Global Health Institute, University of Antwerp, Antwerp, Belgium.
Department of Internal Medicine and Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Infect Dis Poverty. 2019 Feb 10;8(1):11. doi: 10.1186/s40249-019-0523-y.
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.
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.
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.
已知盘尾丝虫病流行地区癫痫患病率较高。这些地区资源有限，癫痫患者（PWE）获得医疗保健的机会有限，导致抗癫痫治疗差距较大、癫痫发作控制不佳以及癫痫相关并发症负担沉重。最近的基于社区的调查强调需要针对偏远盘尾丝虫病流行村庄的癫痫管理策略，以确保 PWE 的健康结果得到改善。在本文中，我们提出了一种在这种情况下管理 PWE 的可行方法。
通过分散癫痫护理，可以改善盘尾丝虫病流行地区的 PWE 管理。非医生在医生或专家的监督下，可以使用简化的癫痫诊断和治疗方法。为了缩小治疗差距，应建立定期供应适合不同类型盘尾丝虫病相关癫痫的补贴抗癫痫药物（AED）。建立基于社区的癫痫监测系统将使 PWE 能够早期诊断和治疗，从而预防并发症。必须实施针对癫痫的社区宣传计划，以减少污名化，并促进 PWE 的社会康复。最后，通过优化社区定向治疗伊维菌素（CDTI）并考虑替代治疗策略来加强盘尾丝虫病消除计划，可能会降低癫痫的发病率。
通过将癫痫护理从专家转移到非医师卫生工作者，采用基于社区的方法，可以降低癫痫相关发病率。需要增加宣传和与各利益攸关方的合作，以建立一种可持续且具有成本效益的癫痫慢性病管理模式，这将显著改善盘尾丝虫病流行地区 PWE 的生活质量。
