Global Burden of Disease 2016 Epilepsy Collaborators , 2019. Global, regional, and national burden of epilepsy, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 18: 357–375.
Daras M, Tuchman AJ, Strobos RJ, 1987. Computed tomography in adult onset epileptic seizures in a city hospital population. Epilepsia 28: 519–522.
Dam AM, Fuglsang-Frederiksen A, Svarre-Olsen U, Dam M, 1985. Late-onset epilepsy: etiologies, types of seizures, and value of clinical investigation, EEG, and computerized tomography scan. Epilepsia 26: 227–231.
Caprana ALF, Rissardo JP, Leite MTB, Silveira JOF, Jauris PGM, Arend J, Kegler A, Freire Royes LF, Rechi Fighera M, 2020. Course and prognosis of adult-onset epilepsy in Brazil: a cohort-study. Epilepsy Behav 105: 106969.
Del Brutto OH, Noboa CA, 1991. Late-onset epilepsy in Ecuador: aetiology and clinical features in 225 patients. J Trop Geogr Neurol 1: 31–34.
Medina MT, Rosas E, Rubio-Donnadieu F, Sotelo J, 1990. Neurocysticercosis as the main cause of late-onset epilepsy in Mexico. Arch Intern Med 150: 323–325.
Paradowski B, Zagrajek MM, 2005. Epilepsy in middle-aged and elderly people: a three-year observation. Epileptic Disord 7: 91–95.
Burneo JG, Tellez-Zenteno J, Steven DA, Niaz N, Hader W, Pillay N, Wiebe S, 2008. Adult-onset epilepsy associated with dysembryoplastic neuroepithelial tumors. Seizure 17: 498–504.
Graham NS, Crichton S, Koutroumanidis M, Wolfe CD, Rudd AG, 2013. Incidence and associations of poststroke epilepsy: the prospective South London Stroke Register. Stroke 44: 605–611.
Lezaic N, Roussy J, Masson H, Jetté N, Keezer MR, 2020. Epilepsy in the elderly: unique challenges in an increasing prevalent population. Epilepsy Behav 102: 106724.
Luhdorf K, Jensen LK, Plesner AM, 1986. Etiology of seizures in the elderly. Epilepsia 27: 458–463.
Szaflarski JP, Rackley AY, Kleindorfer DO, Khoury J, Woo D, Miller R, Alwell K, Broderick JP, Kissela M, 2008. Incidence of seizures in the acute phase of stroke: a population-based study. Epilepsia 49: 974–981.
von Podewils F, Suesse M, Geithner J, Gaida B, Wang ZI, Lange J, 2017. Prevalence and outcome of late-onset seizures due to autoimmune etiology: a prospective observational population-based cohort study. Epilepsia 58: 1542–1550.
Forsgren L, Buth G, Eriksson S, Bregmark L, 1996. Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study. Epilepsia 37: 224–229.
Kaiboriboon K, Bakaki PM, Lhatoo SD, Koroukian S, 2013. Incidence and prevalence of treated epilepsy among poor health and low-income Americans. Neurology 80: 1942–1949.
Loiseau J, Loiseau P, Duché B, Guyot M, Daretigues JF, Aublet B, 1990. A survey of epileptic disorders in southwest France: seizures in elderly patients. Ann Neurol 27: 232–237.
Bruno E, Bartoloni A, Zammarchi L, Strohmeyer M, Bartalesi F, Bustos JA, Santivañez S, García HH, Nicoletti A, COHEMI Project Study Group , 2013. Epilepsy and neurocysticercosis in Latin America: a systematic review and meta-analysis. PLoS Negl Trop Dis 7: e2480.
Debacq G, Moyano LM, Garcia HH, Boumediene F, Marin B, Ngoungou EB, Preux PM, 2017. Systematic review and meta-analysis estimating association of cysticercosis and neurocysticercosis with epilepsy. PLoS Negl Trop Dis 11: e0005153.
Fiest KM, Birbeck GL, Jacoby A, Jette N, 2014. Stigma in epilepsy. Curr Neurol Neurosci Rep 14: 444.
Burneo JG, Tellez-Zenteno J, Wiebe S, 2005. Understanding the burden of epilepsy in Latin America: a systematic review of its prevalence and incidence. Epilepsy Res 66: 63–74.
Del Brutto OH, Mera RM, for the Atahualpa Project Investigators , 2016. The importance of people compliance (social desirability bias) in the assessment of epilepsy in rural areas of developing countries. Results of the Atahualpa Project. Epilepsia 57: e221–e224.
Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, Pringsheim T, Lorenzetti DL, Jetté N, 2017. Prevalence and incidence of epilepsy. A systematic review and meta-analysis of international studies. Neurology 88: 296–303.
Hu J et al.2014. Prevalence and treatment gap of active convulsive epilepsy: a large community-based survey in rural West China. Seizure 23: 333–337.
Hunter E et al.2016. The epilepsy treatment gap in rural Tanzania: a community-based study in adults. Seizure 36: 49–56.
Mogal Z, Aziz H, 2020. Epilepsy treatment gap and stigma reduction in Pakistan: a tested public awareness model. Epilepsy Behav 102: 106637.
Del Brutto OH, Mera RM, Peralta LD, Hill JP, Generale LM, Torpey AP, Sedler MJ, 2020. Cardiovascular health status among community-dwelling Ecuadorian natives living in neighboring rural communities: the Three Villages Study. J Community Health 45: 154–160.
Del Brutto OH, Arroyo G, Del Brutto VJ, Zambrano M, Garcia HH, 2017. On the relationship between calcified neurocysticercosis and epilepsy in an endemic village: a large-scale, computed tomography-based population study in rural Ecuador. Epilepsia 58: 1955–1961.
Del Brutto OH, Zambrano M, 2017. Atahualpa, una población rural ideal para la práctica de estudios epidemiológicos. Rev Ecuat Neurol 26: 88–94.
Placencia M, Sander JW, Shorvon SD, Ellison RH, Cascante SM, 1992. Validation of a screening questionnaire for the detection of epileptic seizures in epidemiological studies. Brain 115: 783–794.
Del Brutto OH, Castillo PR, Sedler MJ, Del Brutto VJ, Zambrano M, Mera RM, Wright CB, Rundek T, 2018. Reasons for declining consent in a population-based cohort study conducted in a rural South American community. J Environ Public Health 2018: 8267948.
International Working Group for Disease Monitoring and Forecasting , 1995. Capture-recapture and multiple-record systems estimation I: history and theoretical development. Am J Epidemiol 142: 1047–1058.
von Elm E, Altman G, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, STROBE Initiative , 2007. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370: 1437–1457.
Issa NP, Sedler MJ, Del Brutto VJ, Darsan E, Milla L, Montes J, Zambrano M, Del Brutto OH, 2018. EEG patterns in patients with calcified neurocysticercosis with and without hippocampal atrophy. J Clin Neurophysiol 35: 332–338.
Del Brutto OH, Costa AF, Mera RM, Recalde BY, Bustos JA, Garcia HH, 2021. SARS-CoV-2 in rural Latin America. A population-based study in coastal Ecuador. Clin Infect Dis 73: 314–317.
Del Brutto OH, Nash TE, White AC Jr., Rajshekhar V, Wilkins PP, Singh G, Vasquez CM, Salgado P, Gilman RH, García HH, 2017. Revised diagnostic criteria for neurocysticercosis. J Neurol Sci 372: 202–210.
Del Brutto OH, Salgado P, Lama J, Del Brutto VJ, Campos X, Zambrano M, García HH, 2015. Calcified neurocysticercosis associates with hippocampal atrophy: a population-based study. Am J Trop Med Hyg 92: 64–68.
Del Brutto OH, Engel J Jr, Eliashiv DS, Salamon N, García HH, 2014. Hippocampal sclerosis: the missing link of cysticercosis epileptogenesis? Epilepsia 55: 2077–2078.
Beghi E, 2020. The epidemiology of epilepsy. Neuroepidemiology 54: 185–191.
Alva-Díaz C et al.2021. Prevalence and incidence of Epilepsy in Latin America and the Caribbean: a systematic review and meta-analysis of population-based studies. Epilepsia 62: 984–996.
Nunes ML, Cosalter Geib LT, Apego G, 2011. Incidence of epilepsy and seizure disorders in childhood and association with social determinants: a birth cohort stud. J Pediatr 87: 50–56.
Bruno E, Quattrocchi G, Crespo Gomes EB, Sofia V, Padilla S, Camargo M, Zappia M, Bartoloni A, Nicoletti A, 2015. Prevalence and incidence of epilepsy associated with convulsive seizures in rural Bolivia. A Global Campaign Against Epilepsy Project. PLoS One 10: e0139108.
Lavados J, Germain L, Morales A, Campero M, Lavados P, 1992. A descriptive study of epilepsy in the district of El Salvador, Chile, 1984–1988. Acta Neurol Scand 85: 249–256.
Medina MT et al.2011. Reduction in rate of epilepsy from neurocysticercosis by community interventions: the Salamá, Honduras study. Epilepsia 52: 1177–1185.
Placencia M, 1992. Incidencia de crisis epilépticas en la Sierra Norte Ecuatoriana: un perfil epidemiológico, 1984–1989. Rev Ecuat Neurol 1: 72–76.
Villarán MV, Montano SM, Gonzalvez G, Moyano LM, Chero JC, Rodriguez S, Gonzalez AE, Pan W, Tsang VCW, Gilman RH, García HH, Cysticercosis Working Group in Perú , 2009. Epilepsy and neurocysticercosis: an incidence study in a Peruvian rural population. Neuroepidemiology 33: 25–31.
Placencia M, Shorvon SD, Paredes V, Bimos C, Sander JW, Suarez J, Cascante SM, 1992. Epileptic seizures in an Andean region of Ecuador. Incidence and prevalence and regional variation. Brain 115: 771–782.
Murthy JMK, Jaiswal SK, Reddy MP, Srikrishna S, 2020. Incidence study of epilepsy using the ILAE 2017 classification of epilepsies in a cohort of school children accessing education in government primary schools in south India. Neurol India 68: 1389–1393.
Abramovici S, Bagic A, 2016. Epidemiology of epilepsy. Handb Clin Neurol 138: 159–171.
Nash TE et al.2004. Calcific neurocysticercosis and epileptogenesis. Neurology 62: 1934–1938.
Nash TE et al.2015. Neurocysticercosis: a natural human model of epileptogenesis. Epilepsia 56: 177–183.
Singh G, Singh P, Singh I, Rani A, Kaushal S, Avasthi G, 2006. Epidemiologic classification of seizures associated with neurocysticercosis: observations from a sample of seizure disorders in neurologic care in India. Acta Neurol Scand 113: 233–240.
Bustos JA et al.2020. Frequency and determinant factors for calcification in neurocysticercosis. Clin Infect Dis. doi: 10.1093/cid/ciaa784.
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This prospective cohort study aimed to assess incidence and etiology of adult-onset epilepsy in previously seizure-free Atahualpa residents aged ≥ 20 years. Persons with adult-onset epilepsy occurring over 5 years were identified from annual door-to-door surveys and other overlapping sources. Those who emigrated or declined consent were excluded at the administrative censoring date of the last survey when these subjects were interviewed. Persons who died and those who developed incident epilepsy were censored at the time of these outcomes. Poisson regression models adjusted for demographics, education, alcohol intake, and the length of observation time, were used to estimate annual adult-onset epilepsy incidence rate ratio and cumulative incidence. Systematic neuroimaging screening was offered to participants to get insights on the etiology of epilepsy. Individuals enrolled in this cohort (N = 1,480) contributed to 6,811.6 years of follow-up. Seventeen developed incident adult-onset epilepsy, for an annual incident rate of 249.2 per 100,000 persons-year (95% CI: 130.7–367.7). Cumulative incidence was 1,245.9 per 100,000 persons (95% CI: 653.7–1,838.3) after a mean of 4.6 (SE: 0.06) years of follow-up. Six persons with incident epilepsy had neurocysticercosis (35%). Individuals with neurocysticercosis were six times more likely to develop adult-onset epilepsy than those without this disease (IRR: 6.01; 95% CI: 2.16–16.7), after adjusting for relevant covariates. The attributable fraction of incident adult-onset epilepsy due to neurocysticercosis was 30.9% (95% CI: 25.6–46.2%). This rural Ecuadorian population has a high incidence of adult-onset epilepsy, with neurocysticercosis being an important contributory cause.
Funding support: This study was supported by Universidad Espíritu Santo—Ecuador. The sponsor had no role in the design of the study, nor in data collection or analyses.
Authors’ addresses: Oscar H. Del Brutto, School of Medicine, Universidad Espíritu Santo—Ecuador, Samborondón, Ecuador, E-mail: oscardelbrutto@hotmail.com. Bettsy Y. Recalde, Community Center, The Atahualpa Project, Atahualpa, Ecuador, E-mail: bettsyr@hotmail.es. Robertino M. Mera, Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, E-mail: rmm17189@gmail.com.
Global Burden of Disease 2016 Epilepsy Collaborators , 2019. Global, regional, and national burden of epilepsy, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 18: 357–375.
Daras M, Tuchman AJ, Strobos RJ, 1987. Computed tomography in adult onset epileptic seizures in a city hospital population. Epilepsia 28: 519–522.
Dam AM, Fuglsang-Frederiksen A, Svarre-Olsen U, Dam M, 1985. Late-onset epilepsy: etiologies, types of seizures, and value of clinical investigation, EEG, and computerized tomography scan. Epilepsia 26: 227–231.
Caprana ALF, Rissardo JP, Leite MTB, Silveira JOF, Jauris PGM, Arend J, Kegler A, Freire Royes LF, Rechi Fighera M, 2020. Course and prognosis of adult-onset epilepsy in Brazil: a cohort-study. Epilepsy Behav 105: 106969.
Del Brutto OH, Noboa CA, 1991. Late-onset epilepsy in Ecuador: aetiology and clinical features in 225 patients. J Trop Geogr Neurol 1: 31–34.
Medina MT, Rosas E, Rubio-Donnadieu F, Sotelo J, 1990. Neurocysticercosis as the main cause of late-onset epilepsy in Mexico. Arch Intern Med 150: 323–325.
Paradowski B, Zagrajek MM, 2005. Epilepsy in middle-aged and elderly people: a three-year observation. Epileptic Disord 7: 91–95.
Burneo JG, Tellez-Zenteno J, Steven DA, Niaz N, Hader W, Pillay N, Wiebe S, 2008. Adult-onset epilepsy associated with dysembryoplastic neuroepithelial tumors. Seizure 17: 498–504.
Graham NS, Crichton S, Koutroumanidis M, Wolfe CD, Rudd AG, 2013. Incidence and associations of poststroke epilepsy: the prospective South London Stroke Register. Stroke 44: 605–611.
Lezaic N, Roussy J, Masson H, Jetté N, Keezer MR, 2020. Epilepsy in the elderly: unique challenges in an increasing prevalent population. Epilepsy Behav 102: 106724.
Luhdorf K, Jensen LK, Plesner AM, 1986. Etiology of seizures in the elderly. Epilepsia 27: 458–463.
Szaflarski JP, Rackley AY, Kleindorfer DO, Khoury J, Woo D, Miller R, Alwell K, Broderick JP, Kissela M, 2008. Incidence of seizures in the acute phase of stroke: a population-based study. Epilepsia 49: 974–981.
von Podewils F, Suesse M, Geithner J, Gaida B, Wang ZI, Lange J, 2017. Prevalence and outcome of late-onset seizures due to autoimmune etiology: a prospective observational population-based cohort study. Epilepsia 58: 1542–1550.
Forsgren L, Buth G, Eriksson S, Bregmark L, 1996. Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study. Epilepsia 37: 224–229.
Kaiboriboon K, Bakaki PM, Lhatoo SD, Koroukian S, 2013. Incidence and prevalence of treated epilepsy among poor health and low-income Americans. Neurology 80: 1942–1949.
Loiseau J, Loiseau P, Duché B, Guyot M, Daretigues JF, Aublet B, 1990. A survey of epileptic disorders in southwest France: seizures in elderly patients. Ann Neurol 27: 232–237.
Bruno E, Bartoloni A, Zammarchi L, Strohmeyer M, Bartalesi F, Bustos JA, Santivañez S, García HH, Nicoletti A, COHEMI Project Study Group , 2013. Epilepsy and neurocysticercosis in Latin America: a systematic review and meta-analysis. PLoS Negl Trop Dis 7: e2480.
Debacq G, Moyano LM, Garcia HH, Boumediene F, Marin B, Ngoungou EB, Preux PM, 2017. Systematic review and meta-analysis estimating association of cysticercosis and neurocysticercosis with epilepsy. PLoS Negl Trop Dis 11: e0005153.
Fiest KM, Birbeck GL, Jacoby A, Jette N, 2014. Stigma in epilepsy. Curr Neurol Neurosci Rep 14: 444.
Burneo JG, Tellez-Zenteno J, Wiebe S, 2005. Understanding the burden of epilepsy in Latin America: a systematic review of its prevalence and incidence. Epilepsy Res 66: 63–74.
Del Brutto OH, Mera RM, for the Atahualpa Project Investigators , 2016. The importance of people compliance (social desirability bias) in the assessment of epilepsy in rural areas of developing countries. Results of the Atahualpa Project. Epilepsia 57: e221–e224.
Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, Pringsheim T, Lorenzetti DL, Jetté N, 2017. Prevalence and incidence of epilepsy. A systematic review and meta-analysis of international studies. Neurology 88: 296–303.
Hu J et al.2014. Prevalence and treatment gap of active convulsive epilepsy: a large community-based survey in rural West China. Seizure 23: 333–337.
Hunter E et al.2016. The epilepsy treatment gap in rural Tanzania: a community-based study in adults. Seizure 36: 49–56.
Mogal Z, Aziz H, 2020. Epilepsy treatment gap and stigma reduction in Pakistan: a tested public awareness model. Epilepsy Behav 102: 106637.
Del Brutto OH, Mera RM, Peralta LD, Hill JP, Generale LM, Torpey AP, Sedler MJ, 2020. Cardiovascular health status among community-dwelling Ecuadorian natives living in neighboring rural communities: the Three Villages Study. J Community Health 45: 154–160.
Del Brutto OH, Arroyo G, Del Brutto VJ, Zambrano M, Garcia HH, 2017. On the relationship between calcified neurocysticercosis and epilepsy in an endemic village: a large-scale, computed tomography-based population study in rural Ecuador. Epilepsia 58: 1955–1961.
Del Brutto OH, Zambrano M, 2017. Atahualpa, una población rural ideal para la práctica de estudios epidemiológicos. Rev Ecuat Neurol 26: 88–94.
Placencia M, Sander JW, Shorvon SD, Ellison RH, Cascante SM, 1992. Validation of a screening questionnaire for the detection of epileptic seizures in epidemiological studies. Brain 115: 783–794.
Del Brutto OH, Castillo PR, Sedler MJ, Del Brutto VJ, Zambrano M, Mera RM, Wright CB, Rundek T, 2018. Reasons for declining consent in a population-based cohort study conducted in a rural South American community. J Environ Public Health 2018: 8267948.
International Working Group for Disease Monitoring and Forecasting , 1995. Capture-recapture and multiple-record systems estimation I: history and theoretical development. Am J Epidemiol 142: 1047–1058.
von Elm E, Altman G, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, STROBE Initiative , 2007. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370: 1437–1457.
Issa NP, Sedler MJ, Del Brutto VJ, Darsan E, Milla L, Montes J, Zambrano M, Del Brutto OH, 2018. EEG patterns in patients with calcified neurocysticercosis with and without hippocampal atrophy. J Clin Neurophysiol 35: 332–338.
Del Brutto OH, Costa AF, Mera RM, Recalde BY, Bustos JA, Garcia HH, 2021. SARS-CoV-2 in rural Latin America. A population-based study in coastal Ecuador. Clin Infect Dis 73: 314–317.
Del Brutto OH, Nash TE, White AC Jr., Rajshekhar V, Wilkins PP, Singh G, Vasquez CM, Salgado P, Gilman RH, García HH, 2017. Revised diagnostic criteria for neurocysticercosis. J Neurol Sci 372: 202–210.
Del Brutto OH, Salgado P, Lama J, Del Brutto VJ, Campos X, Zambrano M, García HH, 2015. Calcified neurocysticercosis associates with hippocampal atrophy: a population-based study. Am J Trop Med Hyg 92: 64–68.
Del Brutto OH, Engel J Jr, Eliashiv DS, Salamon N, García HH, 2014. Hippocampal sclerosis: the missing link of cysticercosis epileptogenesis? Epilepsia 55: 2077–2078.
Beghi E, 2020. The epidemiology of epilepsy. Neuroepidemiology 54: 185–191.
Alva-Díaz C et al.2021. Prevalence and incidence of Epilepsy in Latin America and the Caribbean: a systematic review and meta-analysis of population-based studies. Epilepsia 62: 984–996.
Nunes ML, Cosalter Geib LT, Apego G, 2011. Incidence of epilepsy and seizure disorders in childhood and association with social determinants: a birth cohort stud. J Pediatr 87: 50–56.
Bruno E, Quattrocchi G, Crespo Gomes EB, Sofia V, Padilla S, Camargo M, Zappia M, Bartoloni A, Nicoletti A, 2015. Prevalence and incidence of epilepsy associated with convulsive seizures in rural Bolivia. A Global Campaign Against Epilepsy Project. PLoS One 10: e0139108.
Lavados J, Germain L, Morales A, Campero M, Lavados P, 1992. A descriptive study of epilepsy in the district of El Salvador, Chile, 1984–1988. Acta Neurol Scand 85: 249–256.
Medina MT et al.2011. Reduction in rate of epilepsy from neurocysticercosis by community interventions: the Salamá, Honduras study. Epilepsia 52: 1177–1185.
Placencia M, 1992. Incidencia de crisis epilépticas en la Sierra Norte Ecuatoriana: un perfil epidemiológico, 1984–1989. Rev Ecuat Neurol 1: 72–76.
Villarán MV, Montano SM, Gonzalvez G, Moyano LM, Chero JC, Rodriguez S, Gonzalez AE, Pan W, Tsang VCW, Gilman RH, García HH, Cysticercosis Working Group in Perú , 2009. Epilepsy and neurocysticercosis: an incidence study in a Peruvian rural population. Neuroepidemiology 33: 25–31.
Placencia M, Shorvon SD, Paredes V, Bimos C, Sander JW, Suarez J, Cascante SM, 1992. Epileptic seizures in an Andean region of Ecuador. Incidence and prevalence and regional variation. Brain 115: 771–782.
Murthy JMK, Jaiswal SK, Reddy MP, Srikrishna S, 2020. Incidence study of epilepsy using the ILAE 2017 classification of epilepsies in a cohort of school children accessing education in government primary schools in south India. Neurol India 68: 1389–1393.
Abramovici S, Bagic A, 2016. Epidemiology of epilepsy. Handb Clin Neurol 138: 159–171.
Nash TE et al.2004. Calcific neurocysticercosis and epileptogenesis. Neurology 62: 1934–1938.
Nash TE et al.2015. Neurocysticercosis: a natural human model of epileptogenesis. Epilepsia 56: 177–183.
Singh G, Singh P, Singh I, Rani A, Kaushal S, Avasthi G, 2006. Epidemiologic classification of seizures associated with neurocysticercosis: observations from a sample of seizure disorders in neurologic care in India. Acta Neurol Scand 113: 233–240.
Bustos JA et al.2020. Frequency and determinant factors for calcification in neurocysticercosis. Clin Infect Dis. doi: 10.1093/cid/ciaa784.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 1143 | 505 | 138 |
Full Text Views | 106 | 42 | 0 |
PDF Downloads | 67 | 13 | 0 |