Prischich Francesca, De Rinaldis Marta, Bruno Flaminia, Egeo Gabriella, Santori Chiara, Zappaterreno Alessandra, Fattouch Jinane, Di Bonaventura Carlo, Bada Jean, Russo Gianluca, Pizzuti Antonio, Cardona Francesco, Vullo Vincenzo, Giallonardo Anna Teresa, D'Erasmo Emilio, Pelliccia Andrea, Vanacore Nicola
Department of Child Neuropsychiatry, University of Rome La Sapienza, Italy.
Epilepsy Res. 2008 Dec;82(2-3):200-10. doi: 10.1016/j.eplepsyres.2008.09.004. Epub 2008 Oct 30.
In the Littoral Province of Cameroon, in the Sanaga River Valley, a door-to-door epidemiological study was carried out in order to evaluate the prevalence of epilepsy in a small village located in a geographically isolated area, hyper-endemic for onchocerciasis. It was followed by an electro-clinical evaluation of patients and a case-control study.
The study involved a three-phases design: in phase I, a screening questionnaire was administered, in phase II, the presence of epilepsy was confirmed with electro-clinical evaluation, and in phase III, risk factors for epilepsy, socio-economical factors and life habits were evaluated in patients and two matched controls for the age (+/-1 year) residents in the same village. Endemicity level of onchocerciasis was assessed in the village by measuring the prevalence of nodules in adult males aged >or=20 years (PNAM).
One hundred eighty-one subjects (100 male and 81 female) were examined (91.9% of the overall population). The crude prevalence rate of active epilepsy was 105 per 1000 pop (CI 95% 60-150) while the age-adjusted prevalence rate was 134.5 cases per 1000 pop (CI 95% 90-178). Seizures were classified as generalized in 10 patients (52.6%) and partial in nine (47.4%). In 17 patients EEG was recorded. Afterward the electro-clinical classification this distribution was inverted: generalized seizures occurred in 35.3% of cases and partial seizures in 64.7% of cases. The PNAM was 62.5%. The surveyed village was classified as hyper-endemic for onchocerciasis. Among risk factors, only positive family history for epilepsy was found (p=0.031). A sample pedigree of a family with 10 epileptic cases (4 included in the epidemiological study) was showed.
To our knowledge, this is the first door-to-door study that produce an adjusted prevalence rate on epilepsy in Cameroon. In according to studies done in Tanzania, Liberia, Uganda, and Ethiopia, our results (i.e., the high prevalence rate in a restricted area, the clinical characteristics of epileptic seizures, the positive family history for epilepsy and the type of pedigree of a family with epileptic patients) may be accounted for by the presence of an strong interaction between environmental and genetic factors in some circumscribed areas.
在喀麦隆滨海省的萨纳加河谷，开展了一项挨家挨户的流行病学研究，以评估位于盘尾丝虫病高度流行的地理隔离区域的一个小村庄中癫痫的患病率。随后对患者进行了电临床评估并开展了一项病例对照研究。
该研究采用三阶段设计：在第一阶段，发放筛查问卷；在第二阶段，通过电临床评估确认癫痫的存在；在第三阶段，对患者以及同村年龄匹配（±1岁）的两名对照居民评估癫痫的危险因素、社会经济因素和生活习惯。通过测量20岁及以上成年男性的结节患病率（PNAM）评估该村盘尾丝虫病的流行程度。
共检查了181名受试者（100名男性和81名女性）（占总人口的91.9%）。活动性癫痫的粗患病率为每1000人中有105例（95%置信区间60 - 150），而年龄调整后的患病率为每1000人中有134.5例（95%置信区间90 - 178）。癫痫发作分类为全身性发作的有10例（52.6%），部分性发作的有9例（47.4%）。17例患者进行了脑电图记录。在进行电临床分类后这种分布发生了反转：全身性发作占35.3%，部分性发作占64.7%。PNAM为62.5%。被调查的村庄被归类为盘尾丝虫病高度流行地区。在危险因素中，仅发现癫痫家族史呈阳性（p = 0.031）。展示了一个有10例癫痫病例（4例纳入流行病学研究）的家庭的样本谱系。
据我们所知，这是喀麦隆第一项得出癫痫调整患病率的挨家挨户研究。根据在坦桑尼亚、利比里亚、乌干达和埃塞俄比亚所做的研究，我们的结果（即有限区域内的高患病率、癫痫发作的临床特征、癫痫家族史呈阳性以及癫痫患者家庭的谱系类型）可能是由于某些特定区域环境因素和遗传因素之间存在强烈相互作用所致。
