The role of<i>Onchocerca volvulus</i>in the development of epilepsy in a rural area of Tanzania

König, Rebekka; Nassri, Amir; Meindl, Michael; Matuja, William; Kidunda, Aslam; Siegmund, Vera; Bretzel, Gisela; Löscher, Thomas; Jilek-Aall, Louise; Schmutzhard, Erich; Winkler, Andrea Sylvia

doi:10.1017/s0031182010000338

Cited by 68 publications

(72 citation statements)

References 34 publications

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“…Two recent reports from the Mahenge focus in Tanzania presented detailed clinical findings of patients living in an onchocerciasisendemic area, including magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analysis. 27,29 Although these investigations failed to show the presence of the parasite in the central nervous system, in the subset of patients with headnodding syndrome, a correlation was found between the pattern of non-specific MRI findings and skin snip results. The endemic area of Mahenge had been subject to annual mass treatment with ivermectin for several years before these studies were done, and microfilaricidal treatment may have interfered with the results of the parasitological investigations.…”

Section: Discussionmentioning

confidence: 99%

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

Kaiser¹,

Rubaale²,

Tukesiga³

et al. 2011

The American Journal of Tropical Medicine and Hygiene

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Section: Discussionmentioning

confidence: 99%

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

Kaiser¹,

Rubaale²,

Tukesiga³

et al. 2011

The American Journal of Tropical Medicine and Hygiene

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“…42 Gliotic lesions or other types of signal abnormalities may also be seen in an autoimmune response. Gallin et al 43 have demonstrated an association between a hyperreactive onchodermatitis and the presence of autoantibodies to proteins found in neutrophils in affected individuals. Also, an autoimmune process has been hypothesized in the development of ocular onchocerciasis and a shared antigen (OV39) between ocular tissue, including the retina, and O. volvulus has been implicated in the disease process.…”

Section: Mri Findings and O Volvulusmentioning

confidence: 99%

MRI findings in people with epilepsy and nodding syndrome in an area endemic for onchocerciasis: An observational study

Winkler

Friedrich

Velicheti³

et al. 2013

Afr H. Sci.

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Background: Onchocerciasis has been implicated in the pathogenesis of epilepsy. The debate on a potential causal relationship between Onchocerca volvulus and epilepsy has taken a new direction in the light of the most recent epidemic of nodding syndrome. Objective: To document MRI changes in people with different types of epilepsy and investigate whether there is an association with O. volvulus infection. Methods: In a prospective study in southern Tanzania, an area endemic for O. volvulus with a high prevalence of epilepsy and nodding syndrome, we performed MRI on 32 people with epilepsy, 12 of which suffered from nodding syndrome. Polymerase chain reaction (PCR) of O. volvulus was performed in skin and CSF. Results: The most frequent abnormalities seen on MRI was atrophy (twelve patients (37.5%)) followed by intraparenchymal pathologies such as changes in the hippocampus (nine patients (28.1%)), gliotic lesions (six patients (18.8%)) and subcortical signal abnormalities (three patients (9.4%)). There was an overall trend towards an association of intraparenchymal cerebral pathologies and infection with O. volvulus based on skin PCR (Fisher's Exact Test p=0.067) which was most pronounced in children and adolescents with nodding syndrome compared to those with other types of epilepsy (Fisher's Exact Test, p=0.083). Contrary to skin PCR results, PCR of CSF was negative in all patients. Conclusion: The observed trend towards an association of intraparenchymal cerebral pathological results on MRI and a positive skin PCR for O. volvulus despite negative PCR of CSF is intriguing and deserves further attention.

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“…A detailed description of the study population has been described elsewhere [21]. The study had been approved by the Ethics Committee of the Muhimbili University College of Health Sciences,Dar es Salaam.…”

Section: Methodsmentioning

confidence: 99%

“…Four different patient groups were defined: people with epilepsy with and without onchocerciasis and people not suffering from epilepsy with and without detection of onchocerciasis. People with epilepsy were further classified in subgroups of either primary generalized seizures, focal seizures, NS only or NS and occurrence of other epileptic seizure types [21]. According to current nomenclature study groups of patients with NS or NS and other seizures types correspond to NS and NS plus [5,14].…”

Section: Methodsmentioning

confidence: 99%

“…This clinical picture may also be seen in autoimmune encephalopathies [19] and it was therefore tempting to speculate thatNS is associated with antibodies to cellsurface proteins expressed in neurons [20]. Therefore,we investigated sera of a Tanzanian epilepsy cohort including NS patients and community controls originally collected for studies described in [21] -for the presence of anti-NMDA (N-methylDaspartate) receptor and antiVGKC (voltage gated potassium channel) complex antibodies as a pilot study. Furthermore we measured pyridoxalphosphate serum levels in a set of patients and community controls of the same Tanzanian cohort.…”

Section: Introductionmentioning

confidence: 99%

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Nodding syndrome in Tanzania may not be associated with circulating anti-NMDA- and anti-VGKC receptor antibodies or decreased pyridoxal phosphate serum levels-a pilot study

et al. 2014

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Background: Nodding syndrome (NS) is a seemingly progressive epilepsy disorder of unknown underlying cause. We investigated association of pyridoxal-phosphate serum levels and occurrence of anti-neuronal antibodies against Nmethyl-D-aspartate (NMDA) receptor and voltage gated potassium channel (VGKC) complex in NS patients. Methods: Sera of a Tanzanian cohort of epilepsy and NS patients and community controls were tested for the presence of anti-NMDA-receptor and anti-VGKC complex antibodies by indirect immunofluorescence assay. Furthermore pyridoxal-phosphate levels were measured. Results: Auto-antibodies against NMDA receptor or VGKC (LG1 or Caspr2) complex were not detected in sera of patients suffering from NS (n=6), NS plus other seizure types (n=16), primary generalized epilepsy (n=1) and community controls without epilepsy (n=7). Median Pyridoxal-phosphate levels in patients with NS compared to patients with primary generalized seizures and community controls were not significantly different. However, these median pyridoxalphosphate levels are significantly lower compared to the range considered normal in Europeans. Conclusions: In this pilot study NS was not associated with serum anti-NMDA receptor or anti-VGKC complex antibodies and no association to pyridoxal-phosphate serum levels was found.

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The role ofOnchocerca volvulusin the development of epilepsy in a rural area of Tanzania

Cited by 68 publications

References 34 publications

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

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

MRI findings in people with epilepsy and nodding syndrome in an area endemic for onchocerciasis: An observational study

Nodding syndrome in Tanzania may not be associated with circulating anti-NMDA- and anti-VGKC receptor antibodies or decreased pyridoxal phosphate serum levels-a pilot study

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