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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; p=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.

Funding: European Research Council, NSETHIO Project.

Titel:	The temporal relationship between onchocerciasis and epilepsy: a population-based cohort study.
Autor/in / Beteiligte Person:	Chesnais, CB ; Nana-Djeunga, HC ; Njamnshi, AK ; Lenou-Nanga, CG ; Boullé, C ; Bissek, AZ ; Kamgno, J ; Colebunders, R ; Boussinesq, M
Link:	Zum Volltext
Zeitschrift:	The Lancet. Infectious diseases, Jg. 18 (2018-11-01), Heft 11, S. 1278
Veröffentlichung:	New York, NY : Elsevier Science ; The Lancet Pub. Group, 2001-, 2018
Medientyp:	academicJournal
ISSN:	1474-4457 (electronic)
DOI:	10.1016/S1473-3099(18)30425-0
Schlagwort:	Adolescent Animals Cameroon epidemiology Child Child, Preschool Cohort Studies Female Humans Incidence Male Rural Population Skin pathology Surveys and Questionnaires Epilepsy complications Epilepsy epidemiology Onchocerca volvulus isolation & purification Onchocerciasis complications Onchocerciasis epidemiology
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article; Research Support, Non-U.S. Gov't Language: English [Lancet Infect Dis] 2018 Nov; Vol. 18 (11), pp. 1278-1286. <i>Date of Electronic Publication: </i>2018 Sep 26. MeSH Terms: Epilepsy / complications ; Epilepsy / epidemiology ; Onchocerca volvulus / isolation & purification ; Onchocerciasis / complications ; Onchocerciasis / *epidemiology ; Adolescent ; Animals ; Cameroon / epidemiology ; Child ; Child, Preschool ; Cohort Studies ; Female ; Humans ; Incidence ; Male ; Rural Population ; Skin / pathology ; Surveys and Questionnaires Comments: Comment in: Lancet Infect Dis. 2018 Nov;18(11):1172-1174. (PMID: 30268644) ; Comment in: Lancet Infect Dis. 2019 Jan;19(1):21-22. (PMID: 30587287) ; Comment in: Lancet Infect Dis. 2019 Jan;19(1):22. (PMID: 30587288) Entry Date(s): Date Created: 20181001 Date Completed: 20190702 Latest Revision: 20220409 Update Code: 20240513

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