Clinical presentations of onchocerciasis-associated epilepsy (OAE) in Cameroon

Siewe, Joseph J.F.N.; Ngarka, Leonard; Tatah, Godwin Y.; Mengnjo, Michel K.; Nfor, Leonard N.; Chokote, Eric; Boullé, Charlotte; Nkouonlack, Cyrille; Déma, Fidèle; Nkoro, Grace G.A.; Njamnshi, Wepnyu W.Y.; Tabah, Earnest Njih; Bissek, Anne Cécile Zoung-Kanyi; Colebunders, Robert; Njamnshi, Alfred Kongnyu

doi:10.1016/j.yebeh.2018.11.008

Cited by 42 publications

(45 citation statements)

References 33 publications

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“…A positive correlation between the frequency of seizures and mf density supports recent findings from a cohort study in Cameroon which showed that the risk to develop epilepsy increases with increasing intensity of childhood infection with O. volvulus [5]. In that cohort study, the population attributable fraction of epilepsy associated with onchocerciasis was estimated at 91.7% [5], and PWE in the investigated villages had similar clinical manifestations as observed in our study [23]. By meticulously taking the history of our study participants, we were able to identify 32 PWE who reported experiencing nodding seizures.…”

Section: Discussionsupporting

confidence: 92%

“…This complements previous suspicions from a recent study in the DRC, that both epilepsy and retarded growth may be related to O. volvulus exposure [26]. Although stunting is a common feature in persons with OAE including nodding syndrome [7,23,26], other factors such as undernutrition and poverty observed among PWE may contribute to their abnormal growth, as reported in an Ethiopian study [27]. However, given that we did not investigate the feeding habits of our participants, our study is unable to confirm this.…”

Section: Discussionsupporting

confidence: 85%

“…This is most probably due to 14 rounds of CDTI that had already taken place in Aketi, while the participants from Logo were ivermectinnaïve. Up to 61.7% of PWE in Aketi had received ivermectin in the year preceding the study, much higher than the 25% CDTI coverage observed among PWE in onchocerciasis-endemic areas in Cameroon [23]; p < 0.001. The belief that ivermectin may help to reduce epilepsy is frequent in the Aketi health zone [10] and this probably motivates PWE to adhere to CDTI.…”

Section: Discussionmentioning

confidence: 71%

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Onchocerciasis-associated epilepsy in the Democratic Republic of Congo: Clinical description and relationship with microfilarial density

Fodjo

Mandro²,

Mukendi³

et al. 2019

Preprint

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Background: High epilepsy prevalence and incidence were observed in onchocerciasis-endemic villages in the Democratic Republic of Congo (DRC). We sought to investigate the clinical characteristics of onchocerciasis-associated epilepsy (OAE), and the relationship with microfilarial density. Methods: In October 2017, ivermectin-naive persons with epilepsy (PWE) were recruited from onchocerciasis-endemic areas in the Logo health zone in the DRC. Additional PWE were enrolled in the Aketi health zone, where ivermectin had been distributed annually for 14 years. Past medical history, clinical characteristics and skin snips for Onchocerca volvulus detection were obtained from participants. Bivariate and multivariable analyses were used to investigate associations with microfilarial density. Results: Of the 420 PWE in the Logo health zone, 392 were skin snipped (36.5% positive). Generalized motor seizures were most frequent (392 PWE, 93.3%), and nodding seizures were reported in 32 (7.6%) participants. Twelve PWE (3.1%) presented Nakalanga features. More skin snip-positive participants reported a family history of epilepsy (p=0.027). Eighty-one onchocerciasis-infected PWE were recruited in the Aketi health zone. Positive correlations between seizure frequency and microfilarial density were observed in Logo (Spearman-rho=0.181; p=0.0003) and Aketi (Spearman-rho=0.228; p=0.046). In the multivariable analysis which adjusted for age, gender and previous anti-epileptic drug use, factors associated with high seizure frequency included: high microfilarial density (RR=1.004, 95% CI: 1.002–1.007; p<0.001), history of nodding seizures (RR=3.852, 95% CI: 2.926–5.082; p<0.001) and shorter duration of epilepsy (RR=0.948, 95% CI: 0.928–0.968; p<0.001). In Aketi, previous ivermectin use was associated with reduced seizures (RR=0.69, 95% CI: 0.58–0.83; p<0.001). Conclusion: In onchocerciasis-endemic regions in the DRC, a wide spectrum of seizures was observed. Nodding seizures, Nakalanga features, and a positive association between microfilarial density and seizures suggest a high OAE prevalence in the study villages, requiring a double management strategy: treatment with anti-epileptic drugs and stronger onchocerciasis elimination programs.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 71%

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Onchocerciasis-associated epilepsy in the Democratic Republic of Congo: Clinical description and relationship with microfilarial density

Fodjo

Mandro²,

Mukendi³

et al. 2019

Preprint

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“…Most cases of NS have been described in the onchocerciasis-endemic regions in northern Uganda [3,6], western Uganda [7], South Sudan [8], and the Mahenge area in Tanzania [9]. More recent studies have reported nodding seizures among persons with epilepsy (PWE) in the onchocerciasis-endemic regions in Cameroon [10] and the Democratic Republic of Congo [11]. A high prevalence of epilepsy has also been reported in many onchocerciasis meso-and hyper-endemic regions [12][13][14][15] particularly where transmission is poorly controlled [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and incidence of nodding syndrome and other forms of epilepsy in onchocerciasis-endemic areas in northern Uganda after the implementation of onchocerciasis control measures

et al. 2020

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Background: Around 2007, a nodding syndrome (NS) epidemic appeared in onchocerciasis-endemic districts of northern Uganda, where ivermectin mass distribution had never been implemented. This study evaluated the effect of community-directed treatment with ivermectin (CDTI) and ground larviciding of rivers initiated after 2009 and 2012 respectively, on the epidemiology of NS and other forms of epilepsy (OFE) in some districts of northern Uganda. Methods: In 2012, a population-based community survey of NS/epilepsy was carried out by the Ugandan Ministry of Health in Kitgum and Pader districts. In August 2017, we conducted a new survey in selected villages of these districts and compared our findings with the 2012 data. In addition, two villages in Moyo district (where CDTI was ongoing since 1993) served as comparative onchocerciasis-endemic sites in which larviciding had never been implemented. The comparison between 2012 and 2017 prevalence and cumulative incidence were done using the Fisher's and Pearson's Chi-square tests at 95% level of significance. Results: A total of 2138 individuals in 390 households were interviewed. In the selected villages of Kitgum and Pader, there was no significant decrease in prevalence of NS and OFE between 2012 and 2017. However, the cumulative incidence of all forms of epilepsy decreased from 1165 to 130 per 100 000 persons per year (P = 0.002); that of NS decreased from 490 to 43 per 100 000 persons per year (P = 0.037); and for OFE from 675 to 87 per 100 000 persons per year (P = 0.024). The median age of affected persons (NS and OFE) shifted from 13.5 (IQR: 11.0-15.0) years in 2012 to 18.0 (IQR: 15.0-20.3) years in 2017; P < 0.001. The age-standardized prevalence of OFE in Moyo in 2017 was 4.6%, similar to 4.5% in Kitgum and Pader. Conclusions: Our findings support the growing evidence of a relationship between infection by Onchocerca volvulus and some types of childhood epilepsy, and suggest that a combination of biannual mass distribution of ivermectin and ground larviciding of rivers is an effective strategy to prevent NS and OFE in onchocerciasis-hyperendemic areas.

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“…In villages in Maridi County in 2017, only 25.6% of PWE were treated with ivermectin [24] while the overall ivermectin coverage in persons above the age of 11 years was 50-60% [25]. Lower coverage among PWE compared to the general population has also been reported in Cameroon [26]. We equally observed that participants who presented with epilepsy of shorter duration were more likely to be seizure-free at month 4.…”

Section: Discussionmentioning

confidence: 51%

Ivermectin as an adjuvant to anti-epileptic treatment in persons with onchocerciasis-associated epilepsy: A randomized proof-of-concept clinical trial

et al. 2020

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Introduction Recent findings from onchocerciasis-endemic foci uphold that increasing ivermectin coverage reduces the epilepsy incidence, and anecdotal evidence suggests seizure frequency reduction in persons with onchocerciasis-associated epilepsy, when treated with ivermectin. We conducted a randomized clinical trial to assess whether ivermectin treatment decreases seizure frequency. Methods A proof-of-concept randomized clinical trial was conducted in the Logo health zone in the Ituri province, Democratic Republic of Congo, to compare seizure frequencies in onchocerciasisinfected persons with epilepsy (PWE) randomized to one of two treatment arms: the anti-epileptic drug phenobarbital supplemented with ivermectin, versus phenobarbital alone. The primary endpoint was defined as the probability of being seizure-free at month 4. A secondary endpoint was defined as >50% reduction in seizure frequency at month 4, compared to baseline. Both endpoints were analyzed using multiple logistic regression. In longitudinal analysis, the probability of seizure freedom during the follow-up period was assessed for both treatment arms by fitting a logistic regression model using generalized estimating equations (GEE). Results Ninety PWE enrolled between October and November 2017 were eligible for analysis. A multiple logistic regression analysis showed a borderline association between ivermectin

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Clinical presentations of onchocerciasis-associated epilepsy (OAE) in Cameroon

Cited by 42 publications

References 33 publications

Onchocerciasis-associated epilepsy in the Democratic Republic of Congo: Clinical description and relationship with microfilarial density

Onchocerciasis-associated epilepsy in the Democratic Republic of Congo: Clinical description and relationship with microfilarial density

Prevalence and incidence of nodding syndrome and other forms of epilepsy in onchocerciasis-endemic areas in northern Uganda after the implementation of onchocerciasis control measures

Ivermectin as an adjuvant to anti-epileptic treatment in persons with onchocerciasis-associated epilepsy: A randomized proof-of-concept clinical trial

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