High prevalence of epilepsy in onchocerciasis endemic health areas in Democratic Republic of the Congo

Lenaerts, Evy; Mandro, Michel; Mukendi, Déby; Suykerbuyk, Patrick; Dolo, Housseini; Wonya’Rossi, Deogratias; Ngave, Francoise; Ensoy-Musoro, Chellafe; Laudisoit, Anne; Hotterbeekx, An; Colebunders, Robert

doi:10.1186/s40249-018-0452-1

Cited by 57 publications

(60 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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]. A study in an onchocerciasis-endemic region in the Mbam valley in Cameroon showed that the risk of developing epilepsy increased with increasing O. volvulus microfilarial density [20].…”

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

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

Self Cite

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…Therefore, we initially performed a four months proof-of-concept trial to investigate the effect of ivermectin on the frequency of seizures in OIPWE treated with phenobarbital. The trial was performed in the Logo health zone, an onchocerciasis-endemic area with a high epilepsy prevalence (4.6%) in the Ituri province in the Democratic Republic of Congo (DRC), where ivermectin had never been distributed previously [7]. Between October and November 2017, a community-based treatment of epilepsy was initiated and 387 persons with confirmed epilepsy (PWE) were enrolled in the program.…”

Section: Introductionmentioning

confidence: 99%

Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo

Mandro¹,

Fodjo

Dusabimana

et al. 2020

Pathogens

Self Cite

View full text Add to dashboard Cite

Background: There is anecdotal evidence that ivermectin may decrease seizure frequency in Onchocerca volvulus-infected persons with epilepsy (PWE). Methods: In October 2017, a 12-month clinical trial was initiated in rural Democratic Republic of Congo. PWE with onchocerciasis-associated epilepsy experiencing ≥2 seizures/month were randomly allocated to receive, over a one-year period, ivermectin once or thrice (group 1), while other onchocerciasis-infected PWE (OIPWE) were randomized to ivermectin twice or thrice (group 2). All participants also received anti-epileptic drugs. Data was analyzed using multiple logistic regression. Results: We enrolled 197 participants. In an intent-to-treat analysis (data from group 1 and 2 combined), seizure freedom was more likely among OIPWE treated with ivermectin thrice (OR: 5.087, 95% CI: 1.378–19.749; p = 0.018) and twice (OR: 2.471, 95% CI: 0.944–6.769; p = 0.075) than in those treated once. Similarly, >50% seizure reduction was more likely among those treated with ivermectin twice (OR: 4.469, 95% CI: 1.250–16.620) and thrice (OR: 2.693, 95% CI: 1.077–6.998). Absence of microfilariae during the last 4 months increased the odds of seizure freedom (p = 0.027). Conclusions: Increasing the number of ivermectin treatments was found to suppress both microfilarial density and seizure frequency in OIPWE, suggesting that O. volvulus infection plays an etiological role in causing seizures.

show abstract

High prevalence of epilepsy in onchocerciasis endemic health areas in Democratic Republic of the Congo

Cited by 57 publications

References 21 publications

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

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

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

Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo

Contact Info

Product

Resources

About