Abstract
A high burden of epilepsy is observed in Africa where parasitological infections are endemic. In 2016, in an Onchocerciasis endemic area in the Logo health zone, in Ituri province in the Democratic Republic of Congo, a door-to-door study showed an epilepsy prevalence of 4.6%, and 50.6% of persons with epilepsy were infected with Onchocerca volvulus. In the current study, the serum of 195 people infected with O. volvulus persons with epilepsy were tested to determine the proportion of co-infections with Taenia solium, Toxocara canis and Strongyloides. These proportions were, respectively, 8.2, 18.5 and 12.8%. Persons with a T. solium co-infection were older than those without co-infection (p = 0.021). In six (37.5%) of the T. solium co-infected persons, the first seizures appeared after the age of 30 years compared to three (2.1%) persons without a co-infection (p < 0.0001). Our study suggests that an O. volvulus infection is the main parasitic cause of epilepsy in the Ituri province, but in some persons, mainly in those with late onset epilepsy and with focal seizures, the epilepsy may be caused by neurocysticercosis. As the population in the area rears pigs, activities to limit T. solium transmission should be implemented.
Highlights
A higher burden of epilepsy is observed in low and middle incomes countries where parasitological infections are endemic. [1]
To identify onchocerciasisassociated epilepsy (OAE), certain epidemiological and clinical criteria were proposed [11]: (1) the person has to live in an onchocerciasis endemic region for at least 3 years, (2) the onset of seizures has to occur between 3–18 years of age, (3) there is a high prevalence of epilepsy in the village and there are several families with more than one child with epilepsy in this village, (4) there is no obvious cause of epilepsy such as perinatal trauma, recent head trauma, cerebral malaria, encephalitis, (5) prior to the onset of epilepsy, the psychomotor development of the child was normal, and (6) the person presents onchocerciasis antibodies and/or microfilariae in skin snips
A higher proportion of persons infected with O. volvulus with epilepsy co-infected with T. solium were men compared to persons with O. volvulus infection only (Table 1)
Summary
A higher burden of epilepsy is observed in low and middle incomes countries where parasitological infections are endemic. [1]. If a person meets the criteria above, but in addition presents with head nodding seizures (nodding syndrome) or Nakalanga features (stunted growth, eventually with thoracic or spinal abnormalities and/or with delayed sexual development) [12], even in the absence of an OV16 antibody or skin snip result, such a person should be considered as a person with OAE [9] This OAE definition was shown to be useful in epidemiological studies to estimate the burden of epilepsy potentially caused by onchocerciasis and to identify hotspots where most likely onchocerciasis elimination programs are working sub-optimally [9]. As long as there is no biomarker for OAE, meeting the criteria of this definition cannot exclude that the epilepsy is caused by another parasite such as T. solium
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