刚果民主共和国盘尾丝虫病相关性癫痫：临床描述及与微丝蚴密度的关系。
Onchocerciasis-associated epilepsy in the Democratic Republic of Congo: Clinical description and relationship with microfilarial density.
机构信息
Global Health Institute, University of Antwerp, Antwerp, Belgium.
Ministry of Health, Ituri, Democratic Republic of Congo.
出版信息
PLoS Negl Trop Dis. 2019 Jul 17;13(7):e0007300. doi: 10.1371/journal.pntd.0007300. eCollection 2019 Jul.
BACKGROUND
High epilepsy prevalence and incidence were observed in onchocerciasis-endemic villages in the Democratic Republic of Congo (DRC). We investigated the clinical characteristics of onchocerciasis-associated epilepsy (OAE), and the relationship between seizure severity and microfilarial density.
METHODS
In October 2017, ivermectin-naive persons with epilepsy (PWE) were recruited from onchocerciasis-endemic areas in the Logo health zone in the DRC. Additional PWE were enrolled in the Aketi health zone, where ivermectin had been distributed annually for 14 years. Past medical history, clinical characteristics and skin snips for Onchocerca volvulus detection were obtained from participants. Bivariate and multivariable analyses were used to investigate associations with microfilarial density.
RESULTS
Of the 420 PWE in the Logo health zone, 392 were skin snipped (36.5% positive). Generalized motor seizures were most frequent (392 PWE, 93.3%), and nodding seizures were reported in 32 (7.6%) participants. Twelve PWE (3.1%) presented Nakalanga features. Sixty-three (44.1%) skin snip-positive PWE had a family history of epilepsy, compared to only 82 (32.9%) skin snip-negative PWE (p = 0.027). Eighty-one onchocerciasis-infected PWE were recruited in the Aketi health zone. Positive correlations between seizure frequency and microfilarial density were observed in Logo (Spearman-rho = 0.175; p<0.001) and Aketi (Spearman-rho = 0.249; p = 0.029). In the multivariable model adjusted for age, gender, and previous treatment, high seizure frequency was associated with increasing microfilarial density in Aketi (p = 0.025) but not in Logo (p = 0.148).
CONCLUSION
In onchocerciasis-endemic regions in the DRC, a wide spectrum of seizures was observed. The occurrence of Nodding seizures and Nakalanga features, as well as an association between seizure severity and O. volvulus microfilarial density suggest a high OAE prevalence in the study villages.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03052998.
背景
在刚果民主共和国（DRC）的盘尾丝虫病流行地区，观察到癫痫的高患病率和发病率。我们调查了盘尾丝虫病相关癫痫（OAE）的临床特征，以及癫痫发作严重程度与微丝蚴密度之间的关系。
方法
2017 年 10 月，从 DRC 的洛戈卫生区的盘尾丝虫病流行地区招募了伊维菌素初治癫痫患者（PWE）。阿克泰卫生区还招募了过去 14 年每年都接受伊维菌素分发的 PWE。从参与者那里获得了既往病史、临床特征和用于检测旋毛虫的皮肤切片。采用双变量和多变量分析来研究与微丝蚴密度的关联。
结果
在洛戈卫生区的 420 名 PWE 中，有 392 人进行了皮肤切片（36.5%阳性）。全身性运动性发作最为常见（392 名 PWE，93.3%），32 名（7.6%）参与者报告有点头发作。12 名 PWE（3.1%）出现了 Nakalanga 特征。63 名（44.1%）皮肤切片阳性的 PWE 有癫痫家族史，而皮肤切片阴性的 PWE 只有 82 名（32.9%）（p = 0.027）。阿克泰卫生区还招募了 81 名感染盘尾丝虫的 PWE。在洛戈（Spearman-rho = 0.175；p<0.001）和阿克泰（Spearman-rho = 0.249；p = 0.029）都观察到癫痫发作频率与微丝蚴密度之间存在正相关。在调整年龄、性别和既往治疗的多变量模型中，阿克泰的高癫痫发作频率与微丝蚴密度的增加相关（p = 0.025），但在洛戈则无相关性（p = 0.148）。
结论
在 DRC 的盘尾丝虫病流行地区，观察到广泛的癫痫发作。点头发作和 Nakalanga 特征的发生，以及癫痫发作严重程度与 O.volvulus 微丝蚴密度之间的关联，表明研究村中的 OAE 患病率较高。
试验注册
ClinicalTrials.gov NCT03052998。
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