Meta‐analysis of the association between cysticercosis and epilepsy in Africa

Abstract

Summary Purpose: The association between cysticercosis and epilepsy has been widely studied in Latin America and Asia and has proven to be one of the main causes of epilepsy. Despite high prevalences of both diseases in Africa, their association remains unclear. In this article we quantified the strength of the association between epilepsy and cysticercosis in Africa and we proposed some guidelines for future studies. Methods: We performed a systematic review of literature on cysticercosis (considered as exposure) and epilepsy (considered as the disease) and collected data from both cross‐sectional and case–control studies. A common odds ratio was estimated using a random‐effects meta‐analysis model of aggregate published data. Results: Among 21 retrieved documents, 11 studies located in 8 African countries were included in the meta‐analysis. Odds ratio of developing epilepsy when presenting cysticercosis (defined as Taenia solium seropositivity) ranged from 1.3–6.1. Overall, association between cysticercosis and epilepsy was found significant with a common odds ratio of 3.4 [95% confidence interval (CI) 2.7–4.3; p < 0.001]. Discussion: The variability of the association found between the studies could be due to differences in study design or in pathogenesis of cysticercosis. Further studies should overcome identified problems by following some guidelines to improve epidemiologic and clinical assessment of the association. Better understanding of the relation between cysticercosis and epilepsy is a key issue in improving prevention of epilepsy in Africa.

Association Between Onchocerciasis and Epilepsy in the Itwara Hyperendemic Focus, West Uganda: Controlling for Time and Intensity of Exposure

“…In those areas already subject to ivermectin mass therapy, the prevalence of palpable nodules and nodule load may be used as indicators for intensity of infection at least during the first years after the start of control campaigns when only minor changes of nodule counts are expected. 32 More rigorous casecontrolled studies using the example of those studies carried out on cysticercosis 33 are needed to enhance our understanding of the enigmatic phenomenon of river epilepsy. …”

Epilepsy and tropical parasitic infections in Sub-Saharan Africa: a review

“…Epidemiological studies from sub-Saharan Africa have shown the association of neurocysticercosis with seizures or epilepsy (Gemmell & Johnstone, 1976;Andriantsimahavandy et al, 1997;Pal et al, 2000;Carpio, 2002;Nsengiyumwa et al, 2003;Wagner & Newton, 2009;Coyle et al, 2012;Millogo et al, 2012). Evidence from neuroimaging studies in people with epilepsy and the recent meta-analysis and systematic review which included only studies conducted in sub-Saharan Africa demonstrated a significant association between neurocysticercosis and epilepsy, suggesting that neurocysticercosis could be the major contributing factor for the high prevalence of epilepsy observed (Carpio et al, 1998;Nsengiyumwa et al, 2003;Quet et al, 2010;Ndimubanzi et al, 2010). The major limitation on establishing evidence on the association of neurocysticercosis and epilepsy in sub-Saharan Africa is the lack of longitudinal surveys to examine the incidence of epilepsy following infections with T. solium (Blocher et al, 2011) or the impact of T. solium treatment using praziquantel on the prevalence of epilepsy.…”

A case of imported neurocysticercosis in Portugal

“…It is estimated that people with cysticercosis have a 3.4 to 3.8-fold increased risk for developing epilepsy [4].…”