乌干达西部高度流行区盘尾丝虫病消除后癫痫负担的变化：两项基于人群的横断面研究比较。
Changes in epilepsy burden after onchocerciasis elimination in a hyperendemic focus of western Uganda: a comparison of two population-based, cross-sectional studies.
机构信息
Department of Psychiatry, Busitema University Mbale, Mbale, Uganda.
Practice for Child and Adolescent Health, Baden-Baden, Germany.
出版信息
Lancet Infect Dis. 2020 Nov;20(11):1315-1323. doi: 10.1016/S1473-3099(20)30122-5. Epub 2020 Jun 26.
BACKGROUND
In 1994, prevalence and incidence of epilepsy were high in the Itwara onchocerciasis focus (western Uganda), and cases of nodding and Nakalanga syndrome were documented. Onchocerciasis transmission was interrupted successfully in 2001. 17 years later, we re-investigated the epilepsy burden in this area.
METHODS
From Dec 11 to Dec 15, 2018, a door-to-door survey was done in the three villages (Kabende Centre, Masongora South, and Rwesenene) with the highest epilepsy rates in 1994 to identify people with suspected epilepsy. Epilepsy diagnoses were confirmed by an interview and physical examination by a study clinician. The prevalence and incidence of epilepsy were measured using methods consistent with those used in 1994. Results from 2018 were compared with those from 1994.
FINDINGS
The overall crude prevalence of epilepsy in the study villages decreased from 3·0% (35 of 1169) in 1994 to 1·2% (27 of 2325) in 2018 (p=0·0002), with a concomitant decrease in the proportion of people with epilepsy with unknown cause (p=0·037). Between 1994 and 2018, the overall incidence of epilepsy decreased from 418 cases per 100 000 person-years (95% CI 265-626) to 73 new cases per 100 000 person-years (32-114; p<0·0001); this reduction was more pronounced for cases having the first seizure between ages 3 years and 18 years (p<0·0001). No new case of nodding or Nakalanga syndromes had occurred since the interruption of onchocerciasis transmission.
INTERPRETATION
Our findings support the existence of a negative association between onchocerciasis elimination and epilepsy burden in previously hyperendemic areas. Therefore, onchocerciasis elimination efforts should be intensified in endemic regions with a high prevalence of epilepsy, which might reduce the burden of epilepsy.
FUNDING
Flemish University Development Cooperation and the European Research Council.
背景
1994 年，乌干达西部的伊特瓦拉盘尾丝虫病流行区（Itwara onchocerciasis focus）癫痫的患病率和发病率较高，曾有过点头和纳卡兰加（Nakalanga）综合征的病例记录。2001 年成功阻断了盘尾丝虫病的传播。17 年后，我们重新调查了该地区的癫痫负担。
方法
2018 年 12 月 11 日至 15 日，对三个村庄（Kabende 中心、Masongora 南部和 Rwesenene）进行了逐户调查，这三个村庄是 1994 年癫痫发病率最高的村庄，目的是发现疑似癫痫患者。由一名研究临床医生通过访谈和体检来确认癫痫诊断。使用与 1994 年相同的方法来测量癫痫的患病率和发病率。将 2018 年的结果与 1994 年的结果进行比较。
结果
研究村庄的总体粗患病率从 1994 年的 3.0%（1169 人中 35 人）下降到 2018 年的 1.2%（2325 人中 27 人）（p=0.0002），原因是未知原因的癫痫患者比例下降（p=0.037）。1994 年至 2018 年间，癫痫的总发病率从 418 例/100000 人年（95%CI 265-626）下降到 73 例/100000 人年（32-114）（p<0.0001）；年龄在 3 岁至 18 岁之间首次发作的病例发病率下降更为明显（p<0.0001）。自阻断盘尾丝虫病传播以来，没有出现新的点头或纳卡兰加综合征病例。
结论
我们的研究结果支持在曾经高度流行的地区，消除盘尾丝虫病与癫痫负担之间存在负相关。因此，在癫痫发病率高的流行地区，应加强消除盘尾丝虫病的努力，这可能会降低癫痫负担。
资金
佛兰芒大学发展合作组织和欧洲研究理事会。
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