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Multicenter Study
. 2018 Oct 8;7(1):79.
doi: 10.1186/s40249-018-0465-9.

Onchocerca volvulus as a risk factor for developing epilepsy in onchocerciasis endemic regions in the Democratic Republic of Congo: a case control study

Michel Mandro  1 , Patrick Suykerbuyk  2 , Floribert Tepage  3 , Degratias Rossy  4 , Francoise Ngave  5 , Mirza Nazmul Hasan  6 , An Hotterbeekx  2 , Germain Mambandu  7 , Jean Marie Kashama  8 , Anne Laudisoit  2   9 , Robert Colebunders  10
Affiliations
Multicenter Study

Onchocerca volvulus as a risk factor for developing epilepsy in onchocerciasis endemic regions in the Democratic Republic of Congo: a case control study

Michel Mandro et al. Infect Dis Poverty. .

Abstract

Background: A high prevalence of epilepsy has been observed in onchocerciasis endemic areas in the Democratic Republic of Congo (DRC). With this study we aimed to investigate whether Onchocerca volvulus infection is a risk factor for developing epilepsy in onchocerciasis endemic regions in the DRC.

Methods: Between October and December 2015, a multi-centre case control study was performed in onchocerciasis endemic health zones (HZ) in the DRC: one study site was situated in Tshopo Province in the HZ of Wanierukula (village of Salambongo) where there had been 13 annual community distributions of treatment with ivermectin (CDTI), a second was situated in Ituri Province in the HZ of Logo (village of Draju) where ivermectin had never been distributed and in the HZ of Rethy (village of Rassia) where there had been THREE CDTI annual campaigns before the study. Individuals with unprovoked convulsive epilepsy of unknown etiology were enrolled as cases (n = 175). Randomly selected healthy members of families without epilepsy cases from the same village and age-groups and were recruited as controls (n = 170).

Results: Onchocerciasis associated symptoms (e.g., itching and abnormal skin) were more often present in cases compared to controls (respectively, OR = 2.63, 95% CI: 1.63-4.23, P < 0.0001 and OR = 3.23, 95% CI: 1.48-7.09, P = 0.0034). A higher number of cases was found to present with microfilariae in skin snips and with O. volvulus IgG4 antibodies in the blood compared to controls. Moreover, the microfilariae load in skin snips was 3-10 times higher in cases than controls.

Conclusions: This case control study confirms that O. volvulus is a risk factor for developing epilepsy in onchocerciasis endemic regions in the DRC.

Keywords: Case control study; Democratic Republic of Congo; Epilepsy; Onchocerciasis; Risk factors.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Institutional Review Board of the University of Kisangani (CER/001/GEAK/2014) and the provincial division of the Ministry of Health, DRC. The purpose and the nature of the investigation were explained to participants or parents/guardians, including risks and benefits of each of the procedures. All participants or parents/guardians provided written informed consent (either by signature or by finger printing if the participant was unable to sign). Authorization to collect, transport and ship biological material were granted by the Faculty of Sciences of the University of Kisangani, DRC.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study sites located in the Ubundu territory in Tshopo Province and the Djugu-Mahagi territories in Ituri Province, DRC
Fig. 2
Fig. 2
Histogram of age of the participants: Cases (left) & Controls (Right)
See this image and copyright information in PMC

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