Toxocara spp. seropositivity. A positive association was constantly reported in the restricted analysis (WB as confirmatory or diagnostic test, younger population, and population–based studies). Meta-regression showed no statistically significant association between covariates and outcome. Conclusion The updated meta-analysis provides epidemiological evidence of a positive association between Toxocara seropositivity and epilepsy. New surveys supported the association, mainly population-based studies. On this basis, health strategies to reduce the impact of Toxocara spp are strongly advised. Further research should be performed to understand the physiopathological mechanisms of toxocara-associated epileptogenesis. Human toxocariasis is a parasitic zoonosis caused by the larval stages of Toxocara canis (T. canis), the common roundworm of dogs, and by the roundworm of cats, Toxocara cati (T. cati). Toxocariasis is one of the most prevalent helminthiasis worldwide. Humans become infected by the ingestion of contaminated food or soil or by direct contact with dogs and cats. Epilepsy is the most common chronic neurological disorder worldwide with a global estimate of about 70 million cases of lifetime epilepsy. Early studies suggested high rate of toxocara exposure (toxocara seropositivity) among people with epilepsy. Despite several studies support the possible role of toxocariasis in the incidence of epilepsy, this association is still debated. We updated our previous research to gain further insight on the association. This study provides new evidence of a positive association between the two diseases. On this basis, health strategies to reduce the impact of Toxocara spp are strongly advised. Further studies are necessary to clarify the role of certain parasites in epilepsy.
Collapse
|
44
|
Mmbando BP, Suykerbuyk P, Mnacho M, Kakorozya A, Matuja W, Hendy A, Greter H, Makunde WH, Colebunders R. High prevalence of epilepsy in two rural onchocerciasis endemic villages in the Mahenge area, Tanzania, after 20 years of community directed treatment with ivermectin. Infect Dis Poverty 2018; 7:64. [PMID: 29921319 PMCID: PMC6009039 DOI: 10.1186/s40249-018-0450-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Epilepsy is a neurological disorder with a multitude of underlying causes, which may include infection with Onchocerca volvulus, the parasitic worm that causes human onchocerciasis. A survey carried out in 1989 revealed a high prevalence of epilepsy (1.02% overall, ranging from 0.51 to 3.71% in ten villages) in the Mahenge area of Ulanga district, an onchocerciasis endemic region in south eastern Tanzania. This study aimed to determine the prevalence and incidence of epilepsy following 20 years of onchocerciasis control through annual community directed treatment with ivermectin (CDTI). Methods The study was conducted in January 2017 in two suburban and two rural villages in the Mahenge area. Door-to-door household visits were carried out by trained community health workers and data assistants to screen for persons suspected of having epilepsy, using a standardised questionnaire. Persons with suspected epilepsy were then interviewed and examined by a neurologist for case verification. Onchocerciasis associated epilepsy was defined as epilepsy without an obvious cause, with an onset of seizures between the ages of 3–18 years in previously healthy children. In each village, fifty males aged ≥20 years were tested for onchocerciasis antibodies using an OV16 rapid test and were examined for presence of onchocerciasis nodules. Children aged 6–10 years were also tested using OV16 tests. Results 5117 individuals (median age 18.5 years, 53.2% female) from 1168 households were screened. 244 (4.8%) were suspected of having epilepsy and invited for neurological assessment. Prevalence of epilepsy was 2.5%, with the rural villages having the highest rate (3.5% vs 1.5%), P < 0.001. Overall incidence of epilepsy was 111 cases (95% CI: 73–161) per 100 000 person-years, while that of onchocerciasis associated epilepsy was 131 (95% CI: 70–223). Prevalence of OV16 antibodies in adult males and among children 6–10 years old was higher in rural villages than in suburban villages (76.5% vs 50.6, and 42.6% vs 4.7% respectively), (P < 0.001), while overall prevalence of onchocerciasis nodules was 1.8%. Conclusions This survey revealed a high prevalence and incidence of epilepsy in two rural onchocerciasis endemic villages in the Mahenge area. Despite 20 years of CDTI, a high prevalence of OV16 antibodies in children aged 6–10 years suggests on-going O. volvulus transmission. Reasons for the persistence of on-going parasite transmission in the Mahenge area need to be investigated. Electronic supplementary material The online version of this article (10.1186/s40249-018-0450-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Bruno P Mmbando
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania.
| | | | | | | | - William Matuja
- Muhimbili University of Health and allied Sciences, Dar es Salaam, Tanzania
| | - Adam Hendy
- University of Texas Medical Branch, Galveston, TX, USA
| | - Helena Greter
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Williams H Makunde
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | | |
Collapse
|
45
|
Alvarado-Esquivel C, Rico-Almochantaf YDR, Hernández-Tinoco J, Quiñones-Canales G, Sánchez-Anguiano LF, Torres-González J, Ramírez-Valles EG, Minjarez-Veloz A. Toxoplasma gondii exposure and epilepsy: A matched case-control study in a public hospital in northern Mexico. SAGE Open Med 2018; 6:2050312118767767. [PMID: 29662676 PMCID: PMC5898655 DOI: 10.1177/2050312118767767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/06/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to determine the association between infection with Toxoplasma gondii and epilepsy in patients attended to in a public hospital in the northern Mexican city of Durango. Methods We performed an age- and gender-matched case-control study of 99 patients suffering from epilepsy and 99 without epilepsy. Sera of participants were analyzed for anti-T. gondii IgG and IgM antibodies using commercially available enzyme-linked immunoassays. Seropositive samples to T. gondii were further analyzed for detection of T. gondii DNA by polymerase chain reaction. Results Anti-T. gondii IgG antibodies were found in 10 (10.1%) of the 99 cases and in 6 (6.1%) of the 99 controls (odds ratio = 1.74; 95% confidence interval: 0.60-4.99; p = 0.43). High (> 150 IU/mL) levels of anti-T. gondii IgG antibodies were found in 6 of the 99 cases and in 4 of the 99 controls (odds ratio = 1.53; 95% confidence interval: 0.41-5.60; p = 0.74). Anti-T. gondii IgM antibodies were found in 2 of the 10 IgG seropositive cases, and in 2 of the 6 IgG seropositive controls (odds ratio = 0.50; 95% confidence interval: 0.05-4.97; p = 0.60). T. gondii DNA was not found in any of the 10 anti-T. gondii IgG positive patients. Bivariate analysis of IgG seropositivity to T. gondii and International Statistical Classification of Diseases and related Health Problems, 10th Edition codes of epilepsy showed an association between seropositivity and G40.1 code (odds ratio = 22.0; 95% confidence interval: 2.59-186.5; p = 0.008). Logistic regression analysis showed an association between T. gondii infection and consumption of goat meat (odds ratio = 6.5; 95% confidence interval: 1.22-34.64; p = 0.02), unwashed raw vegetables (odds ratio = 26.3; 95% confidence interval: 2.61-265.23; p = 0.006), and tobacco use (odds ratio = 6.2; 95% confidence interval: 1.06-36.66; p = 0.04). Conclusions Results suggest that T. gondii infection does not increase the risk of epilepsy in our setting; however, infection might be linked to specific types of epilepsy. Factors associated with T. gondii infection found in this study may aid in the design of preventive measures against toxoplasmosis.
Collapse
Affiliation(s)
- Cosme Alvarado-Esquivel
- Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juárez University of Durango State, Durango, Mexico
| | | | - Jesús Hernández-Tinoco
- Institute for Scientific Research "Dr. Roberto Rivera Damm," Juárez University of Durango State, Durango, Mexico
| | | | | | - Jorge Torres-González
- Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Durango, Mexico
| | | | | |
Collapse
|
46
|
Greter H, Mmbando B, Makunde W, Mnacho M, Matuja W, Kakorozya A, Suykerbuyk P, Colebunders R. Evolution of epilepsy prevalence and incidence in a Tanzanian area endemic for onchocerciasis and the potential impact of community-directed treatment with ivermectin: a cross-sectional study and comparison over 28 years. BMJ Open 2018; 8:e017188. [PMID: 29605818 PMCID: PMC5884367 DOI: 10.1136/bmjopen-2017-017188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Worldwide, there are an estimated 50 million people affected by epilepsy. Its aetiology is manifold, and parasitic infections play an important role, specifically onchocerciasis. In onchocerciasis endemic areas, a distinctive form of epilepsy has been described as nodding syndrome, affecting children and causing nodding seizures, mental retardation and debilitating physical development. Onchocerciasis control programmes using community-directed treatment with ivermectin (CDTI) are implemented in endemic countries. This study is designed to contribute to a better understanding of the linkage between the onset of epilepsy, onchocerciasis and CDTI. Comparing the epidemiological data on epilepsy and onchocerciasis from pre-CDTI and 20 years after its introduction will allow identifying a potential impact of ivermectin on the onset of epilepsy. METHODS AND ANALYSIS The study will be conducted in the Mahenge highlands in Tanzania. Study site selection is based on an in-depth study on epilepsy in that area dating from 1989. CDTI was introduced in 1997. By a door-to-door approach, the population will be screened for epilepsy using a validated questionnaire. Suspected cases will be invited for a neurological examination for case verification. Onchocerciasis prevalence will be assessed by a rapid epidemiological assessment. As an indicator for ongoing transmission, children younger than 10 years of age will be tested for Ov16 antibodies. Ivermectin use will be assessed at household level. Epilepsy data will be analysed in comparison with the 1989 data to reveal pre-CDTI and post-CDTI prevalence and incidence. ETHICS AND DISSEMINATION The protocol has received ethical approval from the ethics committees of the University of Antwerp, Belgium, and of the National Institut of Medical Research, Dar es Salaam, Tanzania. The findings will be published in peer-reviewed journals, and presented to the health authorities in Tanzania, at national, regional and village level.
Collapse
Affiliation(s)
- Helena Greter
- Global Health Institute, University of Antwerp, Wilrijk, Belgium
| | - Bruno Mmbando
- National Institute of Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Williams Makunde
- National Institute of Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Mohamed Mnacho
- Department of Neurology, Muhimbili University of Health Sciences, Dar es Salaam, Tanzania
| | - William Matuja
- Department of Neurology, Muhimbili University of Health Sciences, Dar es Salaam, Tanzania
| | | | | | | |
Collapse
|
47
|
Kind CJ, Newton CRJC, Kariuki SM. Prevalence, risk factors, and neurobehavioral comorbidities of epilepsy in Kenyan children. Epilepsia Open 2017; 2:388-399. [PMID: 29588970 PMCID: PMC5862110 DOI: 10.1002/epi4.12069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 12/25/2022] Open
Abstract
Objective To investigate the prevalence, risk factors, clinical features, and neurobehavioral comorbidities of epilepsy and acute symptomatic seizures in school‐aged children in Kilifi, Kenya. Methods Randomly selected children (N = 11,223) were screened for epilepsy and other neurodevelopmental disorders. Those who screened positive were invited for further clinical, electroencephalographic (EEG), and neuropsychological evaluations. Prevalence was measured by dividing cases by screened population, providing Agresti–Coull confidence intervals (CIs). Prevalence ratios were computed using log binomial regression, and odds ratios (ORs) were computed using logistic regression; both were implemented with generalized linear models. Attention‐deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other neurodevelopmental impairments were assessed in cases and controls. Results Prevalence of lifetime epilepsy was 20.9 per 1,000 (95% CI = 18.4–23.7), and that of active epilepsy was 11.5 per 1,000 (95% CI = 9.7–13.6). Prevalence of acute symptomatic seizures was 68.8 per 1,000 (95% CI = 64.2–73.6). Acute symptomatic seizures preceded a diagnosis of epilepsy in 8% of children. Of 98 children diagnosed with epilepsy, focal seizures were seen in 79%, abnormal EEG was seen in 39%, and 83% were not receiving antiepileptic drugs. Childhood absence epilepsy and Lennox–Gastaut epilepsy were the most easily identifiable epilepsy syndromes. Perinatal complications, previous hospitalization, geophagia, and snoring were risk factors for epilepsy. Family history of seizures, abnormal pregnancy, previous hospitalization, and snoring were risk factors for acute symptomatic seizures. Neurobehavioral comorbidities were present in 54% of subjects with lifetime epilepsy and in 3% of controls, with associations for individual comorbidities being statistically significant: ADHD (OR = 14.55, 95% CI = 7.54–28.06), ASD (OR = 36.83, 95% CI = 7.97–170.14), and cognitive impairments (OR = 14.55, 95% CI = 3.52–60.14). Significance The burden of seizure disorders in this area is higher than in locations in high‐income countries, and can be reduced by preventing risk factors. A comprehensive management plan for neurobehavioral comorbidities of epilepsy should be incorporated into standard epilepsy care.
Collapse
Affiliation(s)
- Charles J Kind
- St. Johns College University of Oxford Oxford United Kingdom
| | - Charles R J C Newton
- St. Johns College University of Oxford Oxford United Kingdom.,KEMRI-Wellcome Trust Research Programme Kilifi Kenya.,Department of Psychiatry University of Oxford Oxford United Kingdom
| | | | | |
Collapse
|
48
|
Levick B, Laudisoit A, Tepage F, Ensoy-Musoro C, Mandro M, Bonareri Osoro C, Suykerbuyk P, Kashama JM, Komba M, Tagoto A, Falay D, Begon M, Colebunders R. High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo. PLoS Negl Trop Dis 2017; 11:e0005732. [PMID: 28708828 PMCID: PMC5529017 DOI: 10.1371/journal.pntd.0005732] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/26/2017] [Accepted: 06/20/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An increased prevalence of epilepsy has been reported in many onchocerciasis endemic areas. The objective of this study was to determine the prevalence of epilepsy in onchocerciasis endemic areas in the Democratic Republic of the Congo (DRC) and investigate whether a higher annual intake of Ivermectin was associated with a lower prevalence of epilepsy. METHODOLOGY/PRINCIPLE FINDINGS Between July 2014 and February 2016, house-to-house epilepsy prevalence surveys were carried out in areas with a high level of onchocerciasis endemicity: 3 localities in the Bas-Uele, 24 in the Tshopo and 21 in the Ituri province. Ivermectin uptake was recorded for every household member. This database allowed a matched case-control pair subset to be created that enabled putative risk factors for epilepsy to be tested using univariate logistic regression models. Risk factors relating to onchocerciasis were tested using a multivariate random effects model. To identify presence of clusters of epilepsy cases, the Kulldorff's scan statistic was used. Of 12, 408 people examined in the different health areas 407 (3.3%) were found to have a history of epilepsy. A high prevalence of epilepsy was observed in health areas in the 3 provinces: 6.8-8.5% in Bas-Uele, 0.8-7.4% in Tshopo and 3.6-6.2% in Ituri. Median age of epilepsy onset was 9 years, and the modal age 12 years. The case control analysis demonstrated that before the appearance of epilepsy, compared to the same life period in controls, persons with epilepsy were around two times less likely (OR: 0.52; 95%CI: (0.28, 0.98)) to have taken Ivermectin than controls. After the appearance of epilepsy, there was no difference of Ivermectin intake between cases and controls. Only in Ituri, a significant cluster (p-value = 0.0001) was identified located around the Draju sample site area. CONCLUSIONS The prevalence of epilepsy in health areas in onchocerciasis endemic regions in the DRC was 2-10 times higher than in non-onchocerciasis endemic regions in Africa. Our data suggests that Ivermectin protects against epilepsy in an onchocerciasis endemic region. However, a prospective population based intervention study is needed to confirm this.
Collapse
Affiliation(s)
- Bethany Levick
- Institute of Integrative Biology, School of Biological Sciences, University of Liverpool, Liverpool, United-Kingdom
| | - Anne Laudisoit
- Institute of Integrative Biology, School of Biological Sciences, University of Liverpool, Liverpool, United-Kingdom
- CIFOR, Jalan Cifor, Situ Gede, Sindang Barang, Bogor Bar, Jawa Barat, Indonesia
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Floribert Tepage
- National Onchocerciasis Control Program (PNLO), Ministry of Health, Buta, Democratic Republic of the Congo
| | - Chellafe Ensoy-Musoro
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, University of Hasselt, Hasselt, Belgium
| | - Michel Mandro
- Ituri Provincial Health Division, Ministry of Health, Bunia, Democratic Republic of the Congo
| | - Caroline Bonareri Osoro
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, University of Hasselt, Hasselt, Belgium
- Nanyuki Teaching and Referral Hospital, Nanyuki, Kenya
| | | | - Jean Marie Kashama
- Neuropsychopathologic Centre of Mont Amba (CNPP), University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Michel Komba
- Biodiversity Monitoring Centre, Faculty of Sciences, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Alliance Tagoto
- National HIV program, Ministry of Health, Kisangani, Democratic Republic of the Congo
| | - Dadi Falay
- Department of Pediatrics, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Michael Begon
- Institute of Integrative Biology, School of Biological Sciences, University of Liverpool, Liverpool, United-Kingdom
| | | |
Collapse
|
49
|
Colebunders R, Njamnshi AK, van Oijen M, Mukendi D, Kashama JM, Mandro M, Gumisiriza N, Preux PM, Suykerbuyk P, Idro R. Onchocerciasis-associated epilepsy: From recent epidemiological and clinical findings to policy implications. Epilepsia Open 2017; 2:145-152. [PMID: 29588943 PMCID: PMC5719844 DOI: 10.1002/epi4.12054] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 11/12/2022] Open
Abstract
A high prevalence of epilepsy is reported in many onchocerciasis‐endemic regions. In this paper we discuss recent epidemiological and clinical aspects as well as public health implications of onchocerciasis‐associated epilepsy (OAE) and propose a strategy to reduce the burden of disease. OAE probably presents in a variety of clinical manifestations, including the nodding syndrome and the Nakalanga syndrome. The most common clinical presentation, however, is generalized (primarily tonic‐clonic) seizures. A characteristic of OAE is the onset of seizures between the ages of 3 and 18 years and clustering in certain families and villages close to rapid‐flowing black‐fly‐infested rivers. A strategy combining active surveillance for epilepsy with early treatment with antiepileptic drugs and prevention of onchocerciasis by increasing the geographical and therapeutic coverage of community‐directed treatment with ivermectin (CDTi) may considerably decrease the burden of disease.
Collapse
Affiliation(s)
| | - Alfred K Njamnshi
- Neurology Department Central Hospital Yaoundé Faculty of Medicine and Biomedical Sciences the University of Yaoundé IYaoundé IRepublic of Cameroon
| | - Marieke van Oijen
- Global Health Institute University of Antwerp Antwerp Belgium.,Department of Neurology Academic Medical Center Amsterdam the Netherlands
| | - Deby Mukendi
- Neuro-psycho-pathological Centre University of Kinshasa Kinshasa Democratic Republic of the Congo
| | - Jean Marie Kashama
- Neuro-psycho-pathological Centre University of Kinshasa Kinshasa Democratic Republic of the Congo
| | - Michel Mandro
- Provincial division of Health of Ituri Ministery of Health Bunia Democratic Republic of the Congo
| | | | | | | | - Richard Idro
- College of Health Sciences Makerere University Kampala Uganda.,Nuffield Department of Medicine Centre for Tropical Medicine and Global Health University of Oxford Oxford United Kingdom
| |
Collapse
|
50
|
Uzorka JW, Arend SM. A critical assessment of the association between postnatal toxoplasmosis and epilepsy in immune-competent patients. Eur J Clin Microbiol Infect Dis 2017; 36:1111-1117. [PMID: 28083719 PMCID: PMC5495839 DOI: 10.1007/s10096-016-2897-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/29/2016] [Indexed: 11/07/2022]
Abstract
While postnatal toxoplasmosis in immune-competent patients is generally considered a self-limiting and mild illness, it has been associated with a variety of more severe clinical manifestations. The causal relation with some manifestations, e.g. myocarditis, has been microbiologically proven, but this is not unequivocally so for other reported associations, such as with epilepsy. We aimed to systematically assess causality between postnatal toxoplasmosis and epilepsy in immune-competent patients. A literature search was performed. The Bradford Hill criteria for causality were used to score selected articles for each component of causality. Using an arbitrary but defined scoring system, the maximal score was 15 points (13 for case reports). Of 704 articles, five case reports or series and five case–control studies were selected. The strongest evidence for a causal relation was provided by two case reports and one case–control study, with a maximal causality score of, respectively, 9/13, 10/13 and 10/15. The remaining studies had a median causality score of 7 (range 5–9). No selection bias was identified, but 6/10 studies contained potential confounders (it was unsure whether the infection was pre- or postnatal acquired, or immunodeficiency was not specifically excluded). Based on the evaluation of the available literature, although scanty and of limited quality, a causal relationship between postnatal toxoplasmosis and epilepsy seems possible. More definite proof requires further research, e.g. by performing Toxoplasma serology in all de novo epilepsy cases.
Collapse
Affiliation(s)
- J W Uzorka
- Department of Infectious Diseases, C5P-40, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Faculty of Medicine, Leiden University, Leiden, The Netherlands
| | - S M Arend
- Department of Infectious Diseases, C5P-40, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| |
Collapse
|