Epilepsy and tropical parasitic infections in Sub-Saharan Africa: a review

Abstract

Several reports have suggested that the high prevalence of epilepsy in sub-Saharan Africa is associated with the high prevalence of parasitic infections affecting the central nervous system. Though epidemiological evidence suggests an association between parasitic infections and epilepsy, the biological causal relationship has not been fully demonstrated for many of these infections. The objective of this paper is to review the available epidemiological evidence on the links between parasitic infections and epilepsy, the pathogenesis and the current gap of knowledge indicating the areas requiring further research. Data for this review were identified and collected using manual and electronic search strategies of published and unpublished sources. In Sub-Saharan Africa, the epidemiology of epilepsy remains unclear and given the differing study designs, the results of available epidemiological studies are difficult to interpret and compare. Evidence from surveys reported a median prevalence of 1.5%. Co-infection of parasitic infections and epilepsy in sub-Saharan Africa are common, particularly in areas characterized by poor hygiene standards. There is an epidemiological link on the association between epilepsy and various parasitic infections. However, the biological causal relationship requires further investigation in adequately designed studies. In conclusion, although several epidemiological and case control studies indicate a relationship between parasitic agents and epilepsy in sub-Saharan Africa, there is a considerable gap of knowledge on the cause and magnitude of the association. Thus, there is an urgent need for systematic epidemiological studies to understand the burden of epilepsy in areas endemic due to preventable parasitic infections, to prove a causal relationship, and to understand the impact of controlling these parasitic diseases on reduction of the burden of epilepsy.___________________________________________________________________________________

<p>Epilepsy diagnosis and management of children in Kenya: review of current literature</p>

“…Falciparum malaria infection is not only a risk for acute seizures but also for later development of epilepsy,15,16 with increased prevalence of epilepsy in children previously admitted with cerebral malaria (9.2%, OR, 4.4, 95% CI 1.4–13.7) or malaria complicated with seizures (11.5%, OR, 6.1, 95% CI 2.0–18.3) in malaria-endemic Kilifi 17. Other parasitic infections are implicated in the pathogenesis of epilepsy, and studies from African sites outside of Kenya that included adult patients have identified associations including Taenia solium , which causes neurocysticercosis,10 toxoplasmosis,5 onchorcerciasis,18 tuberculosis19 and T. canis 1. Other identified uninfectious predisposing conditions for childhood epilepsy include traumatic head injuries, sickle-cell disease, stroke, and acute encephalopathy 8–10,16…”

“…Other parasitic infections are implicated in the pathogenesis of epilepsy, and studies from African sites outside of Kenya that included adult patients have identified associations including Taenia solium , which causes neurocysticercosis,10 toxoplasmosis,5 onchorcerciasis,18 tuberculosis19 and T. canis 1. Other identified uninfectious predisposing conditions for childhood epilepsy include traumatic head injuries, sickle-cell disease, stroke, and acute encephalopathy 8–10,16…”

“…such as preventable brain injuries, and to poor access to health-care services due to multiple barriers, including financial cost. The chronic nature of epilepsy has wide-ranging socioeconomic impacts, including high health-resource utilization, reduced participation in education and work due to seizures, comorbidities, and stigma,behavioral problems, and psychological morbidity,all of which may contribute to overall poorer quality of life,1,8–10 in addition to increased mortality rates 1…”

Seroprevalence and determinants of toxoplasmosis in pregnant women attending antenatal clinic at the university teaching hospital, Lusaka, Zambia

“…Toxoplasmosis is a neglected zoonotic disease caused by a blood protozoan parasite called Toxoplasma gondii [1–4]. The organism is found worldwide and it infects nearly all warm-blooded animals including human beings [5, 6].…”

Mapping epilepsy risks through porcine farming in North West Cameroon

“…Whereas the works of , Thomas et al (2016), Garcia et al (1993Garcia et al ( , 2003, WHO (2012), Willingham (2002), Praet et al (2009) and Cruz et al (1989) are conclusive on T. solium cysticercosis as a cause of epilepsy in general, Dongmo et al (2004), Elliot et al (2013) and Mazigo et al (2013) not only doubt the epidemiological relationship between cysticercosis infection and epilepsy, but indicate that there is severe knowledge deficiency in sub-Saharan Africa on the cause and magnitude of the association. Although Elliot et al (2013) conclude that there is no likelihood of cysticercosis causing the high prevalence of epilepsy in Ngie sub-division of the North-West of Cameroon, their study is limited by ignoring the fact that neurocysticercosis is a major cause of focal epilepsy meaning that their sample was faulty by lumping both generalized and focal epileptics together.…”