Bhwana Dan, Amaral Luís-Jorge, Kamoen Olivia, Mhina Athanas, Mushi Vivian, Makunde William, Matuja William, Mpogole Meshack, Mmbando Bruno P, Colebunders Robert
National Institute for Medical Research, Tanga, Tanzania.
Global Health Institute, University of Antwerp, Antwerp, Belgium.
Epilepsia. 2025 Mar;66(3):739-752. doi: 10.1111/epi.18230. Epub 2024 Dec 19.
In onchocerciasis-endemic areas, limited access to antiseizure medications (ASMs) contributes to a high epilepsy burden. This study evaluated the impact of a community-based epilepsy care program in Mahenge, Tanzania, an onchocerciasis-endemic area with high epilepsy prevalence.
A baseline survey (2017-2018) identified persons with epilepsy (PWE) in four rural villages. Subsequently, PWE were invited to enroll in the epilepsy treatment program (2019-2022), where trained community health workers (CHWs) screened for epilepsy, promoted ivermectin intake to treat onchocerciasis, distributed ASMs, and monitored seizure frequency and ASM adherence monthly under supervision from the project clinician trained in epilepsy diagnosis and treatment. A concluding survey (2022) collected sociodemographic data and participants' status as alive, deceased, or lost to follow-up. Mixed-effects negative binomial regression analyzed risk factors for weekly seizure incidence rate.
Of 206 participants, 77.7% reported bilateral tonic-clonic seizures, and 32.0% reported focal seizures. More than one third (38.5%) were suspected of having nodding syndrome. Weekly seizure frequency decreased significantly from a mean of 1.9 seizures (interquartile range [IQR] = 0-2) at enrollment to .4 seizures (IQR = 0-0) at the last follow-up (Wilcoxon test p < .0001), with significantly improved ASM adherence (57.5%-94.7%, McNemar test p < .0001). Factors associated with lower weekly seizure incidence included longer program participation, ASM adherence, carbamazepine use compared to phenobarbital, and ivermectin intake in 2022. ASM adverse events were associated with increased seizure frequency. The mortality rate was 32.7 deaths per 1000 person-years, with most deceased not fully adhering to ASM (88%) and having epilepsy-related causes of death (60%).
The community-based program using CHWs was associated with a significant reduction in seizure frequency and improved ASM adherence. In onchocerciasis-endemic areas, it should be investigated whether carbamazepine should be a preferred ASM in PWE. Ivermectin's impact on seizure frequency merits further investigation in onchocerciasis-endemic areas. Community-based epilepsy care is a promising strategy for scaling up epilepsy care in rural areas in Africa.
在盘尾丝虫病流行地区，抗癫痫药物（ASMs）的可及性有限导致癫痫负担沉重。本研究评估了坦桑尼亚马亨盖（一个盘尾丝虫病流行且癫痫患病率高的地区）一项基于社区的癫痫护理项目的影响。
一项基线调查（2017 - 2018年）在四个乡村确定了癫痫患者（PWE）。随后，邀请PWE参加癫痫治疗项目（2019 - 2022年），在此项目中，经过培训的社区卫生工作者（CHWs）筛查癫痫、推广使用伊维菌素治疗盘尾丝虫病、分发抗癫痫药物，并在接受癫痫诊断和治疗培训的项目临床医生的监督下每月监测癫痫发作频率和抗癫痫药物依从性。一项总结性调查（2022年）收集了社会人口学数据以及参与者的存活、死亡或失访状态。混合效应负二项回归分析了每周癫痫发作发生率的危险因素。
在206名参与者中，77.7%报告有双侧强直阵挛发作，32.0%报告有局灶性发作。超过三分之一（38.5%）被怀疑患有点头综合征。每周癫痫发作频率从入组时的平均1.9次发作（四分位间距[IQR]=0 - 2）显著降至最后一次随访时的0.4次发作（IQR = 0 - 0）（Wilcoxon检验p < 0.0001），抗癫痫药物依从性显著提高（57.5% - 94.7%，McNemar检验p < 0.0001）。与较低的每周癫痫发作发生率相关的因素包括参与项目时间更长、抗癫痫药物依从性、与苯巴比妥相比使用卡马西平以及2022年服用伊维菌素。抗癫痫药物不良事件与癫痫发作频率增加有关。死亡率为每1000人年32.7例死亡，大多数死亡者未完全坚持服用抗癫痫药物（88%）且有与癫痫相关的死亡原因（60%）。
使用社区卫生工作者的基于社区的项目与癫痫发作频率显著降低和抗癫痫药物依从性提高相关。在盘尾丝虫病流行地区，应研究卡马西平是否应成为癫痫患者首选的抗癫痫药物。伊维菌素对癫痫发作频率的影响值得在盘尾丝虫病流行地区进一步研究。基于社区的癫痫护理是在非洲农村地区扩大癫痫护理的一项有前景的策略。
