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      Comprehensive management of epilepsy in onchocerciasis-endemic areas: lessons learnt from community-based surveys

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          Abstract

          Background

          Onchocerciasis -endemic regions are known to have a high epilepsy prevalence. Limited resources in these areas and poor access to healthcare by persons with epilepsy (PWE) result in a wide anti-epileptic treatment gap, poor seizure control and a high burden of seizure-related complications. Recent community-based surveys highlight the need for epilepsy management strategies suitable for remote onchocerciasis-endemic villages to ensure better health outcomes for PWE. In this paper, we propose a feasible approach to manage PWE in such settings.

          Main text

          Improved management of PWE in onchocerciasis-endemic areas may be achieved by decentralizing epilepsy care. Simplified approaches for the diagnosis and treatment of epilepsy may be used by non-physicians, under the supervision of physicians or specialists. To reduce the treatment gap, a regular supply of subsidized anti-epileptic drugs (AED) appropriate for different types of onchocerciasis-associated epilepsy should be instituted. Setting up a community-based epilepsy surveillance system will enable early diagnosis and treatment of PWE thereby preventing complications. Community awareness programs on epilepsy must be implemented to reduce stigma and facilitate the social rehabilitation of PWE. Finally, strengthening onchocerciasis elimination programs by optimizing community-directed treatment with ivermectin (CDTI) and considering alternative treatment strategies might reduce the incidence of epilepsy.

          Conclusions

          A community-based approach with task-shifting of epilepsy care from specialists to non-physician health workers will reduce epilepsy-associated morbidity. Increased advocacy and collaboration with various stakeholders is needed to establish a sustainable, cost-effective chronic care model for epilepsy that will significantly improve the quality of life of PWE in onchocerciasis-endemic regions.

          Electronic supplementary material

          The online version of this article (10.1186/s40249-019-0523-y) contains supplementary material, which is available to authorized users.

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          Most cited references30

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          Part 1: Executive Summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

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

            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.
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              Relationship between onchocerciasis and epilepsy: a matched case-control study in the Mbam Valley, Republic of Cameroon.

              Studies conducted during the past 10 years to investigate the possible relationship between onchocerciasis and epilepsy have led to contradictory results. In 1991-92 and 2001 we investigated 14 villages in central Cameroon to evaluate the relationship, at the community level, between the prevalence of epilepsy and the endemicity level of onchocerciasis. A case-control study compared the microfilarial loads of 72 epileptic and 72 non-epileptic individuals, matched according to sex, age, and village of residence. The prevalence of epilepsy and the community microfilarial load (CMFL) were closely related (P < 0.02), and the case-control study demonstrated that the microfilarial loads (microfilariae per snip) in the epileptic group (arithmetic mean = 288, median = 216) were significantly higher (P < 10(-4)) than in the control group (arithmetic mean = 141, median = 63). The results strongly support the existence of a link between onchocerciasis and epilepsy. The fact that such a relationship has not been found recently in some other West and Central African areas is probably due to the lowered endemicity of onchocerciasis following vector- and ivermectin-related control measures applied over the past 5-25 years. The socio-economic and demographic impact of onchocerciasis-related epilepsy should be evaluated, and taken into account as part of all onchocerciasis control programmes.
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                Author and article information

                Contributors
                josephnelson.siewefodjo@uantwerpen.be
                marieke@zwets.com
                ridro1@gmail.com
                michel.mandrondahura@student.uantwerpen.be
                pierre-marie.preux@unilim.fr
                alfredknjamnshi@gmail.com
                robert.colebunders@uantwerpen.be
                Journal
                Infect Dis Poverty
                Infect Dis Poverty
                Infectious Diseases of Poverty
                BioMed Central (London )
                2095-5162
                2049-9957
                10 February 2019
                10 February 2019
                2019
                : 8
                : 11
                Affiliations
                [1 ]ISNI 0000 0001 0790 3681, GRID grid.5284.b, Global Health Institute, , University of Antwerp, ; Antwerp, Belgium
                [2 ]ISNI 0000 0004 0648 072X, GRID grid.415218.b, Department of Internal Medicine and Pediatrics, , Kilimanjaro Christian Medical Centre, ; Moshi, Tanzania
                [3 ]ISNI 0000 0004 0444 9382, GRID grid.10417.33, Department of Neurology, , Radboud University Medical Centre, ; Nijmegen, The Netherlands
                [4 ]ISNI 0000 0004 0620 0548, GRID grid.11194.3c, Department of Paediatrics and Child Health, , Makerere University, College of Health Sciences, ; Kampala, Uganda
                [5 ]Provincial Health Division Ituri, Ministry of Health, Bunia, Democratic Republic of the Congo
                [6 ]INSERM, Univ. Limoges, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, GEIST, 87000, Limoges, CHU, UMR 1094 Limoges, France
                [7 ]ISNI 0000 0001 2173 8504, GRID grid.412661.6, Department of Neurology, , Yaoundé Central Hospital / FMBS, The University of Yaoundé 1, ; Yaoundé, Cameroon
                [8 ]Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
                Author information
                http://orcid.org/0000-0003-3544-1239
                Article
                523
                10.1186/s40249-019-0523-y
                6368958
                30738437
                bd983656-b220-4d09-a53f-2fabb72627f5
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 June 2018
                : 23 January 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000781, European Research Council;
                Award ID: 768815
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Award ID: MR/M025489/1
                Award Recipient :
                Categories
                Scoping Review
                Custom metadata
                © The Author(s) 2019

                epilepsy,onchocerciasis,community-based approach,comprehensive management

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