The temporal relationship between onchocerciasis and epilepsy: a population-based cohort study
The temporal relationship between onchocerciasis and epilepsy: a population-based cohort study
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DOI：
10.1016/s1473-3099(18)30425-0
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发表时间：
2018-11-01
影响因子：
56.3
通讯作者：
Boussinesq, Michel
中科院分区：
文献类型：
--
作者：
Chesnais, Cedric B.;Nana-Djeunga, Hugues C.;Boussinesq, Michel
背景 许多研究表明盘尾丝虫病可能与癫痫有关。因此，我们进行了一项队列研究，以评估与儿童时期测量的盘尾丝虫皮肤微丝虫密度 (MFD) 相关的癫痫发病率，并评估时间关系的可能性。 方法 1991-93 年在喀麦隆 25 个村庄进行的盘尾丝虫病调查期间，我们测量了 5 岁或以上个体的 MFD。 2017年，我们重新访问了其中七个村庄。通过标准化的五项问卷，我们收集了 1991-93 年 856 名 5-10 岁个体的癫痫发生情况信息，并在原始调查中确定了 MFD。我们进行了多变量分析，以评估总体发病率和发病率，考虑了年龄、性别、1991-93 年个人 MFD 以及村中盘尾丝虫病流行水平。结果 2017 年，我们获得了 85%（856 人中的 729 人）的癫痫病史数据。在这些人中，我们将 60 人归类为疑似癫痫病例。癫痫的总体发病率为每 10 万人年 350 例（95% CI 270-450）。调整后的癫痫发病率在初始 MFD 为每皮剪 1 至 5 条微丝蚴（mf/snip）的个体中为 7.07（95% CI 0.98-51.26；p=0.0530），在每剪 6 至 20 mf 的个体中为 11.26（2.73-46.43），在每剪处 6 至 20 mf 的个体中为 12.90（4.40-37.83）在 21-50 mf 的个体中 每剪 51-100 mf 的个体为 20.00 (3.71-108.00)，每剪 101-200 mf 的个体为 22.58 (3.21-158.56)，每剪 101-200 mf 的个体为 28.50 (95% CI 3.84-211.27; 13=0.0010)与没有可检测到皮肤密度的个体相比，每次剪断 200 mf 微丝蚴。解释 在喀麦隆盘尾丝虫病病灶中，儿童时期的个体盘尾丝虫 MFD 与癫痫发作或癫痫的风险相关。这种时间关系表明盘尾丝虫病和癫痫之间存在潜在的因果关系。版权所有 (C) 2018 爱思唯尔有限公司。保留所有权利。
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.