Prevalence of River Epilepsy in the Orientale Province in the Democratic Republic of the Congo

Colebunders, Robert; Tepage, Floribert; Rood, Ente; Mandro, Michel; Abatih, Emmanuel; Musinya, Gisele; Mambandu, Germain; Kabeya, José; Komba, Michel; Levick, Bethany; Mokili, John L.; Laudisoit, Anne

doi:10.1371/journal.pntd.0004478

Cited by 33 publications

(41 citation statements)

References 27 publications

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“…In this study, the prevalence of epilepsy increased with decreasing distance to the Mbam River, a breeding site for black flies, and with increasing community microfilariae load . Since then, similar associations have been documented in studies from many other African countries . In particular, a huge case‐control study conducted in several countries of sub‐Saharan Africa found an increased prevalence of epilepsy with onchocerciasis, with an odds ratio of 2.2 (confidence interval [CI] 95%: 1.6–3.2) .…”

Section: Epidemiological Aspectssupporting

confidence: 81%

“…It is possible that other children, slightly less exposed to Ov and/or exposed later in life, may develop NS (the mean age for developing NS in children in Tumango, in northern Uganda was 7.6 years). Children less exposed to Ov and much later in life may develop epilepsy with minimal or no cognitive impairment and no decrement of growth or sexual development (the mean age of developing tonic‐clonic seizures in the DRC was 11 years).…”

Section: Clinical Aspectsmentioning

confidence: 99%

“…8 Since then, similar associations have been documented in studies from many other African countries. [9][10][11][12] In particular, a huge case-control study conducted in several countries of sub-Saharan Africa found an increased prevalence of epilepsy with onchocerciasis, with an odds ratio of 2.2 (confidence interval [CI] 95%: 1.6-3.2). 3 A meta-analysis of African population-based surveys showed a variation in epilepsy prevalence consistent with onchocerciasis prevalence, with epilepsy prevalence being increased, on average, by 0.4% for each 10% increase in onchocerciasis prevalence.…”

Section: Epidemiological Aspectsmentioning

confidence: 99%

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Onchocerciasis‐associated epilepsy: From recent epidemiological and clinical findings to policy implications

et al. 2017

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SummaryA high prevalence of epilepsy is reported in many onchocerciasis‐endemic regions. In this paper we discuss recent epidemiological and clinical aspects as well as public health implications of onchocerciasis‐associated epilepsy (OAE) and propose a strategy to reduce the burden of disease. OAE probably presents in a variety of clinical manifestations, including the nodding syndrome and the Nakalanga syndrome. The most common clinical presentation, however, is generalized (primarily tonic‐clonic) seizures. A characteristic of OAE is the onset of seizures between the ages of 3 and 18 years and clustering in certain families and villages close to rapid‐flowing black‐fly‐infested rivers. A strategy combining active surveillance for epilepsy with early treatment with antiepileptic drugs and prevention of onchocerciasis by increasing the geographical and therapeutic coverage of community‐directed treatment with ivermectin (CDTi) may considerably decrease the burden of disease.

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Section: Epidemiological Aspectssupporting

confidence: 81%

Section: Clinical Aspectsmentioning

confidence: 99%

Section: Epidemiological Aspectsmentioning

confidence: 99%

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Onchocerciasis‐associated epilepsy: From recent epidemiological and clinical findings to policy implications

et al. 2017

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“…In most PWE, no obvious other cause could be identified and their psycho-motoric development before the onset of seizures had been normal. The peak onset of epilepsy between the ages of seven and 16 years is a characteristic of OAE as observed elsewhere in Africa (Colebunders et al, 2016b(Colebunders et al, , 2017 when they became heavily infected with O. volvulus at a young age. An argument for this hypothesis is a recent study in South Sudan which showed that the age at onset of nodding seizures was around eight years, while the age of other forms of seizures was around 10 years (Colebunders et al, 2018).…”

Section: Discussionmentioning

confidence: 52%

Clinical presentation of epilepsy in six villages in an onchocerciasis endemic area in Mahenge, Tanzania

Bhwana

Mmbando

Dekker

et al. 2019

Epileptic Disorders

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Aims . To describe the clinical manifestations of epilepsy and access to antiseizure treatment in Mahenge in Central Tanzania, an onchocerciasis endemic area with a high prevalence of epilepsy. Methods . A door‐to‐door epilepsy prevalence survey was conducted in four rural and two sub‐urban villages. Trained community workers used five screening questions to identify persons suspected to have epilepsy. Such individuals were interviewed and examined by a neurologist or a medical doctor with additional training in epilepsy, and were tested for Onchocerca volvulus antibodies. Results . A total of 221 out of 8,062 (2.74%) surveyed individuals were confirmed to have epilepsy. The median age at seizure onset was 12 years (interquartile range: 7–16). Seventy‐nine persons with epilepsy (PWE) (36.1%) had a family member with epilepsy, which was a sibling in 52.1%. Tonic‐clonic seizures (142 individuals; 64.2%) were the most common seizure type. Nodding seizures were reported in 12.7% of PWE; the majority of them living in rural villages. Persons with nodding seizures reported more frequent seizures, presented with more psychiatric symptoms, and more often had onchocerciasis antibodies than those with other seizure types. The high rate of individuals with a seizure onset at between seven and 16 years is characteristic of onchocerciasis‐associated epilepsy (OAE). Of the PWE, 77.9% met the criteria for the clinical case definition of OAE. Eighty‐three PWE (37.6%) were not taking any antiepileptic medication. Phenobarbital was the antiepileptic drug most commonly prescribed in 76.1% of treated PWE. Conclusion . The high prevalence of epilepsy in rural villages in Mahenge most likely is related to the high prevalence of OAE. To prevent children developing OAE, strengthening the onchocerciasis elimination programme in Mahenge is urgently needed. Moreover, a decentralised epilepsy treatment programme is also needed to provide uninterrupted access to affordable antiepileptic drugs for the many PWE living in rural villages in the Mahenge area.

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“…There is, however, accruing evidence from case-control studies associating it with epilepsy [26]. Epilepsy prevalence has been shown to increase near to rivers, which are breeding grounds for the vector, the simulium fly [27,28]. There is also a positive correlation between hyperendemicity of onchocerciasis and high prevalence of epilepsy [29].…”

Section: Onchocerciasismentioning

confidence: 99%

Parasites and epilepsy: Understanding the determinants of epileptogenesis

Angwafor

Bell

Njamnshi

et al. 2019

Epilepsy & Behavior

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There is a large body of evidence suggesting that parasites could be a major preventable risk factor for epilepsy in low and middle-income countries. We review potentially important substrates for epileptogenesis in parasitic diseases. Taenia solium is the most widely known parasite associated with epilepsy and the risk seems determined mainly by the extent of cortical involvement and the evolution of the primary cortical lesion to gliosis or to a calcified granuloma. For most parasites, however, epileptogenesis is more complex and other favourable host genetic factors and parasite-specific characteristics may be critical. In situations where cortical involvement by the parasite is either absent or minimal, parasiteinduced epileptogenesis through an autoimmune process seems plausible. Further research to identify important markers of epileptogenesis in parasitic diseases will have huge implications for the development of trials to halt or delay onset of epilepsy.

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Prevalence of River Epilepsy in the Orientale Province in the Democratic Republic of the Congo

Cited by 33 publications

References 27 publications

Onchocerciasis‐associated epilepsy: From recent epidemiological and clinical findings to policy implications

Onchocerciasis‐associated epilepsy: From recent epidemiological and clinical findings to policy implications

Clinical presentation of epilepsy in six villages in an onchocerciasis endemic area in Mahenge, Tanzania

Parasites and epilepsy: Understanding the determinants of epileptogenesis

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