Clinical presentation of epilepsy in six villages in an onchocerciasis endemic area in Mahenge, Tanzania
Clinical presentation of epilepsy in six villages in an onchocerciasis endemic area in Mahenge, Tanzania
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DOI：
10.1684/epd.2019.1093
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发表时间：
2019-10-01
影响因子：
2.3
通讯作者：
Colebunders, Robert
中科院分区：
文献类型：
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作者：
Bhwana, Dan;Mmbando, Bruno P.;Colebunders, Robert
目标。描述坦尚尼亚中部盘尾丝虫病高发地区马亨格地区癫痫的临床表现和抗癫痫治疗的可及性。在4个农村和2个城郊村庄进行了挨家挨户的癫痫患病率调查。训练有素的社区工作人员使用五个筛查问题来确定疑似患有癫痫的人。由神经科医生或接受过额外癫痫培训的医生对这些人进行访谈和检查，并对其进行盘尾丝虫扭转抗体检测。8062人中有221人（2.74%）被确诊患有癫痫。癫痫发作的中位年龄为12岁（四分位数范围：7-16岁）。79例癫痫患者（36.1%）有家族成员患有癫痫，其中兄弟姐妹占52.1%。强直阵挛性发作（142例，64.2%）是最常见的发作类型。12.7%的PWE患者出现点头发作；他们中的大多数人住在农村。与其他类型的癫痫发作相比，伴有点头性癫痫发作的患者癫痫发作更频繁，表现出更多的精神症状，并且更常出现盘尾丝虫病抗体。在7至16岁之间发作的个体的高发生率是盘尾丝虫病相关癫痫（OAE）的特征。在PWE中，77.9%符合OAE临床病例定义标准。83例（37.6%）未服用任何抗癫痫药物。苯巴比妥是最常用的抗癫痫药物，占治疗后pwe患者的76.1%。马横阁农村地区癫痫的高患病率很可能与OAE的高患病率有关。为防止儿童发生盘尾丝虫病，迫切需要加强马亨格消除盘尾丝虫病规划。此外，还需要一个分散的癫痫治疗规划，为生活在Mahenge地区农村的许多贫困儿童不间断地提供负担得起的抗癫痫药物。
Aims. To describe the clinical manifestations of epilepsy and access to antiseizure treatment in Mahenge in Central Tanzania, an onchocerciasis endemic area with a high prevalence of epilepsy.Methods. A door-to-door epilepsy prevalence survey was conducted in four rural and two sub-urban villages. Trained community workers used five screening questions to identify persons suspected to have epilepsy. Such individuals were interviewed and examined by a neurologist or a medical doctor with additional training in epilepsy, and were tested for Onchocerca volvulus antibodies.Results. A total of 221 out of 8,062 (2.74%) surveyed individuals were confirmed to have epilepsy. The median age at seizure onset was 12 years (interquartile range: 7-16). Seventy-nine persons with epilepsy (PWE) (36.1%) had a family member with epilepsy, which was a sibling in 52.1%. Tonic-clonic seizures (142 individuals; 64.2%) were the most common seizure type. Nodding seizures were reported in 12.7% of PWE; the majority of them living in rural villages. Persons with nodding seizures reported more frequent seizures, presented with more psychiatric symptoms, and more often had onchocerciasis antibodies than those with other seizure types. The high rate of individuals with a seizure onset at between seven and 16 years is characteristic of onchocerciasis-associated epilepsy (OAE). Of the PWE, 77.9% met the criteria for the clinical case definition of OAE. Eighty-three PWE (37.6%) were not taking any antiepileptic medication. Phenobarbital was the antiepileptic drug most commonly prescribed in 76.1% of treated PWE.Conclusion. The high prevalence of epilepsy in rural villages in Mahenge most likely is related to the high prevalence of OAE. To prevent children developing OAE, strengthening the onchocerciasis elimination programme in Mahenge is urgently needed. Moreover, a decentralised epilepsy treatment programme is also needed to provide uninterrupted access to affordable antiepileptic drugs for the many PWE living in rural villages in the Mahenge area.