High prevalence of epilepsy in an onchocerciasis endemic health zone in the Democratic Republic of the Congo, despite 14 years of community-directed treatment with ivermectin: A mixed-method assessment

Mukendi, Déby; Tepage, Floribert; Akonda, Innocent; Siewe, Joseph Nelson Fodjo; Rotsaert, Anke; Ndibmun, Carl Nwana; Laudisoit, Anne; Couvreur, Simon; Kabutako, Blandine; Menon, Sonia; Hotterbeekx, An; Colebunders, Robert

doi:10.1016/j.ijid.2018.10.021

Cited by 44 publications

(49 citation statements)

References 23 publications

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“…Onchocerciasis‐associated epilepsy (OAE) and the nodding syndrome, an epileptic condition which affects children living in areas where onchocerciasis is endemic, are important entities …”

Section: Treatmentmentioning

confidence: 99%

Onchocerciasis (river blindness): larva‐induced eczema (onchodermatitis) from an important oculocutaneous tropical disease spilling over into North America and Europe

et al. 2019

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Onchocerciasis is a leading cause of blindness in the world. It may be seen in temperate climates of the United States and Europe in immigrants and travelers from endemic regions, often linked to poverty and war. One should be aware of an incubation period that can be up to 15 months. In its early stage and throughout its course, onchocerciasis has noteworthy skin findings, facilitating diagnosis, as onchodermatitis resembles common eczema with variable degrees of papular, lichenoid, atrophic, and pigmentary alterations, features not suggestive if one is unaware of an individual's immigration and travel history. The same concept applies for the encysted worms (onchocercomas), as they tend to appear as common skin cysts and benign neoplasms. New methods can be employed to increase diagnostic sensitivity and specificity. Ivermectin is the gold standard of therapy, the use of which has almost miraculously eliminated this disease from large areas of the earth. However, its effect remains isolated to microfilariae and can be devastating in those coinfected with Loa loa. Recently, the symbiotic relationship between adult worms and Wolbachia bacteria has been discovered and, with it, the possibility of adding doxycycline as a treatment option. We also discuss coinfection with HIV and other diseases.

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“…Onchocerciasis‐associated epilepsy (OAE) and the nodding syndrome, an epileptic condition which affects children living in areas where onchocerciasis is endemic, are important entities …”

Section: Treatmentmentioning

confidence: 99%

Onchocerciasis (river blindness): larva‐induced eczema (onchodermatitis) from an important oculocutaneous tropical disease spilling over into North America and Europe

et al. 2019

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“…Case-control studies NSETHIO performed four case-control studies in the DRC (Colebunders et al 2016b;Levick et al 2017;Mandro et al 2018;Mukendi et al 2019). The lesson learned from these case-control studies is that in order to determine whether onchocerciasis is a risk factor for developing epilepsy, we need to take into account previous ivermectin use as a confounder.…”

Section: Studies Performed By the Nsethio Consortium Includedmentioning

confidence: 99%

“…This could rather be because all the children in these families have been exposed to O. volvulus-infected blackflies and are more susceptible to develop OAE (Colebunders et al 2018d). Because of the clustering of PWE in families, there is a common belief in local communities, even by local health care workers, that epilepsy is contagious and transmissible by contact (Mukendi et al 2019). In Aketi, in the DRC, focus group discussions revealed that children were not accepted in schools because it was considered they could transmit the epilepsy to others.…”

Section: Qualitative Researchmentioning

confidence: 99%

Nodding syndrome research, lessons learned from the NSETHIO project

et al. 2019

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Background.Until recently, nodding syndrome (NS) was considered as a mysterious disease of unknown etiology. A link between onchocerciasis and epilepsy was suspected for a long time. However, onchocerciasis was not considered as the cause of NS because NS was believed to occur only in onchocerciasis-endemic regions in Uganda, South Sudan, and Tanzania. In October 2015, with funding from the European Research Council, the NSETHIO group launched a trans-disciplinary, multi-country research project to identify the cause of NS and to study the link between onchocerciasis and epilepsy.Methods.We reviewed NSETHIO activities as well as all published papers, and compared project findings with results of previous research on NS.ResultsFindings from the NSETHIO project showed that NS is only one of the clinical manifestations in the wide spectrum of onchocerciasis-associated epilepsy (OAE) that could be prevented by strengthening onchocerciasis elimination programs. NSETHIO demonstrated that OAE is an important neglected public health problem in onchocerciasis-endemic areas with no or a sub-optimally functioning onchocerciasis control strategies.Conclusions.Today there is overwhelming evidence that NS together with the Nakalanga syndrome is clinical presentations of OAE, a condition that could be prevented by strengthening onchocerciasis elimination programs. While research needs to continue to elucidate the pathophysiological mechanisms causing NS, new strategies to accelerate onchocerciasis elimination coupled with community-based surveillance and treatment programs for epilepsy are urgently needed in areas of high Onchocerca volvulus transmission.

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“…An association between onchocerciasis (river blindness) and epilepsy was reported as early as 1938 [1]. This association was later documented in many cross-sectional studies [2][3][4][5], but the causal relationship between onchocerciasis and epilepsy remains controversial. A recent cohort study performed in an onchocerciasis-endemic region in Cameroon strongly suggested that infection with Onchocerca volvulus is able to cause epilepsy depending on the microfilarial (mf) density [6].…”

Section: Introductionmentioning

confidence: 99%

Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo

Mandro¹,

Fodjo

Dusabimana

et al. 2020

Pathogens

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Background: There is anecdotal evidence that ivermectin may decrease seizure frequency in Onchocerca volvulus-infected persons with epilepsy (PWE). Methods: In October 2017, a 12-month clinical trial was initiated in rural Democratic Republic of Congo. PWE with onchocerciasis-associated epilepsy experiencing ≥2 seizures/month were randomly allocated to receive, over a one-year period, ivermectin once or thrice (group 1), while other onchocerciasis-infected PWE (OIPWE) were randomized to ivermectin twice or thrice (group 2). All participants also received anti-epileptic drugs. Data was analyzed using multiple logistic regression. Results: We enrolled 197 participants. In an intent-to-treat analysis (data from group 1 and 2 combined), seizure freedom was more likely among OIPWE treated with ivermectin thrice (OR: 5.087, 95% CI: 1.378–19.749; p = 0.018) and twice (OR: 2.471, 95% CI: 0.944–6.769; p = 0.075) than in those treated once. Similarly, >50% seizure reduction was more likely among those treated with ivermectin twice (OR: 4.469, 95% CI: 1.250–16.620) and thrice (OR: 2.693, 95% CI: 1.077–6.998). Absence of microfilariae during the last 4 months increased the odds of seizure freedom (p = 0.027). Conclusions: Increasing the number of ivermectin treatments was found to suppress both microfilarial density and seizure frequency in OIPWE, suggesting that O. volvulus infection plays an etiological role in causing seizures.

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High prevalence of epilepsy in an onchocerciasis endemic health zone in the Democratic Republic of the Congo, despite 14 years of community-directed treatment with ivermectin: A mixed-method assessment

Cited by 44 publications

References 23 publications

Onchocerciasis (river blindness): larva‐induced eczema (onchodermatitis) from an important oculocutaneous tropical disease spilling over into North America and Europe

Onchocerciasis (river blindness): larva‐induced eczema (onchodermatitis) from an important oculocutaneous tropical disease spilling over into North America and Europe

Nodding syndrome research, lessons learned from the NSETHIO project

Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo

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