A high prevalence of epilepsy (up to 1.3%) was observed in an area hyperendemic for onchocerciasis in the province of Bururi, Burundi. Following this observation, epileptics and controls were examined in 2 communes (administrative units) with different endemicity for onchocerciasis. Altogether, onchocerciasis was more frequent in epileptics (81.8%) than in controls from the same households (68.3%; P < 0.05). This difference was more marked in the hyperendemic area. Other possible causes of epilepsy, including cysticercosis, were infrequent (18 possible cases among 110 epileptics). During this survey, 9 epileptics with growth retardation were seen. They showed most characteristics of Nakalanga syndrome, which was described from Uganda. All 9 such cases were suffering from onchocerciasis. These findings give more evidence of a possible association between onchocerciasis and epilepsy, and between onchocerciasis and Nakalanga syndrome.

In the province of Bururi in Burundi, 103 epileptics and 72 control subjects from the same households were examined for cysticercosis. Antigen was detected by enzyme-linked immunosorbent assay in 4.9% of epileptic persons and in 4.2% of controls. Antibody was detected by enzyme-linked electroimmunotransfer blot assay (EITB) in 11.7% of epileptics and in 2.8% of controls. Neither difference was statistically significant, nor was a history of taeniasis significantly more frequent in epileptics than in controls. However, cysticercosis was significantly more frequently diagnosed by EITB in people with a history of taeniasis than in those without such a history. The prevalence of taeniasis in schoolchildren ranged between 0 and 1.0%. Meat inspection detected cysticercosis in 2% and 39% of pigs in 2 localities, respectively.

Abstract. To find out whether biannual treatments of onchocerciasis with ivermectin were necessary or whether annual treatments could suffice, parasitologic and clinical results in Burundi were compared at 12 months after a single treatment and after two treatments with an interval of six months. Adverse reactions were also compared at 12 months, after a second or third treatment, respectively. The biannual treatment resulted in a greater reduction of parasitologic parameters, had a longer-lasting effect on itching, and produced less side effects (especially itching, rash, and swellings) at 12 months than an annual treatment. Skin lesions were not significantly modified by any of the treatment schemes at 12 months. Notwithstanding this slight advantage of biannual treatment, operational constraints forced us to choose an annual distribution of ivermectin. With minimal resources, a distribution scheme was organized that was adapted to the different levels of endemicity of onchocerciasis. The results of this study may be of interest to policy makers and public health officials in areas where logistical and resource issues severely restrict the scope of treatment programs. In view of the planned activities of the African Programme of Onchocerciasis Control, the achievements in Burundi indicate that even with limited resources, an appropriate annual distribution scheme can give meaningful results. In spite of the persistence of skin lesions, their severity decreased and most patients considered that their condition had improved even after just one year.