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Colebunders R, Hadermann A, Njamnshi AK, Mmbando BP, Kamoen O, Siewe Fodjo JN. Onchocerciasis-associated epilepsy and biomarkers. PLoS Negl Trop Dis 2024; 18:e0011808. [PMID: 38722830 PMCID: PMC11081238 DOI: 10.1371/journal.pntd.0011808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 05/13/2024] Open
Affiliation(s)
| | - Amber Hadermann
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Alfred K. Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
- Neuroscience Lab, Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Bruno P. Mmbando
- National Institute for medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Olivia Kamoen
- Department of Neurology, Heilig Hart Ziekenhuis, Lier, Belgium
| | - Joseph Nelson Siewe Fodjo
- Global Health Institute, University of Antwerp, Antwerp, Belgium
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
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Van Cutsem G, Siewe Fodjo JN, Hadermann A, Amaral LJ, Trevisan C, Pion S, Colebunders R. Onchocerciasis-associated epilepsy: Charting a path forward. Seizure 2024:S1059-1311(24)00123-7. [PMID: 38677953 DOI: 10.1016/j.seizure.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
This narrative review intends to inform neurologists and public health professionals about Onchocerciasis-Associated Epilepsy (OAE), a neglected public health problem in many remote onchocerciasis-endemic areas. For epidemiological purposes, we define OAE as sudden-onset of convulsive and non-convulsive seizure types, including head nodding seizures (nodding syndrome) in a previously healthy child aged 3 to 18 years in the absence of any other obvious cause for epilepsy, all happening within an area with high ongoing Onchocerca volvulus transmission. Several OAE pathophysiological mechanisms have been proposed, but none has been proven yet. Recent population-based studies showed that strengthening onchocerciasis elimination programs was followed by a significant reduction in the incidence of OAE and nodding syndrome. Treating epilepsy in onchocerciasis-endemic regions is challenging. More advocacy is needed to provide uninterrupted, free access to anti-seizure medication to persons with epilepsy in these remote, impoverished areas. It is crucial todevelop policies and increase funding for the prevention and treatment of OAE to reduce the associated burden of disease, notably via the establishment of morbidity management and disability prevention programs (MMDP). Moreover, effective collaboration between onchocerciasis elimination and mental health programs is imperative to alleviate the burden of OAE. This synergy promises reciprocal advantages and underscores the need for a comprehensive approach to address this multifaceted challenge.
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Affiliation(s)
- G Van Cutsem
- Department of Neurology, Centre Hospitalier de Luxembourg, Luxembourg; Faculty of Science, Technology and Medicine, University of Luxembourg, Luxembourg; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - J N Siewe Fodjo
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - A Hadermann
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - L-J Amaral
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - C Trevisan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - S Pion
- Institute of Research for Sustainable Development, Montpelier, France
| | - R Colebunders
- Global Health Institute, University of Antwerp, Antwerp, Belgium.
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Metanmo S, Dossa D, Ahmat DN, Winkler AS, Boumediene F. Mapping, Associated Factors, and Pathophysiology of Nodding Syndrome in Africa: A Systematic Review. Neuroepidemiology 2024; 58:92-119. [PMID: 38171341 DOI: 10.1159/000536013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Nodding syndrome (NS) remains a poorly understood disorder. For a long time, it has been thought to be restricted to East Africa; however, cases in Central Africa have been increasing over time. The objective of this systematic review (SR) was to provide a summary of the state of knowledge on NS to date. METHODS All original articles published on NS up to November 2021 were searched in four major databases and in the gray literature. Commentaries, editorials, book chapters, books, conference paper, qualitative studies that mentioned NS cases were also included. Data retrieved included study location (with GPS coordinates searched), year of study and publication, population characteristics, definition and diagnosis of NS, associated factors, and treatment if applicable. A meta-analysis of associated factors was performed where possible, and results were presented as odds ratios (ORs) and visualized as forest plots. Geographic information systems were used for cartographic representations. The quality of the articles included was assessed. RESULTS Of the 876 articles initially identified, 67 (corresponding to 59 studies) were included in the SR. NS is only present in Central and East Africa. Interestingly, there were reports of NS in Central Africa prior to 2010, earlier than previously thought. The way NS diagnosis was established varies according to studies, and the 2012 WHO classification was used in only 60% of the studies. Approximately 11% of the articles did not meet the quality requirements set for this review. In our meta-analysis, the main factor associated with NS was onchocerciasis (OR = 8.8 [4.8, 15.9]). However, the pathophysiology of the disease remains poorly understood. The lack of common anti-epileptic drugs is a significant barrier to the management of head nodding and associated epileptic seizures. DISCUSSION/CONCLUSION The lack of an operational definition of NS is an obstacle to its diagnosis and, thus, to its appropriate treatment. Indeed, diagnostic difficulties might have led to false positives and false negatives which could have altered the picture of NS presented in this article. Treatment should take into account nutritional and psychological factors, as well as associated infections. Some risk factors deserve further investigation; therefore, we suggest a multicentric study with an etiological focus using a more operational definition of NS.
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Affiliation(s)
- Salvatore Metanmo
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Djamirou Dossa
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Djibrine Nassir Ahmat
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Andrea Sylvia Winkler
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Farid Boumediene
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France,
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Bhwana D, Massawe IS, Mushi AK, Magili P, Amaral LJ, Makunde W, Mmbando BP, Colebunders R. Factors associated with low-uptake of ivermectin in Mahenge, an area with high prevalence of onchocerciasis and epilepsy in Tanzania: A qualitative perspective. FRONTIERS IN TROPICAL DISEASES 2023. [DOI: 10.3389/fitd.2023.1079012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
IntroductionDespite over 20 years of community-directed treatment with ivermectin (CDTI) in Mahenge area in Tanzania, the prevalence of onchocerciasis has remained high (over 40% in children 6-10 years using antibody testing and 49% using skinsnips in adults). The area has one of the highest prevalence of epilepsy, exceeding 3.5% in some of rural villages.MethodsBetween June and July 2019, in four rural villages using qualitative methods, we assessed factors potentially associated with the persistence of high Onchocerca volvulus transmission.ResultsEleven focus group discussions were organized with persons with epilepsy and their caretakers, community resource persons, and community drug distributors (CDDs), and two in-depth interviews with district programme coordinators of neglected tropical diseases (NTD). Factors considered being responsible for the persistence of onchocerciasis transmission included not taking ivermectin during CDTI for fear of adverse reactions such as itching, swelling and misconception that the drug causes infertility. Challenges for high CDTI coverage included, long walking distance by CDDs to deliver drugs to households, persons being away for farming, low awareness of the disease including the association between onchocerciasis and epilepsy and limited supervision by the NTD coordinators.ConclusionIvermectin uptake in Mahenge should be optimised by continuous advocacy about the importance of taking ivermectin to prevent onchocerciasisassociated morbidity and by improving supervision during CDTI.
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Morin A, Guillaume M, Ngarka L, Tatah GY, Siewe Fodjo JN, Wyart G, Nokam G, Tchoumi T, Nkinin MB, Njamnshi WY, Chokote E, Boussinesq M, Colebunders R, Chesnais CB, Gargala G, Parain D, Njamnshi AK. Epilepsy in the Sanaga-Mbam valley, an onchocerciasis-endemic region in Cameroon: electroclinical and neuropsychological findings. Epilepsia Open 2021; 6:513-527. [PMID: 35138694 PMCID: PMC8408605 DOI: 10.1002/epi4.12510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Epilepsy is highly prevalent in onchocerciasis-endemic African regions. Various types of epilepsy have been described in such regions based essentially on clinical characteristics. METHODS We conducted a clinical, neurophysiological and neuropsychological study of epilepsy in the onchocerciasis-endemic region of Ntui, Sanaga-Mbam area, Cameroon. RESULTS One hundred and eighty-seven persons with presumed epilepsy were recruited in an epilepsy clinic in Ntui. Epilepsy was clinically confirmed in 144 (79%) subjects, 69 (46.0%) of them met the onchocerciasis-associated epilepsy (OAE) criteria, and 51 of 106 tested (48.1%) presented Ov16 antibodies. Electroencephalograms (EEG) were recorded in 91 participants, of which 36 (33%) were considered abnormal and 27 of 36 (75%) revealed bifrontotemporal spike and slow waves. Concerning the neuropsychological evaluation, 29% showed severe global cognitive impairment, 28% severe episodic memory impairment, and 66% severe frontal cognitive impairment. Half of the persons with epilepsy (PWE) suffered from a mental disorder. SIGNIFICANCE In PWE in the Sanaga-Mbam area in Cameroon, we observed EEG patterns similar to those described among persons with OAE, including nodding syndrome in other onchocerciasis-endemic areas. Most PWE presented with severe cognitive impairment. We hypothesize that onchocerciasis may induce neurocognitive disorders and epilepsy via a mechanism that involves mainly the frontal and temporal regions of the brain.
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Affiliation(s)
| | | | - Leonard Ngarka
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Department of NeurologyYaoundé Central Hospital/Faculty of Medicine and Biomedical SciencesThe University of Yaoundé 1YaoundéCameroon
| | - Godwin Y. Tatah
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Department of NeurologyCH Saint‐NazaireSaint‐NazaireFrance
| | - Joseph Nelson Siewe Fodjo
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Global Health InstituteUniversity of AntwerpAntwerpBelgium
| | | | | | | | - Mary Bello Nkinin
- Department of NeurologyYaoundé Central Hospital/Faculty of Medicine and Biomedical SciencesThe University of Yaoundé 1YaoundéCameroon
| | - Wepnyu Y. Njamnshi
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Department of NeurologyYaoundé Central Hospital/Faculty of Medicine and Biomedical SciencesThe University of Yaoundé 1YaoundéCameroon
| | - Eric‐Samuel Chokote
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
| | - Michel Boussinesq
- UMI 233Institut de Recherche pour le Développement (IRD)/Research and Development InstituteMontpellierFrance
- Montpellier UniversityMontpellierFrance
- INSERM Unit 1175MontpellierFrance
| | | | - Cédric B. Chesnais
- UMI 233Institut de Recherche pour le Développement (IRD)/Research and Development InstituteMontpellierFrance
- Montpellier UniversityMontpellierFrance
- INSERM Unit 1175MontpellierFrance
| | - Gilles Gargala
- Laboratory of Parasitology‐Mycology & EA7510Rouen University HospitalRouenFrance
| | | | - Alfred K. Njamnshi
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Department of NeurologyYaoundé Central Hospital/Faculty of Medicine and Biomedical SciencesThe University of Yaoundé 1YaoundéCameroon
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Vergonjeanne M, Auditeau E, Erazo D, Luna J, Gelle T, Gbessemehlan A, Boumediene F, Preux PM. Epidemiology of Epilepsy in Low- and Middle-Income Countries: Experience of a Standardized Questionnaire over the Past Two Decades. Neuroepidemiology 2021; 55:369-380. [PMID: 34315167 DOI: 10.1159/000517065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Epilepsy affects >50 million people worldwide, with 80% of them living in low- and middle-income countries (LMICs). Studies with a standardized methodology are required to obtain comparable data on epilepsy and implement health policies in order to reduce the treatment gap and improve the diagnosis and management of epilepsy. In 2000, following the guidelines of the International League Against Epilepsy (ILAE), the "questionnaire for investigation of epilepsy in tropical countries" (IENT questionnaire) was developed to promote epidemiological surveys on epilepsy using a standard methodology. This study aims to describe how, when, where, and why the IENT questionnaire has been used through epidemiological studies on epilepsy over the last 2 decades and to acquire users' opinions about the tool. METHODS Studies that used the IENT questionnaire were searched through international and local bibliographic databases, including the gray literature. An online survey was carried out, including a snowball effect. Original research studies were included. Characteristics of the studies and populations and general information on the instrument and its use were collected. RESULTS Eighty-two documents were selected referring to 61 studies that were mostly carried out on the African continent (n = 54). Most of them aimed to determine the prevalence (n = 31) and associated factors (n = 28) of epilepsy in LMICs. Among the 61 studies, 35 were population-based, and 30 included both adults and children. A methodological heterogeneity was found between studies, and in cases where the IENT questionnaire alone did not ensure complete data collection, other tools were used concomitantly (n = 40). DISCUSSION/CONCLUSION Over the last 2 decades, the IENT questionnaire has been continuously used in different LMICs. This result favors its promotion and updating, with the inclusion of new topics related to epilepsy (e.g., comorbidities, quality of life, and stigma), current ILAE guidelines, and digital versions.
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Affiliation(s)
- Marion Vergonjeanne
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France,
| | - Emilie Auditeau
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Daniells Erazo
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Jaime Luna
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Thibaut Gelle
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Antoine Gbessemehlan
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Farid Boumediene
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Pierre-Marie Preux
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
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Hotterbeekx A, Lammens M, Onzivua S, Lukande R, Olwa F, Kumar-Singh S, Van Hees S, Idro R, Colebunders R. Neuropathological Changes in Nakalanga Syndrome-A Case Report. Pathogens 2021; 10:pathogens10020116. [PMID: 33498763 PMCID: PMC7912209 DOI: 10.3390/pathogens10020116] [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: 12/23/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
Nakalanga syndrome is a clinical manifestation of onchocerciasis-associated epilepsy characterized by stunting, delayed or absent secondary sexual development and skeletal deformities, and is often accompanied by epileptic seizures. The pathophysiology of Nakalanga syndrome is unknown. Here, we describe the post-mortem findings of a 17-year-old female who died with Nakalanga syndrome in northern Uganda. Macroscopic and histopathological examination of all major organs (liver, lungs, kidney and heart), including the brain and the pituitary gland, was performed. The suspected cause of death was malaria, and all major organs and pituitary gland appeared normal, except the lungs, which were edematous consistent with the malaria. Neuropathological changes include signs of neuro-inflammation (gliosis and activated microglia), which co-localized with tau-reactive neurofibrillary tangles and threads. The pathology was most abundant in the frontal cortex, thalamic and hypothalamic regions, and mesencephalon. The choroid plexus showed psammoma bodies. These findings indicate accelerated aging, probably due to repeated seizures. The neuropathological findings were similar to other persons who died with onchocerciasis-associated epilepsy. Examination of the pituitary gland did not reveal new information concerning the underlying pathophysiological mechanism of Nakalanga syndrome. Therefore, more post-mortem studies should be performed.
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Affiliation(s)
- An Hotterbeekx
- Global Health Institute, University of Antwerp, 2100 Antwerp, Belgium; (S.V.H.); (R.C.)
- Molecular Pathology Group, Laboratory of Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2100 Antwerp, Belgium;
- Correspondence: ; Tel.: +32-32-65-89-15; Fax: +32-3-265-26-63
| | - Martin Lammens
- Department of Pathology, Antwerp University Hospital, 2100 Antwerp, Belgium;
- Department of Neuropathology, Born-Bunge Institute, University of Antwerp, 2100 Antwerp, Belgium
| | - Sylvester Onzivua
- Department of Pathology, Makerere University Medical School, Kampala P.O. Box 7072, Uganda; (S.O.); (R.L.)
| | - Robert Lukande
- Department of Pathology, Makerere University Medical School, Kampala P.O. Box 7072, Uganda; (S.O.); (R.L.)
| | - Francis Olwa
- Department of Diagnostics, Faculty of Health Sciences, Lira University, Lira P. O. Box 1035, Uganda;
| | - Samir Kumar-Singh
- Molecular Pathology Group, Laboratory of Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2100 Antwerp, Belgium;
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2100 Antwerp, Belgium
| | - Stijn Van Hees
- Global Health Institute, University of Antwerp, 2100 Antwerp, Belgium; (S.V.H.); (R.C.)
| | - Richard Idro
- Department of Pediatrics, Makerere University Medical School, Kampala P.O. Box 7072, Uganda;
| | - Robert Colebunders
- Global Health Institute, University of Antwerp, 2100 Antwerp, Belgium; (S.V.H.); (R.C.)
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Colebunders R, Njamnshi AK, Menon S, Newton CR, Hotterbeekx A, Preux PM, Hopkins A, Vaillant M, Siewe Fodjo JN. Onchocerca volvulus and epilepsy: A comprehensive review using the Bradford Hill criteria for causation. PLoS Negl Trop Dis 2021; 15:e0008965. [PMID: 33411705 PMCID: PMC7790236 DOI: 10.1371/journal.pntd.0008965] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The possibility that onchocerciasis may cause epilepsy has been suggested for a long time, but thus far, an etiological link has not been universally accepted. The objective of this review is to critically appraise the relationship between Onchocerca volvulus and epilepsy and subsequently apply the Bradford Hill criteria to further evaluate the likelihood of a causal association. METHODS PubMed and gray literature published until September 15, 2020, were searched and findings from original research were synthesized. Adherence to the 9 Bradford Hill criteria in the context of onchocerciasis and epilepsy was determined to assess whether the criteria are met to strengthen the evidence base for a causal link between infection with O. volvulus and epilepsy, including the nodding syndrome. RESULTS Onchocerciasis as a risk factor for epilepsy meets the following Bradford Hill criteria for causality: strength of the association, consistency, temporality, and biological gradient. There is weaker evidence supporting causality based on the specificity, plausibility, coherence, and analogy criteria. There is little experimental evidence. Considering the Bradford Hill criteria, available data suggest that under certain conditions (high microfilarial load, timing of infection, and perhaps genetic predisposition), onchocerciasis is likely to cause epilepsy including nodding and Nakalanga syndromes. CONCLUSION Applying the Bradford Hill criteria suggests consistent epidemiological evidence that O. volvulus infection is a trigger of epilepsy. However, the pathophysiological mechanisms responsible for seizure induction still need to be elucidated.
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Affiliation(s)
- Robert Colebunders
- Global Health Institute, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Alfred K. Njamnshi
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé Cameroon
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Sonia Menon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Charles R. Newton
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - An Hotterbeekx
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre-Marie Preux
- Institute of Epidemiology and Tropical Neurology, INSERM UMR1094, University of Limoges, Limoges, France
| | - Adrian Hopkins
- Neglected and Disabling Diseases of Poverty Consultant, Kent, United Kingdom
| | - Michel Vaillant
- Competence Center in Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
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Kaiser C, Mugisa C, Kisembo D, Gumisiriza N, Colebunders R, Tukesiga E, Kipp W, Asaba G. Case Report: Nakalanga Syndrome Revisited: Long-Term Follow-Up of a Patient Living in Western Uganda, 1994-2018. Am J Trop Med Hyg 2020; 104:902-906. [PMID: 33350373 DOI: 10.4269/ajtmh.20-0979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/03/2020] [Indexed: 11/07/2022] Open
Abstract
Nakalanga syndrome is a childhood developmental disorder that has been reported from various parts of sub-Saharan Africa with the major sign of retarded growth, regularly combined with physical deformities, impaired mental and pubertal development, and epilepsy. We present a follow-up over a 24-year period of a patient living in the Itwara onchocerciasis focus of western Uganda. We demonstrate the strong similarity of Nakalanga syndrome to the more recently described Nodding syndrome, and we discuss the possible causation of both disorders by onchocerciasis. We suggest that the growing knowledge about the tight interconnections between Nakalanga and nodding syndrome, other forms of epilepsy, and onchocerciasis should be taken into consideration in a revised classification system.
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Affiliation(s)
| | | | | | | | | | | | | | - George Asaba
- Department of Pediatrics, Regional Referral Hospital, Fort Portal, Uganda
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Dusabimana A, Bhwana D, Mandro M, Mmbando BP, Siewe Fodjo JN, Colebunders R. OV16 Seroprevalence among Persons with Epilepsy in Onchocerciasis Endemic Regions: A Multi-Country Study. Pathogens 2020; 9:pathogens9100847. [PMID: 33081184 PMCID: PMC7650690 DOI: 10.3390/pathogens9100847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 11/16/2022] Open
Abstract
There is growing epidemiological evidence that onchocerciasis may induce epilepsy. High prevalence of onchocerciasis has been reported in onchocerciasis-meso and hyper-endemic regions. We aimed to determine the OV16 antibody prevalence in persons with epilepsy (PWE) in four onchocerciasis-endemic regions. PWE were identified during studies in Mahenge area (Tanzania), Kitgum and Pader districts (Uganda), the Mbam and Sanaga river valleys (Cameroon), and the Logo health zone (Democratic Republic of Congo). Exposure to Onchocerca volvulus was assessed by testing PWE for OV16 IgG4 antibodies using a rapid diagnostic test. The OV16 seroprevalence among PWE in the four onchocerciasis-endemic study sites ranged from 35.2% to 59.7%. OV16 seroprevalence increased with age until the age of 39 years, after which it decreased drastically. Our study suggests that, in onchocerciasis-endemic regions, epilepsy in young people is often associated with onchocerciasis, while epilepsy in older persons seems unrelated to O. volvulus exposure.
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Affiliation(s)
- Alfred Dusabimana
- Global Health Institute, Gouverneur Kinsbergen Centrum, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium; (A.D.); (J.N.S.F.)
| | - Dan Bhwana
- National Institute for Medical Research, Tanga Centre, P.O. Box 5004, Tanga, Tanzania; (D.B.); (B.P.M.)
| | - Michel Mandro
- Provincial Health Division Ituri, Ministry of Health, Bunia, P.O. Box 57, Ituri, Congo;
| | - Bruno P. Mmbando
- National Institute for Medical Research, Tanga Centre, P.O. Box 5004, Tanga, Tanzania; (D.B.); (B.P.M.)
| | - Joseph N. Siewe Fodjo
- Global Health Institute, Gouverneur Kinsbergen Centrum, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium; (A.D.); (J.N.S.F.)
| | - Robert Colebunders
- Global Health Institute, Gouverneur Kinsbergen Centrum, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium; (A.D.); (J.N.S.F.)
- Correspondence:
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