High prevalence of epilepsy in onchocerciasis endemic health areas in Democratic Republic of the Congo
High prevalence of epilepsy in onchocerciasis endemic health areas in Democratic Republic of the Congo
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DOI：
10.1186/s40249-018-0452-1
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发表时间：
2018-08-01
影响因子：
8.1
通讯作者：
Colebunders, Robert
中科院分区：
文献类型：
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作者：
Lenaerts, Evy;Mandro, Michel;Colebunders, Robert
背景：在许多盘尾丝虫病流行地区已观察到癫痫的高患病率。本研究旨在评估刚果民主共和国伊图里省农村人群中活动性癫痫的患病率和螺旋体螺旋体的暴露情况。方法：2016年8月，在伊图里省洛戈农村卫生区的一个盘尾丝虫病流行区进行了一项以社区为基础的横断面研究。对两个相邻卫生区内的家庭进行了随机抽样。为了识别癫痫患者，使用了三阶段方法。在第一阶段，由非医疗现场工作人员使用有效的5个项目的问卷对选定家庭的所有个人进行癫痫筛查。在第二和第三阶段，疑似癫痫病例分别由非专科医生和神经科医生进行检查。根据2014年国际抗癫痫联盟(ILAE)指南定义了一例癫痫病例。结果：在1389名调查对象中，被认为患有活动性癫痫(患病率为4.6%)(95%可信区间[CI]：3.6-5.8)。年龄别癫痫患病率估计值最高的是20至29岁的人群(82%)。癫痫发病年龄中位数为10岁，10~15岁年龄组癫痫发病率最高。912名参与者获得了OV16测试结果，其中30.5%(95%可信区间，27.6-33.6)检测为阳性。某村OV16抗体阳性率为8.6%~68.0%。在调整了年龄、性别和伊维菌素的使用后，发现暴露于盘尾丝虫病和癫痫之间存在显著的相关性(调整后的优势比=3.19，95%可信区间：1.63-5.64)(P<；0.001)。结论：在刚果民主共和国伊图里省的人群中观察到癫痫的高患病率以及癫痫和暴露于螺旋体的显著关联。迫切需要执行CDTI方案，并扩大癫痫治疗和护理方案。
Background: A high prevalence of epilepsy has been observed in many onchocerciasis endemic regions. This study is to estimate the prevalence of active epilepsy and exposure to Onchocerca volvulus infection in a rural population in Ituri province, Democratic Republic of Congo.Methods: In August 2016, a community-based cross-sectional study was conducted in an onchocerciasis endemic area in the rural health zone of Logo, Ituri Province. Households within two neighbouring health areas were randomly sampled. To identify persons with epilepsy, a three-stage approach was used. In the first stage, all individuals of the selected households were screened for epilepsy by non-medical field workers using a validated 5-item questionnaire. In the second and third stage, suspected cases of epilepsy were examined by non-specialist medical doctors, and by a neurologist, respectively. A case of epilepsy was defined according to the 2014 International League Against Epilepsy (ILAE) guidelines. Exposure to O. volvulus was assessed by testing for IgG4 antibodies to an O. volvulus antigen (OV16 Rapid Test,) in individuals aged 3 years and older.Results: Out of 1389 participants included in the survey, 64 were considered to have active epilepsy (prevalence 4.6%) (95% confidence interval [CI]: 3.6-5.8). The highest age-specific epilepsy prevalence estimate was observed in those aged 20 to 29 years (82%). Median age of epilepsy onset was 10 years, with a peak incidence of epilepsy in the 10 to 15 year-old age group. OV16 test results were available for 912 participants, of whom 30.5% (95% CI, 27.6-33.6) tested positive. The prevalence of OV16 positivity in a village ranged from 8.6 to 68.0%. After adjusting for age, gender and ivermectin use, a significant association between exposure to onchocerciasis and epilepsy was observed (adjusted odds ratio = 3.19, 95% CI: 1.63-5.64) (P < 0.001).Conclusions: A high prevalence of epilepsy and a significant association between epilepsy and exposure to O. volvulus were observed in the population in Ituri province, Democratic Republic of Congo. There is an urgent need to implement a CDTI programme and to scale up an epilepsy treatment and care programme.