Ogwang Rodney, Ningwa Albert, Akun Pamela, Bangirana Paul, Anguzu Ronald, Mazumder Rajarshi, Salamon Noriko, Henning Oliver Johannes, Newton Charles R, Abbo Catherine, Mwaka Amos Deogratius, Marsh Kevin, Idro Richard
College of Health Sciences, Makerere University, Kampala, Uganda.
KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Coast, Kilifi, Kenya.
Front Neurol. 2021 Jun 3;12:687281. doi: 10.3389/fneur.2021.687281. eCollection 2021.
Globally, epilepsy is the most common chronic neurological disorder. The incidence in sub-Saharan Africa is 2-3 times higher than that in high income countries. Infection by may be an underlying risk factor for the high burden and based upon epidemiological associations, has been proposed to cause a group of disorders- associated epilepsies (OAE) like nodding syndrome (NS). To improve our understanding of the disease spectrum, we described the clinical, electroencephalographic (EEG) and magnetic resonance imaging (MRI) features of children with epilepsy and sero-positive for (possible OAEs other than nodding syndrome). Twenty-nine children and adolescents with non-nodding syndrome OAE in northern Uganda were enrolled. A diagnosis of OAE was made in patients with epilepsy and seizure onset after age 3 years, no reported exposure to perinatal severe febrile illness or traumatic brain injury, no syndromic epilepsy diagnosis and a positive Ov-16 ELISA test. Detailed clinical evaluation including psychiatric, diagnostic EEG, a diagnostic brain MRI (in 10 patients) and laboratory testing were performed. Twenty participants (69%) were male. The mean age was 15.9 (standard deviation [SD] 1.9) years while the mean age at seizure onset was 9.8 (SD 2.9) years. All reported normal early childhood development. The most common clinical presentation was a tonic-clonic seizure. The median number of seizures was 2 (IQR 1-4) in the previous month. No specific musculoskeletal changes, or cranial nerve palsies were reported, neither were any vision, hearing and speech difficulties observed. The interictal EEG was abnormal in the majority with slow wave background activity in 52% (15/29) while 41% (12/29) had focal epileptiform activity. The brain MRI showed mild to moderate cerebellar atrophy and varying degrees of atrophy of the frontal, parietal and occipital lobes. The clinical spectrum of epilepsies associated with Onchocerca may be broader than previously described. In addition, focal onset tonic-clonic seizures, cortical and cerebellar atrophy may be important brain imaging and clinical features.
在全球范围内，癫痫是最常见的慢性神经系统疾病。撒哈拉以南非洲地区的发病率比高收入国家高2至3倍。 感染可能是高负担的潜在风险因素，基于流行病学关联，已被提出会导致一组疾病相关性癫痫（OAE），如点头综合征（NS）。为了增进我们对疾病谱的了解，我们描述了癫痫且 血清学阳性（可能是除点头综合征外的其他OAE）儿童的临床、脑电图（EEG）和磁共振成像（MRI）特征。乌干达北部29名患有非点头综合征OAE的儿童和青少年被纳入研究。对3岁以后发病的癫痫患者、无围产期严重发热性疾病或创伤性脑损伤暴露史、无综合征性癫痫诊断且Ov-16 ELISA检测呈阳性的患者做出OAE诊断。进行了详细的临床评估，包括精神科评估、诊断性脑电图、诊断性脑部MRI（10例患者）和实验室检查。20名参与者（69%）为男性。平均年龄为15.9岁（标准差[SD] 1.9），癫痫发作的平均年龄为9.8岁（SD 2.9）。所有患者均报告幼儿期发育正常。最常见的临床表现是强直阵挛性发作。前一个月癫痫发作的中位数为2次（四分位间距1-4）。未报告有特定的肌肉骨骼变化或颅神经麻痹，也未观察到任何视力、听力和言语困难。大多数患者的发作间期脑电图异常，52%（15/29）有慢波背景活动，41%（12/29）有局灶性癫痫样活动。脑部MRI显示轻度至中度小脑萎缩以及额叶、顶叶和枕叶不同程度的萎缩。与盘尾丝虫病相关的癫痫临床谱可能比先前描述的更广泛。此外，局灶性发作的强直阵挛性发作、皮质和小脑萎缩可能是重要的脑成像和临床特征。
