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High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo

BACKGROUND: An increased prevalence of epilepsy has been reported in many onchocerciasis endemic areas. The objective of this study was to determine the prevalence of epilepsy in onchocerciasis endemic areas in the Democratic Republic of the Congo (DRC) and investigate whether a higher annual intake...

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Autores principales: Levick, Bethany, Laudisoit, Anne, Tepage, Floribert, Ensoy-Musoro, Chellafe, Mandro, Michel, Bonareri Osoro, Caroline, Suykerbuyk, Patrick, Kashama, Jean Marie, Komba, Michel, Tagoto, Alliance, Falay, Dadi, Begon, Michael, Colebunders, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529017/
https://www.ncbi.nlm.nih.gov/pubmed/28708828
http://dx.doi.org/10.1371/journal.pntd.0005732
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author Levick, Bethany
Laudisoit, Anne
Tepage, Floribert
Ensoy-Musoro, Chellafe
Mandro, Michel
Bonareri Osoro, Caroline
Suykerbuyk, Patrick
Kashama, Jean Marie
Komba, Michel
Tagoto, Alliance
Falay, Dadi
Begon, Michael
Colebunders, Robert
author_facet Levick, Bethany
Laudisoit, Anne
Tepage, Floribert
Ensoy-Musoro, Chellafe
Mandro, Michel
Bonareri Osoro, Caroline
Suykerbuyk, Patrick
Kashama, Jean Marie
Komba, Michel
Tagoto, Alliance
Falay, Dadi
Begon, Michael
Colebunders, Robert
author_sort Levick, Bethany
collection PubMed
description BACKGROUND: An increased prevalence of epilepsy has been reported in many onchocerciasis endemic areas. The objective of this study was to determine the prevalence of epilepsy in onchocerciasis endemic areas in the Democratic Republic of the Congo (DRC) and investigate whether a higher annual intake of Ivermectin was associated with a lower prevalence of epilepsy. METHODOLOGY/PRINCIPLE FINDINGS: Between July 2014 and February 2016, house-to-house epilepsy prevalence surveys were carried out in areas with a high level of onchocerciasis endemicity: 3 localities in the Bas-Uele, 24 in the Tshopo and 21 in the Ituri province. Ivermectin uptake was recorded for every household member. This database allowed a matched case-control pair subset to be created that enabled putative risk factors for epilepsy to be tested using univariate logistic regression models. Risk factors relating to onchocerciasis were tested using a multivariate random effects model. To identify presence of clusters of epilepsy cases, the Kulldorff's scan statistic was used. Of 12, 408 people examined in the different health areas 407 (3.3%) were found to have a history of epilepsy. A high prevalence of epilepsy was observed in health areas in the 3 provinces: 6.8–8.5% in Bas-Uele, 0.8–7.4% in Tshopo and 3.6–6.2% in Ituri. Median age of epilepsy onset was 9 years, and the modal age 12 years. The case control analysis demonstrated that before the appearance of epilepsy, compared to the same life period in controls, persons with epilepsy were around two times less likely (OR: 0.52; 95%CI: (0.28, 0.98)) to have taken Ivermectin than controls. After the appearance of epilepsy, there was no difference of Ivermectin intake between cases and controls. Only in Ituri, a significant cluster (p-value = 0.0001) was identified located around the Draju sample site area. CONCLUSIONS: The prevalence of epilepsy in health areas in onchocerciasis endemic regions in the DRC was 2–10 times higher than in non-onchocerciasis endemic regions in Africa. Our data suggests that Ivermectin protects against epilepsy in an onchocerciasis endemic region. However, a prospective population based intervention study is needed to confirm this.
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spelling pubmed-55290172017-08-07 High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo Levick, Bethany Laudisoit, Anne Tepage, Floribert Ensoy-Musoro, Chellafe Mandro, Michel Bonareri Osoro, Caroline Suykerbuyk, Patrick Kashama, Jean Marie Komba, Michel Tagoto, Alliance Falay, Dadi Begon, Michael Colebunders, Robert PLoS Negl Trop Dis Research Article BACKGROUND: An increased prevalence of epilepsy has been reported in many onchocerciasis endemic areas. The objective of this study was to determine the prevalence of epilepsy in onchocerciasis endemic areas in the Democratic Republic of the Congo (DRC) and investigate whether a higher annual intake of Ivermectin was associated with a lower prevalence of epilepsy. METHODOLOGY/PRINCIPLE FINDINGS: Between July 2014 and February 2016, house-to-house epilepsy prevalence surveys were carried out in areas with a high level of onchocerciasis endemicity: 3 localities in the Bas-Uele, 24 in the Tshopo and 21 in the Ituri province. Ivermectin uptake was recorded for every household member. This database allowed a matched case-control pair subset to be created that enabled putative risk factors for epilepsy to be tested using univariate logistic regression models. Risk factors relating to onchocerciasis were tested using a multivariate random effects model. To identify presence of clusters of epilepsy cases, the Kulldorff's scan statistic was used. Of 12, 408 people examined in the different health areas 407 (3.3%) were found to have a history of epilepsy. A high prevalence of epilepsy was observed in health areas in the 3 provinces: 6.8–8.5% in Bas-Uele, 0.8–7.4% in Tshopo and 3.6–6.2% in Ituri. Median age of epilepsy onset was 9 years, and the modal age 12 years. The case control analysis demonstrated that before the appearance of epilepsy, compared to the same life period in controls, persons with epilepsy were around two times less likely (OR: 0.52; 95%CI: (0.28, 0.98)) to have taken Ivermectin than controls. After the appearance of epilepsy, there was no difference of Ivermectin intake between cases and controls. Only in Ituri, a significant cluster (p-value = 0.0001) was identified located around the Draju sample site area. CONCLUSIONS: The prevalence of epilepsy in health areas in onchocerciasis endemic regions in the DRC was 2–10 times higher than in non-onchocerciasis endemic regions in Africa. Our data suggests that Ivermectin protects against epilepsy in an onchocerciasis endemic region. However, a prospective population based intervention study is needed to confirm this. Public Library of Science 2017-07-14 /pmc/articles/PMC5529017/ /pubmed/28708828 http://dx.doi.org/10.1371/journal.pntd.0005732 Text en © 2017 Levick et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Levick, Bethany
Laudisoit, Anne
Tepage, Floribert
Ensoy-Musoro, Chellafe
Mandro, Michel
Bonareri Osoro, Caroline
Suykerbuyk, Patrick
Kashama, Jean Marie
Komba, Michel
Tagoto, Alliance
Falay, Dadi
Begon, Michael
Colebunders, Robert
High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo
title High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo
title_full High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo
title_fullStr High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo
title_full_unstemmed High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo
title_short High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo
title_sort high prevalence of epilepsy in onchocerciasis endemic regions in the democratic republic of the congo
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529017/
https://www.ncbi.nlm.nih.gov/pubmed/28708828
http://dx.doi.org/10.1371/journal.pntd.0005732
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