The temporal relationship between onchocerciasis and epilepsy: a population-based cohort study

被引:109
作者
Chesnais, Cedric B. [1 ,2 ,3 ]
Nana-Djeunga, Hugues C. [4 ]
Njamnshi, Alfred K. [5 ,8 ]
Lenou-Nanga, Cedric G. [4 ]
Boulle, Charlotte [1 ,2 ,3 ,9 ]
Bissek, Anne-Cecile Zoung-Kanyi [7 ,10 ]
Kamgno, Joseph [4 ,6 ]
Colebunders, Robert [11 ]
Boussinesq, Michel [1 ,2 ,3 ]
机构
[1] Inst Rech Dev, UMI 233, Montpellier, France
[2] Univ Montpellier, Montpellier, France
[3] INSERM, Unite 1175, Montpellier, France
[4] Ctr Res Filariasis & Other Trop Dis, Yaounde, Cameroon
[5] Univ Yaounde I, Neurol Dept, Yaounde, Cameroon
[6] Univ Yaounde I, Publ Hlth Dept, Yaounde, Cameroon
[7] Univ Yaounde I, Fac Med & Biomed Sci, Yaounde, Cameroon
[8] Brain Res Africa Initiat, Yaounde, Cameroon
[9] CHU Nimes, Nimes, France
[10] Minist Publ Hlth, Div Hlth Operat Res, Yaounde, Cameroon
[11] Univ Antwerp, Global Hlth Inst, Antwerp, Belgium
基金
欧洲研究理事会;
关键词
SUB-SAHARAN AFRICA; RURAL AREA; VOLVULUS; MICROFILARIAE; DIETHYLCARBAMAZINE; PREVALENCE; CAMEROON;
D O I
10.1016/S1473-3099(18)30425-0
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background Many studies have suggested that onchocerciasis might be associated with epilepsy. Therefore, we did a cohort study to assess the incidence of epilepsy relative to Onchocerca volvulus skin microfilarial density (MFD) measured during childhood and to assess the possibility of a temporal relationship. Methods During onchocerciasis surveys undertaken in 25 villages in Cameroon during 1991-93, we measured MFD in individuals aged 5 years or older. In 2017, we revisited seven of these villages. With a standardised five-item questionnaire, we collected information on the occurrence of epilepsy in 856 individuals who were aged 5-10 years in 1991-93, and had MFD determined during the original surveys. We did multivariable analyses to assess the overall incidence and incidence ratios taking into account age, sex, individual MFD in 1991-93, and onchocerciasis endemicity level in the village. Findings In 2017, we obtained data on the history of epilepsy for 85% (729 of 856) of individuals. Among these individuals, we classified 60 as being suspected cases of epilepsy. The overall incidence of epilepsy was 350 per 100 000 person-years (95% CI 270-450). The adjusted incidence ratio for developing epilepsy was 7.07 (95% CI 0.98-51.26; p=0.0530) in individuals with initial MFD of one to five microfilariae per skin snip (mf per snip), 11.26 (2.73-46.43) in individuals with six to 20 mf per snip, 12.90 (4.40-37.83) in individuals with 21-50 mf per snip, 20.00 (3.71-108.00) in individuals with 51-100 mf per snip, 22.58 (3.21-158.56) in individuals with 101-200 mf per snip, and 28.50 (95% CI 3.84-211.27; 13=0.0010) in individuals with more than 200 mf per snip, compared with that of individuals without detectable densities of skin microfilariae. Interpretation Individual O volvulus MFD in childhood was associated with the risk of either seizures or epilepsy in an onchocerciasis focus in Cameroon. This temporal relationship suggests a potential causal link between onchocerciasis and epilepsy. Copyright (C) 2018 Elsevier Ltd. All rights reserved.
引用
收藏
页码:1278 / 1286
页数:9
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