Dusabimana Alfred, Tsebeni Wafula Solomon, Raimon Stephen Jada, Fodjo Joseph Nelson Siewe, Bhwana Dan, Tepage Floribert, Abd-Elfarag Gasim, Hotterbeekx An, Abrams Steven, Colebunders Robert
Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium.
Department of Disease Control and Environmental Health, Makerere University, Kampala P.O. Box 7072, Uganda.
Pathogens. 2020 Dec 31;10(1):21. doi: 10.3390/pathogens10010021.
A clinical trial performed in the Democratic Republic of Congo (DRC), among persons with epilepsy (PWE) infected with treated with anti-seizure medication suggested that ivermectin reduces the seizure frequency. We assessed the effect of ivermectin treatment on seizure frequency in PWE with and without anti-seizure medication in three onchocerciasis endemic areas (Maridi, South Sudan; Aketi, DRC; and Mahenge, Tanzania). Pre- and 3-5 months post-ivermectin microfilariae densities in skin snips and seizure frequency were assessed. After ivermectin, the median (IQR) percentage reduction in seizure frequency in the study sites ranged from 73.4% (26.0-90.0) to 100% (50.0-100.0). A negative binomial mixed model showed that ivermectin significantly reduced the seizure frequency, with a larger decrease in PWE with a high baseline seizure frequency. Mediation analysis showed that ivermectin reduced the seizure frequencies indirectly through reduction in microfilariae densities but also that ivermectin may have a direct anti-seizure effect. However, given the short half-life of ivermectin and the fact that ivermectin does not penetrate the healthy brain, such a direct anti-seizure effect is unlikely. A randomized controlled trial assessing the ivermectin effect in people infected with who are also PWE on a stable anti-seizure regimen may be needed to clarify the causal relationship between ivermectin and seizure frequency.
在刚果民主共和国（DRC）针对感染 且接受抗癫痫药物治疗的癫痫患者（PWE）开展的一项临床试验表明，伊维菌素可降低癫痫发作频率。我们在三个盘尾丝虫病流行地区（南苏丹的马里迪、刚果民主共和国的阿凯蒂和坦桑尼亚的马亨格）评估了伊维菌素治疗对接受和未接受抗癫痫药物治疗的癫痫患者癫痫发作频率的影响。评估了伊维菌素治疗前及治疗后3 - 5个月皮肤切片中的微丝蚴密度和癫痫发作频率。服用伊维菌素后，各研究地点癫痫发作频率降低的中位数（IQR）百分比范围为73.4%（26.0 - 90.0）至100%（50.0 - 100.0）。负二项混合模型显示，伊维菌素显著降低了癫痫发作频率，基线癫痫发作频率高的癫痫患者下降幅度更大。中介分析表明，伊维菌素通过降低微丝蚴密度间接降低了癫痫发作频率，但伊维菌素也可能具有直接的抗癫痫作用。然而，鉴于伊维菌素半衰期短且不能穿透健康大脑，这种直接的抗癫痫作用不太可能。可能需要开展一项随机对照试验，评估伊维菌素对感染 且同时正在接受稳定抗癫痫治疗方案的癫痫患者的影响，以阐明伊维菌素与癫痫发作频率之间的因果关系。
