A review and a meta-analysis of the available epidemiological literature for evidence of an association between onchocerciasis infection and epilepsy were carried out. We used EMBASE (1974–2002), MEDLINE (1966–2002), and PASCAL (1987–2002) databases and relevant journals and bibliographies. We limited our analysis to the epidemiological studies, where the status regarding onchocerciasis infection and epilepsy was available for each subject. Nine African studies were included. The common relative risk estimated by the random-effects model was 1.21 (95% CI 0.99–1.47; p = 0.06). The meta-analysis did not show any difference according to the onchocerciasis endemicity level and the African areas. Our results do not allow to conclude for an association between Onchocerca volvulus infection and epilepsy. However, the results are nearly significant. Further research is needed in this neglected subject, in particular for the better understanding of the neurological pathogenicity in onchocerciasis.

Summary:Purpose: Cerebral malaria (CM) is suspected to be a potential cause of epilepsy in tropical areas, but little information is available. The purpose of this study was to evaluate the role of CM in epilepsy among children in Mali.Methods: An exposed-nonexposed study was performed to identify children who had epilepsy after malaria in the 0-to 15-year age group. The exposure factor was CM defined according to World Health Organization (WHO) criteria, and the nonexposure factor was symptomatic malaria without the characteristics of CM (NCM). All the children underwent a screening questionnaire and were examined by a medical physician. After the screening phase, a specialist in neuropediatrics examined the children suspected to have epilepsy. EEG and computed tomography (CT) scans were performed in some of these patients.Results: In total, 101 subjects who had had CM and 222 who had had NCM were included. Fifty-four children (CM,34; NCM,20) were suspected to have epilepsy, and six were confirmed (CM, five; NCM, one). The incidence rate was 17.0 per 1000 person-years in the CM group and 1.8 per 1000 person-year in the NCM group; thus the relative risk (RR) was 9.4 [95% confidence interval (CI), 1.3-80.3; p = 0.02]. After adjustment on age and duration of follow-up, the RR was 14.3 (95% CI, 1.6-132.0; p = 0.01).Conclusions: The risk of sequelar epilepsy is significantly higher in the CM group compared with the NCM group. A reevaluation of this cohort should be carried out later to search for temporal epilepsy that appeared after age 10 years.

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PurposeTo evaluate the RARE (Réseau Action-Recherche sur l’Epilepsie) program, a model of managing and treating people with epilepsy (PWE) at a primary health-care level in rural areas of Mali, we assessed treatment efficacy and compliance of patients who underwent the first year follow-up.MethodsA network of rural general practitioners (GPs) settled in six rural districts of the regions of Koulikoro, Segou and Sikasso, was involved in the diagnosis, evaluation and monitoring of all the identified PWE and in the distribution of phenobarbital (PB). All the participants were included in a prospective database and followed-up by GPs at 4 months intervals during the first year. Seizure frequency, treatment doses and appearance of adverse events (AEs) were systematically recorded. Efficacy was evaluated in terms of reduction of seizures frequency while noncompliance in terms of time to study withdrawal for any cause.Key findings596 patients treated with PB were included in the analysis. Of these, 74.0% completed the first year follow-up. At the final visit, 59.6% were seizure-free: 31.0% for 12 months, 10.2% for 8 months and 18.4% for 4 months. Adults and patients with convulsive seizures were the most drug-resistant (p<0.002). Few AEs were recorded. The multivariate analysis showed that being a woman, presenting convulsive seizures, having more than 5 seizures/month and had never be treated were predictors of withdrawal (p≤0.05) at 12 months.SignificanceThis study showed a good response and compliance to the treatment and allowed the identification of some factors associated with failure of management in a setting very near to clinical practice. Awareness campaigns are needed to assure a broader accessibility to treatment and to improve the compliance and continuity with treatment programs.