Epidemiology of onchocerciasis-associated epilepsy in the Mbam and Sanaga river valleys of Cameroon: impact of more than 13 years of ivermectin

Fodjo, Joseph Nelson Siewe; Tatah, Godwin Y.; Tabah, Earnest Njih; Ngarka, Leonard; Nfor, Leonard N.; Chokote, Samuel Eric; Mengnjo, Michel K.; Déma, Fidèle; Sitouok, Aurélien Tele; Nkoro, Grace G.A.; Ntone, Felicien Enyime; Bissek, Anne Cécile Zoung-Kanyi; Chesnais, Cédric C.B.; Boussinesq, Michel; Colebunders, Robert; Njamnshi, Alfred Kongnyu

doi:10.1186/s40249-018-0497-1

Cited by 60 publications

(71 citation statements)

References 26 publications

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“…This suggests a greater exposure to onchocerciasis and explains the clustering of PWE in such households, which is a characteristic feature of OAE [7]. This is in line with previous reports of villages and families who are closer to blackfly breeding sites having more PWE [3,11,20,22]. Only skin snip-positive PWE were recruited in the Aketi health zone.…”

Section: Discussionsupporting

confidence: 86%

“…The most frequently reported seizures were generalized motor seizures (93.3%), followed by absences (40.0%). Nodding seizures and Nakalanga features were reported, suggesting a high prevalence of OAE in these communities as previously observed in Ituri (DRC) [9], in the Mbam valley (Cameroon) [20], Mahenge (Tanzania) [21], and Maridi (South Sudan) [22]. Moreover, two thirds of participants in the Logo health zone met the OAE criteria.…”

Section: Discussionsupporting

confidence: 72%

“…Rapid tests may therefore not be optimal for diagnosing ongoing O. volvulus infection, although they do provide information about exposure to the parasite. They however remain key and convenient for field use when assessing onchocerciasis transmission by testing children aged 10 years and below, as was the case in Cameroon [20], Nigeria [28], DRC [10] and Tanzania [21].…”

Section: Discussionmentioning

confidence: 99%

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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: 86%

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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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

Self Cite

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“…2018) in the Democratic Republic of Congo (DRC); in the Sanaga and Mbam valleys in Cameroon (Siewe Fodjo et al . 2018; Boullé et al . 2019); in rural villages in the Mahenge area in Tanzania (Mmbando et al .…”

Section: Resultsmentioning

confidence: 99%

Nodding syndrome research, lessons learned from the NSETHIO project

et al. 2019

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Background.Until recently, nodding syndrome (NS) was considered as a mysterious disease of unknown etiology. A link between onchocerciasis and epilepsy was suspected for a long time. However, onchocerciasis was not considered as the cause of NS because NS was believed to occur only in onchocerciasis-endemic regions in Uganda, South Sudan, and Tanzania. In October 2015, with funding from the European Research Council, the NSETHIO group launched a trans-disciplinary, multi-country research project to identify the cause of NS and to study the link between onchocerciasis and epilepsy.Methods.We reviewed NSETHIO activities as well as all published papers, and compared project findings with results of previous research on NS.ResultsFindings from the NSETHIO project showed that NS is only one of the clinical manifestations in the wide spectrum of onchocerciasis-associated epilepsy (OAE) that could be prevented by strengthening onchocerciasis elimination programs. NSETHIO demonstrated that OAE is an important neglected public health problem in onchocerciasis-endemic areas with no or a sub-optimally functioning onchocerciasis control strategies.Conclusions.Today there is overwhelming evidence that NS together with the Nakalanga syndrome is clinical presentations of OAE, a condition that could be prevented by strengthening onchocerciasis elimination programs. While research needs to continue to elucidate the pathophysiological mechanisms causing NS, new strategies to accelerate onchocerciasis elimination coupled with community-based surveillance and treatment programs for epilepsy are urgently needed in areas of high Onchocerca volvulus transmission.

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“…Onchocerciasis‐associated epilepsy (OAE) and the nodding syndrome, an epileptic condition which affects children living in areas where onchocerciasis is endemic, are important entities …”

Section: Treatmentmentioning

confidence: 99%

Onchocerciasis (river blindness): larva‐induced eczema (onchodermatitis) from an important oculocutaneous tropical disease spilling over into North America and Europe

et al. 2019

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Onchocerciasis is a leading cause of blindness in the world. It may be seen in temperate climates of the United States and Europe in immigrants and travelers from endemic regions, often linked to poverty and war. One should be aware of an incubation period that can be up to 15 months. In its early stage and throughout its course, onchocerciasis has noteworthy skin findings, facilitating diagnosis, as onchodermatitis resembles common eczema with variable degrees of papular, lichenoid, atrophic, and pigmentary alterations, features not suggestive if one is unaware of an individual's immigration and travel history. The same concept applies for the encysted worms (onchocercomas), as they tend to appear as common skin cysts and benign neoplasms. New methods can be employed to increase diagnostic sensitivity and specificity. Ivermectin is the gold standard of therapy, the use of which has almost miraculously eliminated this disease from large areas of the earth. However, its effect remains isolated to microfilariae and can be devastating in those coinfected with Loa loa. Recently, the symbiotic relationship between adult worms and Wolbachia bacteria has been discovered and, with it, the possibility of adding doxycycline as a treatment option. We also discuss coinfection with HIV and other diseases.

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Epidemiology of onchocerciasis-associated epilepsy in the Mbam and Sanaga river valleys of Cameroon: impact of more than 13 years of ivermectin

Cited by 60 publications

References 26 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

Nodding syndrome research, lessons learned from the NSETHIO project

Onchocerciasis (river blindness): larva‐induced eczema (onchodermatitis) from an important oculocutaneous tropical disease spilling over into North America and Europe

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