Abstract
BackgroundAn increased prevalence of epilepsy has been reported in many onchocerciasis endemic areas.ObjectiveTo determine the prevalence and distribution of epilepsy in an onchocerciasis endemic region in the Democratic Republic of the Congo (DRC).Design/MethodsAn epilepsy prevalence study was carried out in 2014, in two localities of the Bas-Uélé district, an onchocerciasis endemic region in the Orientale Province of the DRC. Risk factors for epilepsy were identified using a random effects logistic regression model and the distribution of epilepsy cases was investigated using the Moran’s I statistic of spatial auto-correlation.ResultsAmong the 12,776 individuals of Dingila, 373 (2.9%) individuals with epilepsy were identified. In a house-to-house survey in Titule, 68 (2.3%) of the 2,908 people who participated in the survey were found to present episodes of epilepsy. Epilepsy showed a marked spatial pattern with clustering of cases occurring within and between adjacent households. Individual risk of epilepsy was found to be associated with living close to the nearest fast flowing river where blackflies (Diptera: Simuliidae)–the vector of Onchocerca volvulus–oviposit and breed.ConclusionsThe prevalence of epilepsy in villages in the Bas-Uélé district in the DRC was higher than in non-onchocerciasis endemic regions in Africa. Living close to a blackflies infested river was found to be a risk factor for epilepsy.
Highlights
An association between onchocerciasis and epilepsy was suspected as early as the 1930’s in Mexico [1] and later reports were published showing clustering of epilepsy in several African onchocerciasis foci [2,3,4,5,6,7]
In a house-to-house survey in Titule, 68 (2.3%) of the 2,908 people who participated in the survey were found to present episodes of epilepsy
We investigated whether there was increased epilepsy prevalence in an endemic focus of onchocerciasis of the Orientale Province in the Democratic Republic of the Congo (DRC) and whether nodding syndrome was part of the clinical spectrum of epilepsy in this area
Summary
An association between onchocerciasis and epilepsy was suspected as early as the 1930’s in Mexico [1] and later reports were published showing clustering of epilepsy in several African onchocerciasis foci [2,3,4,5,6,7]. Ecological studies carried out in onchocerciasis endemic areas in West, Central and East Africa found a strong association between the prevalence of onchocerciasis and of epilepsy [8, 9]. In previous case-control studies this association was less clear, but this was probably due to shortcomings in study design and the selection of comparison groups [9,10]. In a study in Cameroon, performed before the introduction of annual ivermectin treatment (to control Onchocerciasis), the prevalence of epilepsy and the community microfilarial load were closely related [11]. A case-control study demonstrated that the microfilarial loads (microfilariae per skin snip) in the epileptic group were significantly higher than in the control group [11]. An increased prevalence of epilepsy has been reported in many onchocerciasis endemic areas.
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