Van Cutsem G, Siewe Fodjo J N, Hadermann A, Amaral L-J, Trevisan C, Pion S, Colebunders R
Department of Neurology, Centre Hospitalier de Luxembourg, Luxembourg; Faculty of Science, Technology and Medicine, University of Luxembourg, Luxembourg; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa.
Global Health Institute, University of Antwerp, Antwerp, Belgium.
Seizure. 2024 Apr 21. doi: 10.1016/j.seizure.2024.04.018.
This narrative review intends to inform neurologists and public health professionals about Onchocerciasis-Associated Epilepsy (OAE), a neglected public health problem in many remote onchocerciasis-endemic areas. For epidemiological purposes, we define OAE as sudden-onset of convulsive and non-convulsive seizure types, including head nodding seizures (nodding syndrome) in a previously healthy child aged 3 to 18 years in the absence of any other obvious cause for epilepsy, all happening within an area with high ongoing Onchocerca volvulus transmission. Several OAE pathophysiological mechanisms have been proposed, but none has been proven yet. Recent population-based studies showed that strengthening onchocerciasis elimination programs was followed by a significant reduction in the incidence of OAE and nodding syndrome. Treating epilepsy in onchocerciasis-endemic regions is challenging. More advocacy is needed to provide uninterrupted, free access to anti-seizure medication to persons with epilepsy in these remote, impoverished areas. It is crucial todevelop policies and increase funding for the prevention and treatment of OAE to reduce the associated burden of disease, notably via the establishment of morbidity management and disability prevention programs (MMDP). Moreover, effective collaboration between onchocerciasis elimination and mental health programs is imperative to alleviate the burden of OAE. This synergy promises reciprocal advantages and underscores the need for a comprehensive approach to address this multifaceted challenge.
本叙述性综述旨在让神经科医生和公共卫生专业人员了解盘尾丝虫病相关性癫痫（OAE），这是许多偏远盘尾丝虫病流行地区被忽视的公共卫生问题。出于流行病学目的，我们将OAE定义为3至18岁既往健康儿童突然出现惊厥性和非惊厥性癫痫发作类型，包括点头样癫痫发作（点头综合征），且不存在任何其他明显的癫痫病因，所有这些均发生在盘尾丝虫病传播活跃的地区。已经提出了几种OAE的病理生理机制，但尚无一种得到证实。最近基于人群的研究表明，加强盘尾丝虫病消除计划后，OAE和点头综合征的发病率显著降低。在盘尾丝虫病流行地区治疗癫痫具有挑战性。需要更多宣传，以便为这些偏远贫困地区的癫痫患者提供不间断的免费抗癫痫药物。制定政策并增加对OAE预防和治疗的资金投入以减轻相关疾病负担至关重要，特别是通过建立发病管理和残疾预防计划（MMDP）。此外，盘尾丝虫病消除计划与心理健康计划之间的有效合作对于减轻OAE负担至关重要。这种协同作用有望带来互利优势，并凸显了采取综合方法应对这一多方面挑战的必要性。
