Cognitive impairment and quality of life of people with epilepsy and neurocysticercosis in Zambia

Abstract

Cognitive impairment and quality of life (Qol) are important to assess the burden of epilepsy and neurocysticercosis (NCC), which are common but neglected in Sub-Saharan Africa (SSA). The aims of this study were to assess cognitive performance and Qol of people with epilepsy (PWE) in Zambia and to explore differences in PWE with and without NCC. In this community based, cross-sectional case-control-study, 47 PWE and 50 healthy controls completed five neuropsychological tests (Mini Mental State Examination (MMSE), Digit Span, Selective Reminding Test (SRT), Spatial Recall Test (SPART), Test Battery of Attentional Performance (TAP)) and a World Health Organization (WHO) questionnaire of Qol. Comparisons were made between PWE (n=47) and healthy controls (n=50) and between PWE with NCC (n=28) and without NCC (n=19), respectively, using Analysis of Covariance (ANCOVA) and Linear Models (LMs) while correcting for confounders such as age, sex, and schooling years, and adjusting for multiplicity. Working memory, spatial memory, verbal memory, verbal learning, orientation, speech and language reception, visuoconstructive ability, and attentional performance were significantly reduced in PWE compared with healthy controls (ANCOVA and LM, p<0.05). Quality of life of PWE was significantly lower in three domains (psychological, social, environmental) and in overall Qol compared with healthy controls (ANCOVA, p<0.05). There were no significant differences between PWE with NCC and PWE without NCC detected by ANCOVA. Using LM, significant differences between the groups were detected in four tests, indicating worse performance of PWE without NCC in MMSE, Digit Span, SPART, and lower physical Qol. Epilepsy was found to be associated with cognitive impairment and reduced Qol. People with epilepsy due to NCC had similar cognitive impairment and Qol compared with PWE due to other causes. Further studies should investigate the role of different conditions of NCC and the role of seizures on cognition and Qol.

High frequency of Taenia solium antigen positivity in patients admitted for neurological disorders in the Rural Hospital of Mosango, Democratic Republic of Congo.

“…Larval cysts (also called cysticerci) may settle in different tissues (muscles, skin) but are preferentially localized in the central nervous system (brain and spinal cord), causing neurocysticercosis, a disease associated with major morbidity, poor quality of life and signi cant cost for the health-care system, particularly in low-resource settings [2,3]. Depending on the number, size, stage, and location of the cysticerci as well as the host's immune response, neurocysticercosis may cause a wide variety of neurological symptoms and signs, including seizures, headaches, focal de cits, psychiatric manifestations and cognitive impairment [4][5][6]. On the other hand, some of the people carrying cysticerci in the central nervous system or in other locations may remain fully asymptomatic [2].…”

High frequency of Taenia solium antigen positivity in patients admitted for neurological disorders in the Rural Hospital of Mosango, Democratic Republic of Congo.

“…Larval cysts (also called cysticerci) may settle in different tissues (muscles, skin) but are preferentially localized in the central nervous system (brain and spinal cord), causing neurocysticercosis, a disease associated with major morbidity, poor quality of life and significant cost for the health-care system, particularly in low-resource settings [2,3]. Depending on the number, size, stage, and location of the cysticerci as well as the host's immune response, neurocysticercosis may cause a wide variety of neurological symptoms and signs, including seizures, headaches, focal deficits, psychiatric manifestations and cognitive impairment [4][5][6]. On the other hand, some of the people carrying cysticerci in the central nervous system or in other locations may remain fully asymptomatic [2].…”

Peripheral Taenia infection increases immunoglobulins in the central nervous system.

“…Cysticercosis is the most common cause of adult-acquired epilepsy world-wide; in T. solium endemic countries, approximately 29% of patients with epilepsy have cysticercosis (Ndimubanzi et al, 2010). In addition to seizures, patients with neurocysticercosis may also experience deficits in learning and memory (Nau et al, 2018). Whether this is a result of a direct function of the parasite, an immune response, recurrent seizures, or a combination of these, is uncertain.…”