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Nicoletti A, Edoardo Cicero C, Todaro V, Colli C, Cosmi F, Anselmi M, Caicedo C, Vilte E, Mario Camargo W, Bartoloni A, Crespo Gomez EB, Giuliano L. Epilepsy and neurocysticercosis in rural areas of the Bolivian Chaco: What has changed during the last 30 years? Epilepsia Open 2024; 9:513-521. [PMID: 38016915 PMCID: PMC10984303 DOI: 10.1002/epi4.12872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE Neurocysticercosis (NCC) is considered the major cause of epilepsy in endemic regions. In the rural areas of the Bolivian Chaco prevalence of NCC among people with epilepsy (PWE) was 27.4%, according to a population-based survey carried out in 1994. The aim of the study was to estimate the prevalence of Epilepsy Associated with Tonic-Clonic Seizures (EATCS) and to evaluate the prevalence of NCC among PWE in the rural communities of the Bolivian Chaco after 30 years. METHODS Twenty-two rural communities (total population 12 852) were involved in the study. PWE in the study area were ascertained by multiple sources and the diagnosis was confirmed by a neurologist. All PWE identified were invited to undergo brain CT scan examination and diagnosis of NCC was sought according to the revised Del Brutto criteria. RESULTS Seventy-eight PWE (30 men, 38.4%; mean age at onset was 12.7 ± 13.2 years) with EATCS were identified giving a crude prevalence of 6.1/1000 (95% CI: 4.7-7.3). Due to the COVID-19 lockdown, the study was interrupted in 2020 and only 36 PWE (46%) of the whole sample underwent CT scan examination. Of these, 8 (22.2%) fulfilled the criteria for NCC of whom 6 (75%) presented only single or multiple calcifications. SIGNIFICANCE This is the first study reassessing the prevalence of NCC among PWE after 30 years, in the same rural area and using a population-based design. T. solium is still endemic in the Bolivian Chaco where more than 20% of EATCS may be attributable to NCC. Our findings show a substantially unchanged prevalence of NCC over the past 30 years despite improved knowledge, underlining the need for active intervention programs to control T. solium transmission in this area. PLAIN LANGUAGE SUMMARY Neurocysticercosis is still endemic in the Bolivian Chaco. The proportion of epilepsy attributable to neurocysticercosis is about 22%. Systematic efforts towards elimination of neurocysticercosis in these areas should be implemented.
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Affiliation(s)
- Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Section of NeurosciencesUniversity of CataniaCataniaItaly
| | - Calogero Edoardo Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Section of NeurosciencesUniversity of CataniaCataniaItaly
| | - Valeria Todaro
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Section of NeurosciencesUniversity of CataniaCataniaItaly
| | - Chiara Colli
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases UnitUniversity of FlorenceFlorenceItaly
| | - Francesco Cosmi
- Center of Anthropological Research of the Teko GuaraníGutierrezBolivia
| | - Mariella Anselmi
- Department of Infectious, Tropical Diseases and MicrobiologyIRCCS Sacro Cuore Don Calabria Hospital, NegrarVeronaItaly
| | - Cintia Caicedo
- Centro de Epidemiología Comunitaria y Medicina Tropical (CECOMET)EsmeraldasEcuador
| | - Estela Vilte
- Center of Anthropological Research of the Teko GuaraníGutierrezBolivia
| | | | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases UnitUniversity of FlorenceFlorenceItaly
| | | | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Section of NeurosciencesUniversity of CataniaCataniaItaly
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Owolabi MO, Leonardi M, Bassetti C, Jaarsma J, Hawrot T, Makanjuola AI, Dhamija RK, Feng W, Straub V, Camaradou J, Dodick DW, Sunna R, Menon B, Wright C, Lynch C, Chadha AS, Ferretti MT, Dé A, Catsman-Berrevoets CE, Gichu M, Tassorelli C, Oliver D, Paulus W, Mohammed RK, Charway-Felli A, Rostasy K, Feigin V, Craven A, Cunningham E, Galvin O, Perry AH, Fink EL, Baneke P, Helme A, Laurson-Doube J, Medina MT, Roa JD, Hogl B, O'Bryan A, Trenkwalder C, Wilmshurst J, Akinyemi RO, Yaria JO, Good DC, Hoemberg V, Boon P, Wiebe S, Cross JH, Haas M, Jabalpurwala I, Mojasevic M, DiLuca M, Barbarino P, Clarke S, Zuberi SM, Olowoyo P, Owolabi A, Oyesiku N, Maly-Sundgren PC, Norrving B, Soekadar SR, van Doorn PA, Lewis R, Solomon T, Servadei F. Global synergistic actions to improve brain health for human development. Nat Rev Neurol 2023; 19:371-383. [PMID: 37208496 PMCID: PMC10197060 DOI: 10.1038/s41582-023-00808-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/21/2023]
Abstract
The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.
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Affiliation(s)
- Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- African Stroke Organization, Ibadan, Nigeria.
- World Federation for Neurorehabilitation, North Shields, UK.
- Lebanese American University of Beirut, Beirut, Lebanon.
- Blossom Specialist Medical Center, Ibadan, Nigeria.
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Claudio Bassetti
- Neurology Department Inselspital - University of Bern, Bern, Switzerland
- European Academy of Neurology, Vienna, Austria
| | - Joke Jaarsma
- European Federation of Neurological Associations, Brussels, Belgium
| | - Tadeusz Hawrot
- European Federation of Neurological Associations, Brussels, Belgium
| | | | | | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Volker Straub
- John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle, UK
| | - Jennifer Camaradou
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- One Neurology Initiative, Brussels, Belgium
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
- Atria Academy of Science and Medicine, New York, NY, USA
- American Brain Foundation, Minneapolis, MN, USA
| | - Rosita Sunna
- Tics and Tourette Across the Globe, Hannover, Germany
- Australian Clinical Psychology Association, Sydney, New South Wales, Australia
| | - Bindu Menon
- Department of Neurology, Apollo Specialty Hospitals, Nellore, India
| | | | - Chris Lynch
- Alzheimer's Disease International, London, UK
| | | | | | - Anna Dé
- Women's Brain Project, Guntershausen, Switzerland
| | - Coriene E Catsman-Berrevoets
- Department of Paediatric Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- European Paediatric Neurology Society, Bolton, UK
| | - Muthoni Gichu
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
- Global Brain Health Institute, San Francisco, CA, USA
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences of the University of Pavia, Pavia, Italy
- IRCCS C. Mondino Foundation Neurological Institute, Pavia, Italy
- International Headache Society, London, UK
| | - David Oliver
- University of Kent, Canterbury, UK
- International Neuro-Palliative Care Society, Roseville, MN, USA
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians University Munich, Klinikum Großhadern, Munich, Germany
- International Federation of Clinical Neurophysiology, Milwaukee, WI, USA
| | - Ramla K Mohammed
- Amal Neuro Developmental Centres, Gudalur, India
- Al Ameen Educational Trust, Gudalur, India
| | | | - Kevin Rostasy
- European Paediatric Neurology Society, Bolton, UK
- Department of Paediatric Neurology, Children's Hospital Datteln, University Witten/Herdecke, Witten, Germany
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Orla Galvin
- European Federation of Neurological Associations, Brussels, Belgium
| | | | - Ericka L Fink
- Department of Paediatric Neurology and Critical Care, University of Pittsburgh Medical Centre Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh Medical Centre Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Peer Baneke
- Multiple Sclerosis International Federation, London, UK
| | - Anne Helme
- Multiple Sclerosis International Federation, London, UK
| | | | - Marco T Medina
- National Autonomous University of Honduras, Tegucigalpa, Honduras
- Pan-American Federation of Neurological Societies, Santiago de Chile, Chile
| | - Juan David Roa
- HOMI Fundacion Hospital Paediatrico la Misericordia, Bogota, Colombia
| | - Birgit Hogl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- World Sleep Society, Rochester, MN, USA
| | | | - Claudia Trenkwalder
- Paracelsus-Elena Hospital, Kassel, Department of Neurosurgery, University Medical Centre, Goettingen, Germany
| | - Jo Wilmshurst
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- International Child Neurology Association, London, UK
| | - Rufus O Akinyemi
- African Stroke Organization, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joseph O Yaria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - David C Good
- World Federation for Neurorehabilitation, North Shields, UK
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Volker Hoemberg
- World Federation for Neurorehabilitation, North Shields, UK
- SRH Neurorehabilitation Hospital Bad Wimpfen, Bad Wimpfen, Germany
| | - Paul Boon
- European Academy of Neurology, Vienna, Austria
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- International League Against Epilepsy, Flower Mound, TX, USA
| | - J Helen Cross
- International League Against Epilepsy, Flower Mound, TX, USA
- Clinical Neurosciences Section, UCL Institute of Child Health, University College London, London, UK
| | - Magali Haas
- Cohen Veterans Bioscience, New York, NY, USA
| | | | | | - Monica DiLuca
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- European Brain Council, Brussels, Belgium
| | | | - Stephanie Clarke
- World Federation for Neurorehabilitation, North Shields, UK
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sameer M Zuberi
- European Paediatric Neurology Society, Bolton, UK
- Paediatric Neurosciences Research Group, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Olowoyo
- Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
- Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Nelson Oyesiku
- Department of Neurosurgery, University of North Carolina at Chapel Hill, North Carolina, NC, USA
- World Federation of Neurosurgical Societies, Prague, Czech Republic
| | - Pia C Maly-Sundgren
- Department of Clinical Sciences/Diagnostic Radiology, Lund University, Lund, Sweden
| | - Bo Norrving
- Department of Clinical Sciences/Neurology, Lund University, Lund, Sweden
| | - Surjo R Soekadar
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Peripheral Nerve Society, Roseville, MN, USA
| | - Richard Lewis
- Peripheral Nerve Society, Roseville, MN, USA
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Tom Solomon
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Encephalitis Society, Malton, North Yorkshire, UK
| | - Franco Servadei
- World Federation of Neurosurgical Societies, Prague, Czech Republic
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Humanitas University, Milan, Italy
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Zulu G, Stelzle D, Mwape KE, Welte TM, Strømme H, Mubanga C, Mutale W, Abraham A, Hachangu A, Schmidt V, Sikasunge CS, Phiri IK, Winkler AS. The epidemiology of human Taenia solium infections: A systematic review of the distribution in Eastern and Southern Africa. PLoS Negl Trop Dis 2023; 17:e0011042. [PMID: 37000841 PMCID: PMC10096517 DOI: 10.1371/journal.pntd.0011042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/12/2023] [Accepted: 03/12/2023] [Indexed: 04/03/2023] Open
Abstract
Background
Taenia solium is a tapeworm that causes taeniosis in humans and cysticercosis in humans and pigs. Within Eastern and Southern Africa (ESA), information on the presence of human taeniosis and cysticercosis seems scarce. This systematic review aimed to describe the current information available and gaps in the epidemiology of human T. solium infections in ESA.
Methods/Principle findings
Scientific literature published between 1st January 2000 and 20th June 2022 in international databases [MEDLINE (Ovid), Embase (Ovid), Global Health (Ovid), Scopus (Elsevier), African Index Medicus (via WHO Global Index Medicus), and Open Grey] was systematically reviewed for ESA. The study area included 27 countries that make up the ESA region. Information on either taeniosis, cysticercosis or NCC was available for 16 of 27 countries within the region and a total of 113 reports were retained for the review. Most case reports for cysticercosis and NCC were from South Africa, while Tanzania had the most aggregated cysticercosis reports. Eleven countries reported on NCC with seven countries reporting data on NCC and epilepsy. Unconfirmed human T. solium taeniosis cases were reported in nine countries while two countries (Madagascar and Zambia) reported confirmed T. solium cases. The cysticercosis seroprevalence ranged between 0.7–40.8% on antigen (Ag) ELISA and between 13.1–45.3% on antibody (Ab) ELISA. Based on immunoblot tests the Ab seroprevalence was between 1.7–39.3%, while the proportion of NCC-suggestive lesions on brain CT scans was between 1.0–76% depending on the study population. The human taeniosis prevalence based on microscopy ranged between 0.1–14.7%. Based on Copro Ag-ELISA studies conducted in Kenya, Rwanda, Tanzania, and Zambia, the highest prevalence of 19.7% was reported in Kenya.
Conclusions
Despite the public health and economic impact of T. solium in ESA, there are still large gaps in knowledge about the occurrence of the parasite, and the resulting One Health disease complex, and monitoring of T. solium taeniosis and cysticercosis is mostly not in place.
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Wang Z, Garcia RM, Huff HV, Niquen-Jimenez M, Marcos LA, Lam SK. Neurocysticercosis control for primary epilepsy prevention: a systematic review. Pathog Glob Health 2022; 116:282-296. [PMID: 34928183 PMCID: PMC9248947 DOI: 10.1080/20477724.2021.2015869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Neurocysticercosis (NCC) is a leading cause of preventable epilepsy in lower- and upper- middle-income countries (LMICs/UMICs). NCC is a human-to-human transmitted disease caused by ingestion of Taenia solium eggs from a Taenia carrier. T. solium infection control is the key to reduce NCC incidence. This systematic review aims to identify T. solium control programs that can provide frameworks for endemic areas to prevent NCC-related epilepsy. A systematic search was conducted in PubMed/Medline, Embase, Web of Science, and Cochrane Library databases in March 2021. After title and abstract review, full texts were screened for qualitative analysis. Additional articles were identified via citation search. Of 1322 total results, 34 unique studies were included. Six major intervention types were identified: national policy (8.8%), community sanitation improvement (8.8%), health education (8.8%), mass drug administration (29.4%), pig vaccination and treatment (32.4%), and combined human and pig treatment (11.8%). Overall, 28 (82.4%) studies reported decreased cysticercosis prevalence following the intervention. Only health education and combined human and pig treatment were effective in all selected studies. NCC causes preventable epilepsy in LMICs/UMICs and its incidence can be reduced through T. solium control. Most interventions that disrupt the T. solium transmission cycle are effective. Long-term sustained results require comprehensive programs, ongoing surveillance, and collaborative effort among multisectoral agencies.
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Affiliation(s)
- Zhe Wang
- Department of Neurological Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA,Division of Infectious Diseases, Department of Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA,Department of Microbiology and Immunology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA,CONTACT Zhe Wang Department of Neurological Surgery, Stony Brook University Renaissance School of Medicine, HSC T12 Rm 080, 100 Nicolls Rd, Stony Brook, NY11790, USA
| | - Roxanna M. Garcia
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hanalise V. Huff
- Fogarty Fellow, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Milagros Niquen-Jimenez
- Facultad de Medicina Humana Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis A. Marcos
- Division of Infectious Diseases, Department of Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA,Department of Microbiology and Immunology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Sandi K. Lam
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
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Evaluation of an Antibody Detecting Point of Care Test for Diagnosis of Taenia solium Cysticercosis in a Zambian Rural Community: A Prospective Diagnostic Accuracy Study. Diagnostics (Basel) 2021; 11:diagnostics11112121. [PMID: 34829468 PMCID: PMC8618153 DOI: 10.3390/diagnostics11112121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022] Open
Abstract
The lack of cheap, easy-to-use, rapid diagnostic tests has led to the development of several rapid diagnostic tests for cysticercosis. The new prototype two-strip, Taenia solium point of care test (TS POC) detects antibodies against taeniosis (TS POC T) and cysticercosis (TS POC CC). This study evaluated the diagnostic performance of the TS POC CC in the Sinda district in eastern Zambia. A sample of 1254 participants was recruited and tested with the TS POC. Out of the 1249 participants with a valid TS POC result, 177 (14%) tested positive while 1072 (86%) tested negative. All individuals with a positive TS POC and a subset of negative TS POC participants were selected for serum sampling, and were subjected to the recombinant glycoprotein T24H enzyme-linked immunoelectrotransfer blot (rT24H EITB) and the serum B60/158 (serum Ag) enzyme-linked immunosorbent assay (Ag ELISA). Performance characteristics were estimated using a Bayesian approach with probabilistic constraints. Based on 255 complete cases, the estimated sensitivity and specificity of the TS POC CC test were 35% (95% CI: 14–63%) and 87% (95% CI: 83–90%), respectively. The diagnostic performance needs to be improved, possibly by titrating antigen and other reagents’ concentration in the strip to produce a performance similar to existing cysticercosis tests such as the rT24H EITB.
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G K M, Singh BB, Sharma R, Aulakh RS, Brookes VJ. Quantitative risk assessment of human Taenia solium exposure from consuming pork produced in Punjab, India. Zoonoses Public Health 2021; 68:937-946. [PMID: 34402584 DOI: 10.1111/zph.12886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
Taenia solium cysticercosis is a neglected zoonosis that affects people throughout much of the developing world. The disease is endemic in Punjab state of India and controlling it is a public health challenge. No studies have been conducted to quantify the risk of T. solium exposure from consuming pork produced in the state. A stochastic quantitative risk assessment (QRA) model was constructed to understand the risk of human T. solium infection from consuming pork produced in Punjab. Input data were collected from official records, published literature, active surveillance and specifically for this study. Sensitivity analyses were conducted to assess the influence of the input parameters on the main output probability that any one pork meal is infective (contains at least one viable cyst) at consumption. The probability of any pork meal in Punjab containing at least one viable T. solium cyst post-storage and post-cooking was median 5.57 × 10-4 (95% PI 1.06 × 10-4 -1.95 × 10-3 ). Sobol' sensitivity analysis demonstrated that the most influential input parameters on consumption of a pork meal with at least one viable T. solium were the probability that a meal is insufficiently cooked to render cysts unviable, and the proportion of infected carcasses following informal slaughter. Whilst improved sanitation and hygiene can prevent cysticercosis in people, efforts to reduce the prevalence of T. solium cysts in pig carcases by preventing pigs' access to human waste, increasing meat inspection and promoting effective cooking practices are also important to reduce this source of taeniasis.
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Affiliation(s)
- Megha G K
- Centre for One Health, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India
| | - Balbir Bagicha Singh
- Centre for One Health, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India.,Sydney School of Veterinary Science, The University of Sydney, Camden, NSW, Australia
| | - Rajnish Sharma
- Centre for One Health, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India
| | - R S Aulakh
- Centre for One Health, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India
| | - Victoria J Brookes
- School of Animal and Veterinary Sciences, Faculty of Science, Charles Sturt University, Wagga Wagga, NSW, Australia.,Graham Centre for Agricultural Innovation (NSW Department of Primary Industries and Charles Sturt University), Wagga Wagga, NSW, Australia
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Bustos J, Gonzales I, Saavedra H, Handali S, Garcia HH. Neurocysticercosis. A frequent cause of seizures, epilepsy, and other neurological morbidity in most of the world. J Neurol Sci 2021; 427:117527. [PMID: 34147957 PMCID: PMC8800347 DOI: 10.1016/j.jns.2021.117527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 12/07/2022]
Abstract
Neurocysticercosis is endemic in most of the world and in endemic areas it accounts for approximately 30% of cases of epilepsy. Appropriate diagnosis and management of neurocysticercosis requires understanding the diverse presentations of the disease since these will vary in regards to clinical manifestation, sensitivity of diagnostic tests, and most importantly, therapeutic approach. This review attempts to familiarize tropical neurology practitioners with the diverse types of neurocysticercosis and the more appropriate management approaches for each.
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Affiliation(s)
- J Bustos
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - I Gonzales
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - H Saavedra
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - S Handali
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - H H Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Dixon MA, Winskill P, Harrison WE, Basáñez MG. Taenia solium taeniasis/cysticercosis: From parasite biology and immunology to diagnosis and control. ADVANCES IN PARASITOLOGY 2021; 112:133-217. [PMID: 34024358 DOI: 10.1016/bs.apar.2021.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Infection with the pork tapeworm (Taenia solium) is responsible for a substantial global burden of disease, not only restricted to its impact on human health, but also resulting in a considerable economic burden to smallholder pig farmers due to pig cysticercosis infection. The life-cycle, parasitology and immunology of T. solium are complex, involving pigs (the intermediate host, harbouring the larval metacestode stage), humans (the definitive host, harbouring the adult tapeworm, in addition to acting as accidental intermediate hosts) and the environment (the source of infection with eggs/proglottids). We review the parasitology, immunology, and epidemiology of the infection associated with each of the T. solium life-cycle stages, including the pre-adult/adult tapeworm responsible for human taeniasis; post-oncosphere and cysticercus associated with porcine and human cysticercosis, and the biological characteristics of eggs in the environment. We discuss the burden associated, in endemic settings, with neurocysticercosis (NCC) in humans, and the broader cross-sectoral economic impact associated both with NCC and porcine cysticercosis, the latter impacting food-value chains. Existing tools for diagnostics and control interventions that target different stages of the T. solium transmission cycle are reviewed and their limitations discussed. Currently, no national T. solium control programmes have been established in endemic areas, with further work required to identify optimal strategies according to epidemiological setting. There is increasing evidence suggesting that cross-sectoral interventions which target the parasite in both the human and pig host provide the most effective approaches for achieving control and ultimately elimination. We discuss future avenues for research on T. solium to support the attainment of the goals proposed in the revised World Health Organisation neglected tropical diseases roadmap for 2021-2030 adopted at the 73rd World Health Assembly in November 2020.
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Affiliation(s)
- Matthew A Dixon
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom; Schistosomiasis Control Initiative Foundation (SCI Foundation), London, United Kingdom
| | - Peter Winskill
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Wendy E Harrison
- Schistosomiasis Control Initiative Foundation (SCI Foundation), London, United Kingdom
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom.
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9
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Alva-Díaz C, Navarro-Flores A, Rivera-Torrejon O, Huerta-Rosario A, Molina RA, Velásquez-Rimachi V, Morán-Mariños C, Farroñay C, Pacheco-Mendoza J, Metcalf T, Burneo JG, Pacheco-Barrios K. Prevalence and incidence of epilepsy in Latin America and the Caribbean: A systematic review and meta-analysis of population-based studies. Epilepsia 2021; 62:984-996. [PMID: 33651439 DOI: 10.1111/epi.16850] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study was undertaken to perform an updated systematic review and meta-analysis to estimate the pooled prevalence and incidence of epilepsy in Latin America and the Caribbean (LAC), describing trends over time, and exploring potential clinical and epidemiological factors explaining the heterogeneity in the region. METHODS Observational studies assessing the incidence or prevalence of epilepsy in LAC countries up to March 2020 were systematically reviewed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses and cumulative analyses were performed using random-effects models. We assessed between-study heterogeneity with sensitivity, subgroup, and meta-regression analyses. Moreover, the quality of the included studies and the certainty of evidence were evaluated using the GRADE (grading of recommendation, assessment, development, and evaluation) approach. RESULTS Overall, 40 studies (from 42 records) were included, 37 for prevalence analyses and six for incidence (312 387 inhabitants; 410 178 person-years). The lifetime prevalence was 14.09 per 1000 inhabitants (95% confidence interval [CI] = 11.72-16.67), for active epilepsy prevalence was 9.06 per 1000 individuals (95% CI = 6.94-11.44), and the incidence rate was 1.11 per 1000 person-years (95% CI = .65-1.70). These high estimates have been constant in the region since 1990. However, substantial statistical heterogeneity between studies and publication bias were found. The overall certainty of evidence was low. Methodological aspects (sample size) and countries' epidemiological characteristics such as access to sanitation services and child and adult mortality rates explained the high heterogeneity. Finally, the prevalence of epilepsy associated with neurocysticercosis (NCC) in the general population was high, and the proportion of NCC diagnosis among people living with epilepsy was 17.37%. SIGNIFICANCE The epilepsy prevalence and incidence in LAC are higher than worldwide estimates, being constant since 1990 and strongly influenced by NCC. We identified high between-study heterogeneity and significant methodological limitations (e.g., heterogeneous definitions, lack of longitudinal studies). The region needs upgraded research using standardized definitions and diagnostic methods, and urgent action against preventable causes.
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Affiliation(s)
- Carlos Alva-Díaz
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru
| | - Alba Navarro-Flores
- Clinical and Health Efficacy Network, REDECS, Lima, Peru.,School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Oscar Rivera-Torrejon
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru
| | - Andrely Huerta-Rosario
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru.,School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Roberto A Molina
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru.,School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Victor Velásquez-Rimachi
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru
| | - Cristian Morán-Mariños
- Clinical and Health Efficacy Network, REDECS, Lima, Peru.,San Ignacio de Loyola University, Lima, Peru
| | | | | | - Tatiana Metcalf
- Neurology Department, Department of Medicine and Office for Teaching Support and Research, Daniel Alcides Carrion Hospital, Callao, Peru
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine, Western University, London, Canada
| | - Kevin Pacheco-Barrios
- Research Unit for the Generation and Synthesis of Evidence in Health, San Ignacio de Loyola University, Lima, Peru.,SYNAPSIS Mental Health and Neurology, Lima, Peru.,Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
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10
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Singh G, Singhal S, Sharma S, Paul BS, Bansal N, Chaudhary A, Sharma S, Bansal RK, Goraya JS, Setia RK, Sander JW. Clinical characteristics of epilepsy in resource-limited communities in Punjab, Northwest India. Epilepsia Open 2020; 5:582-595. [PMID: 33336129 PMCID: PMC7733663 DOI: 10.1002/epi4.12439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/26/2020] [Accepted: 10/02/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To describe clinical characteristics of a community-based epilepsy cohort from resource-limited communities in Punjab, Northwest India. METHODS The cohort was gathered following a two-stage screening survey. We cross-sectionally examined and followed up the cohort for one year. A panel of neurologists assigned seizure types, syndromes, and putative etiologies and categorized drug responsiveness. RESULTS The cohort of 240 included 161 (67.1%) men, 109 (45.4%) illiterates and 149 (62.1%) unemployed. Current age was >18 years in 155 (64.6%) but age at epilepsy onset was <18 years in 173 (72.1%). Epilepsies due to structural and metabolic causes were diagnosed in 99 (41.3%), but syndromic assignments were not possible in 97 (40.4%). After one year, drug-resistant epilepsy was established in 74 (30.8%). Perinatal events (n = 35; 14.6%) followed by CNS infections (n = 32; 13.3%) and traumatic brain injury (n = 12; 5.0%) were common risk factors. Most of those with CNS infections (n = 19; 63.3%), perinatal antecedents (n = 23; 76.7%), and other acquired risk factors (n = 27; 90.0%) presented with epilepsy due to structural and metabolic causes. Perinatal events were the putative etiology for nearly 40.7% of generalized epilepsies due to structural and metabolic causes and 28.2% of all epilepsies with onset <10 years. SIGNIFICANCE Existing classifications schemes should be better suited to field conditions in resource-limited communities in low- and middle-income countries. The finding of drug-resistant epilepsy in nearly at least a third in a community-based sample underscores an unmet need for enhancing services for this segment within healthcare systems. Perinatal events, CNS infections, and head injury account for a third of all epilepsies and hence preventative interventions focusing on these epilepsy risk factors should be stepped up.
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Affiliation(s)
- Gagandeep Singh
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
- Department of NeurologyDayanand Medical CollegeLudhianaIndia
- NIHR University College London Hospitals Biomedical Research CentreUCL Queen Square Institute of NeurologyLondonUK
| | - Sachi Singhal
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Suman Sharma
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | | | - Namita Bansal
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Anurag Chaudhary
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | - Sarit Sharma
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | | | | | | | - Josemir W. Sander
- NIHR University College London Hospitals Biomedical Research CentreUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St PeterUK
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
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11
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Angwafor SA, Bell GS, Njamnshi AK, Singh G, Sander JW. Parasites and epilepsy: Understanding the determinants of epileptogenesis. Epilepsy Behav 2019; 92:235-244. [PMID: 30711777 DOI: 10.1016/j.yebeh.2018.11.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/25/2018] [Accepted: 11/26/2018] [Indexed: 12/25/2022]
Abstract
There is a large body of evidence suggesting that parasites could be a major preventable risk factor for epilepsy in low- and middle-income countries. We review potentially important substrates for epileptogenesis in parasitic diseases. Taenia solium is the most widely known parasite associated with epilepsy, and the risk seems determined mainly by the extent of cortical involvement and the evolution of the primary cortical lesion to gliosis or to a calcified granuloma. For most parasites, however, epileptogenesis is more complex, and other favorable host genetic factors and parasite-specific characteristics may be critical. In situations where cortical involvement by the parasite is either absent or minimal, parasite-induced epileptogenesis through an autoimmune process seems plausible. Further research to identify important markers of epileptogenesis in parasitic diseases will have huge implications for the development of trials to halt or delay onset of epilepsy.
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Affiliation(s)
- Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom
| | - Gail S Bell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé 1, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Gagandeep Singh
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom; Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), the Netherlands.
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12
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13
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Abstract
Neurocysticercosis is the most common helminth infection of nervous system in humans caused by the encysted larvae of Taenia solium. It is a major cause of epilepsy in tropical areas and the most common cause of focal-onset seizures in North Indian children. Children with neurocysticercosis have pleomorphic manifestations depending on the location, number and viability of the cysts and host response. In endemic areas, neurocysticercosis should be clinically suspected in any child with recent-onset seizures, headache or focal motor deficits where there is no other suggestion of an underlying neurological disorder. Diagnosis of neurocysticercosis is essentially based on neuroimaging; visualization of a scolex is diagnostic. Management includes use of cysticidal drugs usually albendazole, which seems to be effective for lesion resolution and seizure remission, use of steroids and anti-epileptic drugs. Single lesions portend good prognosis with resolution of lesions in >60% of the cases within 6 mo and good seizure control. Prognosis is guarded in cysticercus encephalitis, racemose and extraparenchymal neurocysticercosis.
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Affiliation(s)
- Pratibha Singhi
- Pediatric Neurology and Neurodevelopment Unit, Medanta, The Medicity, Gurgaon, Haryana, India.
| | - Arushi Gahlot Saini
- Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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14
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Singh G, Sander JW. Neurocysticercosis as a probable risk factor for hippocampal sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:783-790. [DOI: 10.1590/0004-282x20180130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/09/2018] [Indexed: 11/22/2022]
Abstract
ABSTRACT Neurocysticercosis is one of the most common risk factors for epilepsy but its association with drug-resistant epilepsy remains uncertain. Conjectures of an association with drug-resistant epilepsy have been fueled by reports of an association between calcific neurocysticercosis lesions (CNL) and hippocampal sclerosis (HS) from specialized epilepsy centers in Taenia solium-endemic regions. The debate arising from these reports is whether the association is causal. Evidence for the association is not high quality but sufficiently persuasive to merit further investigation with longitudinal imaging studies in population-based samples from geographically-diverse regions. The other controversial point is the choice of a surgical approach for drug-resistant epilepsy associated with CNL-HS. Three approaches have been described: standard anteromesial temporal lobectomy, lesionectomy involving a CNL alone and lesionectomy with anteromesial temporal lobectomy (for dual pathology); reports of the latter two approaches are limited. Presurgical evaluation should consider possibilities of delineating the epileptogenic zone/s in accordance with all three approaches.
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Affiliation(s)
- Gagandeep Singh
- Dayanand Medical College, India; NIHR University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Josemir W. Sander
- NIHR University College London Hospitals Biomedical Research Centre, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Netherlands
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15
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Vaughan KA, Lopez Ramos C, Buch VP, Mekary RA, Amundson JR, Shah M, Rattani A, Dewan MC, Park KB. An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy. J Neurosurg 2018:1-15. [PMID: 30215556 DOI: 10.3171/2018.3.jns171722] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 03/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEpilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation.METHODSThe authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence.RESULTSThis systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources.CONCLUSIONSUnderstanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.
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Affiliation(s)
- Kerry A Vaughan
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christian Lopez Ramos
- 2University of California San Diego School of Medicine, La Jolla, California.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Vivek P Buch
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rania A Mekary
- 3Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston.,4Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School
| | - Julia R Amundson
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,6Miller School of Medicine, University of Miami, Florida
| | - Meghal Shah
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,7Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abbas Rattani
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,8Meharry Medical College, School of Medicine, Nashville; and
| | - Michael C Dewan
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,9Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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16
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Robertson FC, Lepard JR, Mekary RA, Davis MC, Yunusa I, Gormley WB, Baticulon RE, Mahmud MR, Misra BK, Rattani A, Dewan MC, Park KB. Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide. J Neurosurg 2018:1-20. [PMID: 29905514 DOI: 10.3171/2017.10.jns17359] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVECentral nervous system (CNS) infections cause significant morbidity and mortality and often require neurosurgical intervention for proper diagnosis and treatment. However, neither the international burden of CNS infection, nor the current capacity of the neurosurgical workforce to treat these diseases is well characterized. The objective of this study was to elucidate the global incidence of surgically relevant CNS infection, highlighting geographic areas for targeted improvement in neurosurgical capacity.METHODSA systematic literature review and meta-analysis were performed to capture studies published between 1990 and 2016. PubMed, EMBASE, and Cochrane databases were searched using variations of terms relating to CNS infection and epidemiology (incidence, prevalence, burden, case fatality, etc.). To deliver a geographic breakdown of disease, results were pooled using the random-effects model and stratified by WHO region and national income status for the different CNS infection types.RESULTSThe search yielded 10,906 studies, 154 of which were used in the final qualitative analysis. A meta-analysis was performed to compute disease incidence by using data extracted from 71 of the 154 studies. The remaining 83 studies were excluded from the quantitative analysis because they did not report incidence. A total of 508,078 cases of CNS infections across all studies were included, with a total sample size of 130,681,681 individuals. Mean patient age was 35.8 years (range: newborn to 95 years), and the male/female ratio was 1:1.74. Among the 71 studies with incidence data, 39 were based in high-income countries, 25 in middle-income countries, and 7 in low-income countries. The pooled incidence of studied CNS infections was consistently highest in low-income countries, followed by middle- and then high-income countries. Regarding WHO regions, Africa had the highest pooled incidence of bacterial meningitis (65 cases/100,000 people), neurocysticercosis (650/100,000), and tuberculous spondylodiscitis (55/100,000), whereas Southeast Asia had the highest pooled incidence of intracranial abscess (49/100,000), and Europe had the highest pooled incidence of nontuberculous vertebral spondylodiscitis (5/100,000). Overall, few articles reported data on deaths associated with infection. The limited case fatality data revealed the highest case fatality for tuberculous meningitis/spondylodiscitis (21.1%) and the lowest for neurocysticercosis (5.5%). In all five disease categories, funnel plots assessing for publication bias were asymmetrical and suggested that the results may underestimate the incidence of disease.CONCLUSIONSThis systematic review and meta-analysis approximates the global incidence of neurosurgically relevant infectious diseases. These results underscore the disproportionate burden of CNS infections in the developing world, where there is a tremendous demand to provide training and resources for high-quality neurosurgical care.
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Affiliation(s)
- Faith C Robertson
- 1Harvard Medical School.,2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Boston, Massachusetts
| | - Jacob R Lepard
- 3Department of Neurosurgery, University of Alabama, Birmingham, Alabama
| | - Rania A Mekary
- 2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Boston, Massachusetts.,4MCPHS University, Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, Boston
| | - Matthew C Davis
- 3Department of Neurosurgery, University of Alabama, Birmingham, Alabama
| | - Ismaeel Yunusa
- 2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Boston, Massachusetts.,4MCPHS University, Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, Boston
| | - William B Gormley
- 1Harvard Medical School.,2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Boston, Massachusetts.,5Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ronnie E Baticulon
- 6University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Muhammad Raji Mahmud
- 7Department of Surgery, National Hospital Abuja, PMB 425, Federal Capital Territory, Nigeria
| | - Basant K Misra
- 8Department of Neurosurgery & Gamma Knife Radiosurgery, P. D. Hinduja National Hospital, Mahim, Mumbai, India
| | - Abbas Rattani
- 9Meharry Medical College, School of Medicine, Nashville, Tennessee.,10Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; and
| | - Michael C Dewan
- 10Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; and.,11Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 10Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; and
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17
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Thurman DJ, Begley CE, Carpio A, Helmers S, Hesdorffer DC, Mu J, Touré K, Parko KL, Newton CR. The primary prevention of epilepsy: A report of the Prevention Task Force of the International League Against Epilepsy. Epilepsia 2018; 59:905-914. [PMID: 29637551 PMCID: PMC7004820 DOI: 10.1111/epi.14068] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 02/05/2023]
Abstract
Among the causes of epilepsy are several that are currently preventable. In this review, we summarize the public health burden of epilepsy arising from such causes and suggest priorities for primary epilepsy prevention. We conducted a systematic review of published epidemiologic studies of epilepsy of 4 preventable etiologic categories-perinatal insults, traumatic brain injury (TBI), central nervous system (CNS) infection, and stroke. Applying consistent criteria, we assessed the quality of each study and extracted data on measures of risk from those with adequate quality ratings, summarizing findings across studies as medians and interquartile ranges. Among higher-quality population-based studies, the median prevalence of active epilepsy across all ages was 11.1 per 1000 population in lower- and middle-income countries (LMIC) and 7.0 per 1000 in high-income countries (HIC). Perinatal brain insults were the largest attributable fraction of preventable etiologies in children, with median estimated fractions of 17% in LMIC and 15% in HIC. Stroke was the most common preventable etiology among older adults with epilepsy, both in LMIC and in HIC, accounting for half or more of all new onset cases. TBI was the attributed cause in nearly 5% of epilepsy cases in HIC and LMIC. CNS infections were a more common attributed cause in LMIC, accounting for about 5% of all epilepsy cases. Among some rural LMIC communities, the median proportion of epilepsy cases attributable to endemic neurocysticercosis was 34%. A large proportion of the overall public health burden of epilepsy is attributable to preventable causes. The attributable fraction for perinatal causes, infections, TBI, and stroke in sum reaches nearly 25% in both LMIC and HIC. Public health interventions addressing maternal and child health care, immunizations, public sanitation, brain injury prevention, and stroke prevention have the potential to significantly reduce the burden of epilepsy.
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Affiliation(s)
- David J. Thurman
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Charles E. Begley
- Health Science Center at Houston School of Public Health, University of Texas, Houston, TX, USA
| | - Arturo Carpio
- Faculty of Medical Sciences, University of Cuenca, Cuenca, Ecuador
| | - Sandra Helmers
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Dale C. Hesdorffer
- Gertrude H. Sergievsky Center and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Jie Mu
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Kamadore Touré
- Department of Neurology, Fann University Hospital, Dakar, Senegal
| | - Karen L. Parko
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Charles R. Newton
- Kenya Medical Research Institute–Wellcome Trust Collaborative Program, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
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18
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Del Brutto OH, O'Neal SE, Dorny P, García HH. Spontaneously Arrested Transmission of Cysticercosis in a Highly Endemic Village with a Very Low Migration Rate. Am J Trop Med Hyg 2017; 98:776-778. [PMID: 29260655 DOI: 10.4269/ajtmh.17-0723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Taenia solium cysticercosis is difficult to eliminate without interventions or societal development. Atahualpa is a rural Ecuadorian village with documented low migration rate, where domestic pig raising is common and human cysticercosis is endemic. To assess neurocysticercosis (NCC) prevalence, 1,273 villagers aged ≥ 20 years underwent neuroimaging studies, which showed calcified lesions in 121 (9.5%) individuals, but no active disease. Likewise, positive reactions, apparently nonspecific, were found in only 3/200 subjects by the use of a monoclonal antibody-based enzyme-linked immunosorbent assay to detect T. solium antigens in urine. Only 2/418 pigs reacted to three antibody bands on serum western blot and none to more than three bands. This is the first time that spontaneously arrested T. solium transmission is documented in a known endemic village. Understanding why active transmission stopped could provide insights on potential targets for control interventions. Atahualpa could provide an optimal scenario for longitudinal studies on the consequences of calcified NCC.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo, Ecuador, Guayaquil, Ecuador
| | - Seth E O'Neal
- Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú.,Portland State University, Portland, Oregon.,School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Pierre Dorny
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Héctor H García
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú.,Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú.,Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Perú
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19
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Duque KR, Burneo JG. Clinical presentation of neurocysticercosis-related epilepsy. Epilepsy Behav 2017; 76:151-157. [PMID: 28882721 DOI: 10.1016/j.yebeh.2017.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 11/15/2022]
Abstract
Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and a major risk factor for seizures and epilepsy. Seizure types in NCC vary largely across studies and seizure semiology is poorly understood. We discuss here the studies regarding seizure types and seizure semiology in NCC, and examine the clinical presentation in patients with NCC and drug-resistant epilepsy. We also provide evidence of the role of MRI and EEG in the diagnosis of NCC-related epilepsy. Focal seizures are reported in 60-90% of patients with NCC-related epilepsy, and around 90% of all seizures registered prospectively are focal not evolving to bilateral tonic-clonic seizures. A great number of cases suggest that seizure semiology is topographically related to NCC lesions. Patients with hippocampal sclerosis and NCC have different clinical and neurophysiological characteristics than those with hippocampal sclerosis alone. Different MRI protocols have allowed to better differentiate NCC from other etiologies. Lesions' stages might account on the chances of finding an interictal epileptiform discharge. Studies pursuing the seizure onset in patients with NCC are lacking and they are specially needed to determine both whether the reported events of individual cases are seizures, and whether they are related to the NCC lesion or lesions. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy".
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Affiliation(s)
- Kevin R Duque
- Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru; Hypnos Center for Sleep Medicine, Clínica San Felipe, Lima, Peru.
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine, Western University, London, Canada.
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Braae UC, Devleesschauwer B, Sithole F, Wang Z, Willingham AL. Mapping occurrence of Taenia solium taeniosis/cysticercosis and areas at risk of porcine cysticercosis in Central America and the Caribbean basin. Parasit Vectors 2017; 10:424. [PMID: 28923090 PMCID: PMC5604492 DOI: 10.1186/s13071-017-2362-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to map the occurrence of Taenia solium taeniosis/cysticercosis at national level within Central America and the Caribbean basin, and to map the distribution of porcine cysticercosis at first-level administrative subdivision level (department level) and the porcine population at risk. This zoonotic parasite is believed to be widely endemic across most of Latin America. However, there is little information readily available for Central America and the Caribbean basin. Taenia solium has been ranked the most important foodborne parasitic hazard globally and within endemic areas is a common cause of preventable epilepsy. Methods We conducted a structured literature search in PubMed, supplemented and crossed-referenced with relevant academic databases, grey literature, and active searches in identified literature, to identify all records of T. solium presence in Central America and the Caribbean basin between 1986 and April 2017. To retrieve grey literature, government entities, researchers and relevant institutions across the region were contacted in an attempt to cover all countries and territories. Identified records containing data on porcine cysticercosis were geo-referenced to identify department level distribution and compared to modelled distributions of pigs reared under extensive production systems. Results We identified 51 records of T. solium at the national level, covering 13 countries and an additional three countries were included based on World Organisation for Animal Health (OIE) reports, giving a total of 16 countries out of 41 with evidence of the parasite’s presence. Screening records for porcine cysticercosis data at the departmental level confirmed porcine cysticercosis presence in 11 departments across six countries (Colombia, Guatemala, Honduras, Mexico, Nicaragua and Venezuela). Conclusions When comparing these results to areas where pigs were kept in extensive production systems and areas where no information on porcine cysticercosis exists, it is apparent that porcine cysticercosis is likely to be underreported, and that a substantial part of the regional pig population could be at risk of contracting porcine cysticercosis. More detailed information on the distribution of T. solium and accurate burden estimations are urgently needed to grasp the true extent of this zoonotic parasite and the public health and agricultural problems it potentially poses. Electronic supplementary material The online version of this article (10.1186/s13071-017-2362-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Uffe Christian Braae
- One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, West Indies, Saint Kitts and Nevis.
| | - Brecht Devleesschauwer
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Fortune Sithole
- One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, West Indies, Saint Kitts and Nevis
| | - Ziqi Wang
- Emerging Pathogens Institute and Department of Animal Health, University of Florida, Gainesville, FL, USA.,Center for Translational Research in Neurodegenerative Disease, Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - Arve Lee Willingham
- One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, West Indies, Saint Kitts and Nevis
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Okello AL, Thomas LF. Human taeniasis: current insights into prevention and management strategies in endemic countries. Risk Manag Healthc Policy 2017; 10:107-116. [PMID: 28615981 PMCID: PMC5461055 DOI: 10.2147/rmhp.s116545] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Human taeniasis is a zoonotic condition resulting from infection with the adult stages of Taenia saginata ("beef tapeworm"), Taenia solium ("pork tapeworm") or Taenia asiatica ("Asian tapeworm"). Although these parasites have a worldwide distribution, the overwhelming burden is felt by communities in low- and middle-income countries. This is particularly true for T. solium, whereby infection of the central nervous system with the larval stage of the parasite (neurocysticercosis) is a major cause of acquired epilepsy in low-resource settings. With a focus on endemic countries, this review provides an insight into the prevention and management of human taeniasis, concluding with some recent case studies describing their implementation. Discussion of the opportunities and challenges regarding current fecal and serological diagnostic assays for detecting Taenia spp. highlights the importance of accurate and accessible diagnostic options for the field situation. The lack of long-term impact on the parasites' lifecycle from human anthelmintic treatment, coupled with the propensity for adverse reactions, highlights the importance of a "two-pronged" approach that considers the relevant animal hosts, particularly in the case of T. solium. Aside from the therapeutic options, this review reiterates the importance of adequate assessment and consideration of the associated behavioral and policy aspects around sanitation, hygiene and meat inspection that have been shown to support parasite control, and potential elimination, in endemic regions.
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Affiliation(s)
- Anna L Okello
- Division of Infection and Pathway Medicine, Edinburgh Medical School, Biomedical Sciences College of Medicine and Veterinary Medicine, University of Edinburgh, Scotland
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Garcia HH, Gonzalez AE, Tsang VCW, O'Neal SE, Llanos-Zavalaga F, Gonzalvez G, Romero J, Rodriguez S, Moyano LM, Ayvar V, Diaz A, Hightower A, Craig PS, Lightowlers MW, Gauci CG, Leontsini E, Gilman RH. Elimination of Taenia solium Transmission in Northern Peru. N Engl J Med 2016; 374:2335-44. [PMID: 27305193 PMCID: PMC4962610 DOI: 10.1056/nejmoa1515520] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Taeniasis and cysticercosis are major causes of seizures and epilepsy. Infection by the causative parasite Taenia solium requires transmission between humans and pigs. The disease is considered to be eradicable, but data on attempts at regional elimination are lacking. We conducted a three-phase control program in Tumbes, Peru, to determine whether regional elimination would be feasible. METHODS We systematically tested and compared elimination strategies to show the feasibility of interrupting the transmission of T. solium infection in a region of highly endemic disease in Peru. In phase 1, we assessed the effectiveness and feasibility of six intervention strategies that involved screening of humans and pigs, antiparasitic treatment, prevention education, and pig replacement in 42 villages. In phase 2, we compared mass treatment with mass screening (each either with or without vaccination of pigs) in 17 villages. In phase 3, we implemented the final strategy of mass treatment of humans along with the mass treatment and vaccination of pigs in the entire rural region of Tumbes (107 villages comprising 81,170 people and 55,638 pigs). The effect of the intervention was measured after phases 2 and 3 with the use of detailed necropsy to detect pigs with live, nondegenerated cysts capable of causing new infection. The necropsy sampling was weighted in that we preferentially included more samples from seropositive pigs than from seronegative pigs. RESULTS Only two of the strategies implemented in phase 1 resulted in limited control over the transmission of T. solium infection, which highlighted the need to intensify the subsequent strategies. After the strategies in phase 2 were implemented, no cyst that was capable of further transmission of T. solium infection was found among 658 sampled pigs. One year later, without further intervention, 7 of 310 sampled pigs had live, nondegenerated cysts, but no infected pig was found in 11 of 17 villages, including all the villages in which mass antiparasitic treatment plus vaccination was implemented. After the final strategy was implemented in phase 3, a total of 3 of 342 pigs had live, nondegenerated cysts, but no infected pig was found in 105 of 107 villages. CONCLUSIONS We showed that the transmission of T. solium infection was interrupted on a regional scale in a highly endemic region in Peru. (Funded by the Bill and Melinda Gates Foundation and others.).
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Affiliation(s)
- Hector H Garcia
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Armando E Gonzalez
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Victor C W Tsang
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Seth E O'Neal
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Fernando Llanos-Zavalaga
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Guillermo Gonzalvez
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Jaime Romero
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Silvia Rodriguez
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Luz M Moyano
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Viterbo Ayvar
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Andre Diaz
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Allen Hightower
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Philip S Craig
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Marshall W Lightowlers
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Charles G Gauci
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Elli Leontsini
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
| | - Robert H Gilman
- From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.)
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Petersen I, Evans-Lacko S, Semrau M, Barry MM, Chisholm D, Gronholm P, Egbe CO, Thornicroft G. Promotion, prevention and protection: interventions at the population- and community-levels for mental, neurological and substance use disorders in low- and middle-income countries. Int J Ment Health Syst 2016; 10:30. [PMID: 27069506 PMCID: PMC4827227 DOI: 10.1186/s13033-016-0060-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 03/23/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In addition to services within the health system, interventions at the population and community levels are also important for the promotion of mental health, primary prevention of mental, neurological and substance use (MNS) disorders, identification and case detection of MNS disorders; and to a lesser degree treatment, care and rehabilitation. This study aims to identify "best practice" and "good practice" interventions that can feasibly be delivered at these population- and community-levels in low- and middle-income countries (LMICs), to aid the identification of resource efficiencies and allocation in LMICs. METHODS A narrative review was conducted given the wide range of relevant interventions. Expert consensus was used to identify "best practice" at the population-level on the basis of existing quasi-experimental natural experiments and cost effectiveness, with small scale emerging and promising evidence comprising "good practice". At the community-level, using expert consensus, the ACE (Assessing Cost-Effectiveness in Prevention Project) grading system was used to differentiate "best practice" interventions with sufficient evidence from "good practice" interventions with limited but promising evidence. RESULTS At the population-level, laws and regulations to control alcohol demand and restrict access to lethal means of suicide were considered "best practice". Child protection laws, improved control of neurocysticercosis and mass awareness campaigns were identified as "good practice". At the community level, socio-emotional learning programmes in schools and parenting programmes during infancy were identified as "best practice". The following were all identified as "good practice": Integrating mental health promotion strategies into workplace occupational health and safety policies; mental health information and awareness programmes as well as detection of MNS disorders in schools; early child enrichment/preschool educational programs and parenting programs for children aged 2-14 years; gender equity and/or economic empowerment programs for vulnerable groups; training of gatekeepers to identify people with MNS disorders in the community; and training non-specialist community members at a neighbourhood level to assist with community-based support and rehabilitation of people with mental disorders. CONCLUSION Interventions provided at the population- and community-levels have an important role to play in promoting mental health, preventing the onset, and protecting those with MNS disorders. The importance of inter-sectoral engagement and the need for further research on interventions at these levels in LMICs is highlighted.
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Affiliation(s)
- Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health and School of Applied Human Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Sara Evans-Lacko
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maya Semrau
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Margaret M Barry
- World Health Organization Collaborating Centre for Health Promotion Research, National University of Ireland Galway, Galway, Ireland
| | - Dan Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Petra Gronholm
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Catherine O Egbe
- School of Applied Human Sciences, University of KwaZulu Natal, Durban, South Africa ; Center for Tobacco Control Research and Education, University of California, San Francisco, USA
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Singhi P, Saini AG. Pediatric neurocysticercosis: current challenges and future prospects. Pediatric Health Med Ther 2016; 7:5-16. [PMID: 29388588 PMCID: PMC5683283 DOI: 10.2147/phmt.s79058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Neurocysticercosis (NCC) is an acquired infection of the nervous system caused by encysted larvae of Taenia solium. It is a major cause of epilepsy in the tropics and the commonest cause of focal seizures in North Indian children. T. solium teniasis-cysticercosis is considered a parasitic "Neglected Tropical Diseases" endemic throughout Southeast Asia. NCC in children has pleomorphic manifestations depending on the location, number and viability of the cysts, and host response. Even with advancing knowledge of the disease manifestations, many aspects related to diagnosis and treatment, particularly in children, still remain controversial and pose challenges to clinical practice. There is no gold standard test to diagnose NCC and the management recommendations are still emerging. This review provides an overview of diagnosis of NCC in children and its management with special focus on current challenges and future prospects.
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Affiliation(s)
- Pratibha Singhi
- Department of Pediatrics, Pediatric Neurology and Neurodevelopment Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Gahlot Saini
- Department of Pediatrics, Pediatric Neurology and Neurodevelopment Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Fogang YF, Savadogo AA, Camara M, Toffa DH, Basse A, Sow AD, Ndiaye MM. Managing neurocysticercosis: challenges and solutions. Int J Gen Med 2015; 8:333-44. [PMID: 26527895 PMCID: PMC4621219 DOI: 10.2147/ijgm.s73249] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Taenia solium neurocysticercosis (NCC) is a major cause of neurological morbidity in the world. Variability in the neuropathology and clinical presentation of NCC often make it difficult to diagnose and manage. Diagnosis of NCC can be challenging especially in endemic and resource-limited countries where laboratory and imaging techniques are often lacking. NCC management can also be challenging as current treatment options are limited and involve symptomatic agents, antiparasitic agents, or surgery. Although antiparasitic treatment probably reduces the number of active lesions and long-term seizure frequency, its efficacy is limited and strategies to improve treatment regimens are warranted. Treatment decisions should be individualized in relation to the type of NCC. Initial measures should focus on symptomatic management, with antiparasitic therapy only to be considered later on, when appropriate. Symptomatic treatment remains the cornerstone in NCC management which should not only focuses on epilepsy, but also on other manifestations that cause considerable burden (recurrent headaches, cognitive decline). Accurate patients’ categorization, better antiparasitic regimens, and definition of new clinical outcomes for trials on NCC could improve management quality and prognosis of NCC. Prevention strategies targeting tapeworm carriers and infected pigs are yielding good results in local models. If local elimination of transmission is confirmed and replicated, this will open the door to cysticercosis eradication efforts worldwide.
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Affiliation(s)
- Yannick Fogoum Fogang
- Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Abdoul Aziz Savadogo
- Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Massaman Camara
- Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | | | - Anna Basse
- Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar, Senegal
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Abstract
Neurocysticercosis is the commonest parasitic disease of the nervous system in humans, and constitutes a major public health problem for most of the developing world. The clinical manifestations of Neurocysticercosis (NCC) largely depend on number of lesions, site, and host immune response against the parasite. Diagnosis is mainly based upon neuro imaging studies and is supported by antibody/antigen detection in the serum and occasionally the cerebrospinal fluid. Randomized controlled trials evaluating the clinical benefit of treatment with cysticidal agents have shown hastened resolution of lesions in most, and reduced seizure recurrence in some studies. Outcome is favourable in single lesion parenchymal NCC but is guarded in multiple lesion and extra parenchymal NCC.
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Affiliation(s)
- Pratibha Singhi
- Department of Pediatric Neurology and Neurodevelopment, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India,
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Abstract
The infection of the nervous system by the cystic larvae of Taenia solium (neurocysticercosis) is a frequent cause of seizure disorders. Neurocysticercosis is endemic or presumed to be endemic in many low-income countries. The lifecycle of the worm and the clinical manifestations of neurocysticercosis are well established, and CT and MRI have substantially improved knowledge of the disease course. Improvements in immunodiagnosis have further advanced comprehension of the pathophysiology of this disease. This knowledge has led to individualised treatment approaches that account for the involvement of parenchymal or extraparenchymal spaces, the number and form of parasites, and the extent of degeneration and associated inflammation. Clinical investigations are focused on development of effective treatments and reduction of side-effects induced by treatment, such as seizures, hydrocephalus, infarcts, and neuroinjury.
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Affiliation(s)
- Hector H Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Centre for Global Health-Tumbes and Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Theodore E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador
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Carabin H, Traoré AA. Taenia solium taeniasis and cysticercosis control and elimination through community-based interventions. CURRENT TROPICAL MEDICINE REPORTS 2014; 1:181-193. [PMID: 25544938 DOI: 10.1007/s40475-014-0029-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Taenia solium was declared potentially eradicable by the International Task Force for Disease Eradication in 1992. Yet, very few well-designed community-based randomized controlled trials have been conducted to measure the effectiveness of alternative control strategies. Most strategies have been tested in pre-post intervention designs in very few communities, often without a control group. The only two community-based randomized controlled trials suggest that an educational program alone or a combination of human and porcine mass treatment reduce porcine cysticercosis in the short term. A transmission dynamics model suggests that improved sanitation and pig management are more effective and sustainable than pig vaccination, human or porcine mass treatment. Current evidence does not support the eradication of Taenia solium in the foreseeable future. Investigators should follow international recommendations on the conduct of community-based randomized control trials to provide more valid estimates of the effect and cost-effectiveness of alternative control strategies for cysticercosis.
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Affiliation(s)
- Hélène Carabin
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104
| | - Aminata A Traoré
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104. Tel: 405 271-2229.
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Hotez PJ, Woc-Colburn L, Bottazzi ME. Neglected tropical diseases in Central America and Panama: review of their prevalence, populations at risk and impact on regional development. Int J Parasitol 2014; 44:597-603. [PMID: 24846528 DOI: 10.1016/j.ijpara.2014.04.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 04/04/2014] [Accepted: 04/07/2014] [Indexed: 11/30/2022]
Abstract
A review of the literature since 2009 reveals a staggering health and economic burden resulting from neglected tropical diseases in Panama and the six countries of Central America (referred to collectively here as 'Central America'). Particularly at risk are the 10.2million people in the region who live on less than $2 per day, mostly in Guatemala, Honduras, Nicaragua and El Salvador. Indigenous populations are especially vulnerable to neglected tropical diseases. Currently, more than 8million Central American children require mass drug treatments annually (or more frequently) for their intestinal helminth infections, while vector-borne diseases are widespread. Among the vector-borne parasitic infections, almost 40% of the population is at risk for malaria (mostly Plasmodium vivax infection), more than 800,000 people live with Chagas disease, and up to 39,000 people have cutaneous leishmaniasis. In contrast, an important recent success story is the elimination of onchocerciasis from Central America. Dengue is the leading arbovirus infection with 4-5million people affected annually and hantavirus is an important rodent-borne viral neglected tropical disease. The leading bacterial neglected tropical diseases include leptospirosis and trachoma, for which there are no disease burden estimates. Overall there is an extreme dearth of epidemiological data on neglected tropical diseases based on active surveillance as well as estimates of their economic impact. Limited information to date, however, suggests that neglected tropical diseases are a major hindrance to the region's economic development, in both the most impoverished Central American countries listed above, as well as for Panama and Costa Rica where a substantial (but largely hidden) minority of people live in extreme poverty.
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Affiliation(s)
- Peter J Hotez
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States; Department of Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States; Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX, United States; James A. Baker III Institute for Public Policy, Rice University, Houston, TX, United States.
| | - Laila Woc-Colburn
- Department of Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Maria Elena Bottazzi
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States; Department of Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States; Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX, United States
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Abstract
PURPOSE OF REVIEW This review comments on the recent advances in the understanding of the controversial aspects of neurocysticercosis (NCC). RECENT FINDINGS The number of autochthonous cases of NCC in nonendemic countries has increased during the last few years: it is likely that the migration of Taenia carriers from endemic areas is responsible for the increased prevalence of locally acquired NCC in these regions. NCC is mostly acquired from person to person, and the old theories crediting the environment as the main source of human infection with Taenia solium eggs must be abandoned. There is growing evidence suggesting that cysticercus granulomas (one of the most common forms of presentation of NCC) represent fresh infections and not old infections resulting from spontaneous destruction of viable cysticerci. Calcifications, often seen as inactive lesions producing no symptoms, are responsible for a sizable proportion of NCC-related seizures or headache. It is likely that exposure of parasitic antigens to the host's immune system is the cause of these manifestations. SUMMARY During the last few years, there has been an increased knowledge on the controversial aspects of NCC, including epidemiology, mechanisms of disease acquisition, the natural involution of lesions in the brain parenchyma, and the role of calcifications as responsible for symptom occurrence.
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Del Brutto OH, Lama J. The importance of neurocysticercosis in stroke in rural areas of a developing Latin American country. Am J Trop Med Hyg 2013; 89:374-5. [PMID: 23836572 DOI: 10.4269/ajtmh.13-0196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
There is limited information on the prevalence of neurocysticercosis (NCC) among stroke patients, and no community-based survey has addressed this issue. We performed a 3-Phase, population-based study, to assess the prevalence and pathogenesis of stroke in a rural village of coastal Ecuador, where cysticercosis is highly endemic. Twenty stroke patients were found among 642 individuals ≥ 40 years of age. Eighteen of these patients underwent neuroimaging studies and no patient had evidence of NCC or angiitis of intracranial vessels. The serum immunoblot test for the detection of anticysticercal antibodies, performed in 15 of these 20 patients during a previous survey, were negative in 13 cases and the remaining two had a normal computed tomography of the head. This study suggests that NCC is not responsible for the increasing burden of stroke in rural areas of developing countries.
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Singh G, Burneo JG, Sander JW. From seizures to epilepsy and its substrates: neurocysticercosis. Epilepsia 2013; 54:783-92. [PMID: 23621876 DOI: 10.1111/epi.12159] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2013] [Indexed: 11/29/2022]
Abstract
Neurocysticercosis (NCC) is the main risk factor for late-onset seizures in many Taenia solium endemic countries and is also increasingly recognized in high income countries, where it was once thought to have been eliminated. The course and outcome of NCC-associated seizures and epilepsy are poorly understood. Substrates underlying NCC-associated seizures and epilepsy are unknown. Another unknown is if there is an association between NCC and hippocampal sclerosis (HS) and if it leads to intractable epilepsy. We review evidence regarding the structural basis of seizures and epilepsy in NCC and its association with HS. There are only a limited number of prospective studies of NCC-associated seizures and epilepsy. From these, it can be inferred that the risk of seizure recurrence is high following a first seizure, even though seizures are well-controlled with antiepileptic drugs. The single most important risk factor for ongoing or recurrent seizures is the persistence of either degenerating or residual calcified cysticercus cysts in the brain parenchyma on follow-up imaging studies. Medically intractable epilepsy requiring surgical treatment appears to be rare in people with NCC. In few cases that have been operated, gliosis around the cysticerci is the principal pathologic finding. Reports of the association between NCC and HS might be categorized into those in which the calcified cysticercus is located within the hippocampus and those in which the calcified cysticercus is located remote from the hippocampus. The former are convincing cases of medically intractable epilepsy with good seizure control following hippocampal resection. In the remaining, it is unclear whether a dual pathology relationship exists between HS and the calcified cysticercus. Carefully planned, follow-up studies incorporating high-resolution and quantitative imaging are desirable in order to clarify the outcome, the structural basis of NCC-associated epilepsy, and also its association with HS.
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, Punjab, India.
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Alarcón TA, Del Brutto OH. Neurocysticercosis: declining incidence among patients admitted to a large public hospital in Guayaquil, Ecuador. Pathog Glob Health 2013; 106:310-1. [PMID: 23265556 DOI: 10.1179/2047773212y.0000000044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
It has been stated that new cases of neurocysticercosis (NCC) are declining in some endemic regions over the past years. To confirm this assertion, we evaluated all NCC patients (n = 362) admitted to the Neurological Service of our Hospital from 1982 to 2011, and we noted a significant reduction in the incidence of NCC, when compared with the total number of patients admitted to the Service over the study years (6.4% of 2,723 patients from 1982 to 1991, 2.7% of 3,056 patients from 1992 to 2001, and 3.5% of 2,996 patients from 2002 to 2012; p < 0.0001). It is likely that improved sanitation, together with increased availability of neuroimaging machines which allow prompt recognition and management of NCC cases avoiding disease progression, were the main responsibles for our findings.
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Affiliation(s)
- Tomas A Alarcón
- Neurological Service, Hospital Regional Teodoro Maldonado Carbo, Instituto Ecuatoriano de Seguridad Social, Ecuador
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Ngwing NAN, Poné JW, Mbida M, Pagnah AZ, Njakoi H, Bilong CFB. A preliminary analysis of some epidemiological factors involved in porcine cysticercosis in Bafut and Santa subdivisions, North West Region of Cameroon. ASIAN PAC J TROP MED 2012; 5:814-7. [DOI: 10.1016/s1995-7645(12)60149-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 03/31/2012] [Accepted: 04/05/2012] [Indexed: 10/27/2022] Open
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Abstract
Epilepsy is a common disorder, particularly in poor areas of the world, and can have a devastating effect on people with the disorder and their families. The burden of epilepsy in low-income countries is more than twice that found in high-income countries, probably because the incidence of risk factors is higher. Many of these risk factors can be prevented with inexpensive interventions, but there are only a few studies that have assessed the effect of reducing risk factors on the burden of epilepsy. The mortality associated with epilepsy in low-income countries is substantially higher than in less impoverished countries and most deaths seem to be related to untreated epilepsy (eg, as a result of falls or status epilepticus), but the risk factors for death have not been adequately examined. Epilepsy is associated with substantial stigma in low-income countries, which acts as a barrier to patients accessing biomedical treatment and becoming integrated within society. Seizures can be controlled by inexpensive antiepileptic drugs, but the supply and quality of these drugs can be erratic in poor areas. The treatment gap for epilepsy is high (>60%) in deprived areas, but this could be reduced with low-cost interventions. The substantial burden of epilepsy in poor regions of the world can be reduced by preventing the risk factors, reducing stigma, improving access to biomedical diagnosis and treatment, and ensuring that there is a continuous supply of good quality antiepileptic drugs.
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Del Brutto OH, Del Brutto VJ. Reduced percentage of neurocysticercosis cases among patients with late-onset epilepsy in the new millennium. Clin Neurol Neurosurg 2012; 114:1254-6. [PMID: 22502783 DOI: 10.1016/j.clineuro.2012.03.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 02/22/2012] [Accepted: 03/17/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine if the number of neurocysticercosis cases among patients with late-onset epilepsy has decreased over the past two decades. DESIGN Retrospective cohort study of 431 consecutive patients with recurrent seizures starting after the age of 20 years evaluated at our Institution from 1990 to 2009. METHODS Patients were classified according to the year in which they were first seen. Group I included 129 patients evaluated between 1990 and 1994, Group II included 108 patients evaluated between 1995 and 1999, Group III included 106 patients evaluated between 2000 and 2004, and Group IV included 88 patients evaluated between 2005 and 2009. We correlated the percentage of persons with cryptogenic and symptomatic epilepsy between the groups to determine if there was any change in the causes of late-onset epilepsy. RESULTS One hundred seventy-one patients had cryptogenic and 260 had symptomatic epilepsy. Common causes of symptomatic epilepsy were neurocysticercosis in 120 cases, cerebrovascular disease in 68, and brain tumors in 40. We found a reduction in the number of patients with symptomatic epilepsy (p=0.0007) as well as a reduction in the number of neurocysticercosis cases (p=0.0004) over the study years. There was a reduction in the weight of neurocysticercosis as an etiological factor for symptomatic late-onset epilepsy related to a drop in the number of patients with this condition evaluated between 2005 and 2009 (p=0.0045). CONCLUSION The number of neurocysticercosis cases among patients with late-onset epilepsy has changed over the years. This parasitic disease is no longer the most common cause of symptomatic late-onset epilepsy in our population.
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Affiliation(s)
- Oscar H Del Brutto
- Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
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Del Brutto OH, Del Brutto VJ. Changing pattern of neurocysticercosis in an urban endemic center (Guayaquil, Ecuador). J Neurol Sci 2012; 315:64-6. [DOI: 10.1016/j.jns.2011.11.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 10/31/2011] [Accepted: 11/28/2011] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW Taenia solium neurocysticercosis (NCC) has been long recognized as an important cause of neurological morbidity in most of the world. Unwarranted generalization of diagnostic and treatment recommendations made it difficult to assess individual prognosis and responses for each type of NCC. Understanding of the main clinical presentations (dependent on number, location, size, and stage of parasites, as well as on the immune response of the host) allows a better view of treatment options and expected outcomes. RECENT FINDINGS Current treatment options are still limited and involve symptomatic agents, antiparasitic agents, or surgery. The importance of adequate symptomatic management, the potential for improved antiparasitic treatment regimes, in particular combination therapy, and the increasingly important role of minimally invasive neurosurgery are also reviewed in this article. SUMMARY Treatment decisions in NCC should be individualized in relation to the type of NCC. Initial measures should focus on the symptomatic management before considering antiparasitic therapy when appropriate. Appropriate patient categorization, new antiparasitic regimes, and minimally invasive surgery are improving the prognosis of patients with NCC.
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Clinical Manifestations, Diagnosis, and Treatment of Neurocysticercosis. Curr Neurol Neurosci Rep 2011; 11:529-35. [DOI: 10.1007/s11910-011-0226-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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