Mortality from epilepsy was investigated in a rural area of West Uganda where epilepsy is found to be closely linked to onchocerciasis. Thirty-three female and 28 male patients (age range 4-58 years, median 15 years) were identified in a population-wide prevalence survey and were followed from June 1994 to March 2001 (observation period 3,929 person-months). Patients had continuing access to antiepileptic drug (AED) treatment with phenobarbital. Eighteen patients died during the period of observation, corresponding to a standardised mortality ratio (SMR) of 7.2 (95% CI 4.4-11.6; P<0.0001). Adherence to treatment was considered good in 36 of 56 patients receiving regular AEDs, with a SMR of 7.4 in this group compared with a SMR of 8.0 for those 20 patients considered poorly adherent. These findings show high mortality in patients with onchocerciasis-associated epilepsy despite regular AED treatment. Epilepsy appears to have a dramatic impact on this community with high Onchocerca volvulus infestation. If the suspected causal relationship between epilepsy and infection with O. volvulus could be confirmed, this would further underline the importance of sustained control efforts against onchocerciasis.

No abstract

No abstract

In 38 pairs of epilepsy patients and controls matched for time and intensity of exposure to transmission of onchocerciasis, the presence of microfilariae in the skin of epilepsy patients was found insignificantly elevated compared with controls (odds ratio = 1.68; 95% confidence interval [CI] = 0.60–4.57; P = 0.31). This difference was more pronounced when detection of subcutaneous nodules was used as indication of infection with Onchocerca volvulus (odds ratio = 2.77; 95% CI = 0.92–8.33; P = 0.065). These findings from a patient group of limited size suggest that intensity of infection may play a substantial role in the development of onchocerciasis-associated epilepsy. Our results are in contrast to the results of two other independent studies from the identical endemic area; one case concluded a significant positive correlation between onchocerciasis and epilepsy, and the other case concluded a clearly negative correlation. Studies with a greater sample size are needed to confirm this possible relationship.

Abstract. Nodding syndrome (NS) is a poorly understood condition, which was delineated in 2008 as a new epilepsy syndrome. So far, confirmed cases of NS have been observed in three circumscribed African areas: southern Tanzania, southern Sudan, and northern Uganda. Case-control studies have provided evidence of an association between NS and infection with Onchocerca volvulus, but the causation of NS is still not fully clarified. We report a case of a 15-year old boy with head nodding seizures and other characteristic features of NS from an onchocerciasis endemic area in western Uganda, with no contiguity to the hitherto known areas. We suggest that the existence of NS should be systematically investigated in other areas.