World Health Organization , 2005. Atlas: Epilepsy Care in the World. Geneva, Switzerland: WHO.
Meyer AC , Dua T , Ma J , Saxena S , Birbeck G , 2010. Global disparities in the epilepsy treatment gap: a systematic review. Bull World Health Organ 88: 260–266.
Ngugi AK , Bottomley C , Kleinschmidt I , Sander JW , Newton CR , 2010. Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia 51: 883–890.
Mbuba CK , Ngugi AK , Newton CR , Carter JA , 2008. The epilepsy treatment gap in developing countries: a systematic review of the magnitude, causes, and intervention strategies. Epilepsia 49: 1491–1503.
Carpio A et al., 2005. Mortality of epilepsy in developing countries. Epilepsia 46: 28–32.
2017. GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol 16: 877–897.
Ngugi AK et al., 2013. Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: cross-sectional and case-control studies. Lancet Neurol 12: 253–263.
Edwards T et al., 2008. Active convulsive epilepsy in a rural district of Kenya: a study of prevalence and possible risk factors. Lancet Neurol 7: 50–56.
Garcia HH , Nash TE , Del Brutto OH , 2014. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol 13: 1202–1215.
Montano SM et al., 2005. Neurocysticercosis: association between seizures, serology, and brain CT in rural Peru. Neurology 65: 229–233.
Ndimubanzi PC et al., 2010. A systematic review of the frequency of neurocyticercosis with a focus on people with epilepsy. PLoS Negl Trop Dis 4: e870.
Mwape KE et al., 2015. Prevalence of neurocysticercosis in people with epilepsy in the Eastern Province of Zambia. PLoS Negl Trop Dis 9: e0003972.
Hunter E et al., 2015. Cysticercosis and epilepsy in rural Tanzania: a community-based case-control and imaging study. Trop Med Int Health 20: 1171–1179.
Kamuyu G et al., 2014. Exposure to multiple parasites is associated with the prevalence of active convulsive epilepsy in sub-Saharan Africa. PLoS Negl Trop Dis 8: e2908.
Eshitera E et al., 2012. Prevalence of porcine cysticercosis and associated risk factors in Homa Bay District, Kenya. BMC Vet Res 8: 234.
Thomas LF et al., 2016. Prevalence of Taenia solium cysticercosis in pigs entering the food chain in western Kenya. Trop Anim Health Prod 48: 233–238.
Phiri IK et al., 2003. The emergence of Taenia solium cysticercosis in eastern and southern Africa as a serious agricultural problem and public health risk. Acta Trop 87: 13–23.
Fèvre EM , de Glanville WA , Thomas LF , Cook EAJ , Kariuki S , Wamae CN , 2017. An integrated study of human and animal infectious disease in the Lake Victoria crescent small-holder crop-livestock production system, Kenya. BMC Infect Dis 17: 457.
Wardrop NA et al., 2015. The influence of socio-economic, behavioural and environmental factors on Taenia spp. transmission in western Kenya: evidence from a cross-sectional survey in humans and pigs. PLoS Negl Trop Dis 9: e0004223.
Ngowi HA et al., 2010. Spatial clustering of porcine cysticercosis in Mbulu district, northern Tanzania. PLoS Negl Trop Dis 4: e652.
Madinga J et al., 2017. Geospatial and age-related patterns of Taenia solium taeniasis in the rural health zone of Kimpese, Democratic Republic of Congo. Acta Trop 165: 100–109.
Lescano AG et al., 2018. Clustering of necropsy-confirmed porcine cysticercosis surrounding Taenia solium tapeworm carriers in Peru. Am J Trop Med Hyg 100: 314–322.
Placencia M et al., 1992. Epileptic Seizures in an Andean Region of Ecuador. Brain 115: 771–782.
Mbuba CK et al., 2012. Risk factors associated with the epilepsy treatment gap in Kilifi, Kenya: a cross-sectional study. Lancet Neurol 11: 688–696.
Lhatoo SD , Sander JW , 2005. Cause-specific mortality in epilepsy. Epilepsia 46: 36–39.
Muirhead MR , 1981. Blood sampling in pigs. In Pract 3: 18–20.
Tsang V , Brand J , Boyer A , 1989. An enzyme-linked immunoelectrotransfer blot assay and glycoprotein antigens for diagnosing human cysticercosis (Taenia solium). J Infect Dis 159: 50.
Noh J et al., 2014. Recombinant protein- and synthetic peptide-based immunoblot test for diagnosis of neurocysticercosis. J Clin Microbiol 52: 1429–1434.
Wilkins PP , Wilson M , Allan JC , Tsang VCW , 2002. Taenia solium cysticercosis: immunodiagnosis of neurocysticercosis and taeniasis. In: Singh SP , ed. Taenia solium Cystciercosis: From Basic to Clinical Science. Wallingford, UK: CABI Publishing, 329–341.
Commission on Epidemiology and Prognosis ILAE , 1993. Guidelines for epidemiologic studies on epilepsy. Epilepsia 34: 592–596.
Kale R , 2002. Global Campaign Against Epilepsy: the treatment gap. Epilepsia 43 (Suppl 6): 31–33.
Garcia H , Del Brutto O , Cysticercosis Working Group in Peru , 2005. Neurocysticercosis: updated concepts about an old disease. Lancet Neurol 4: 653–661.
Del Brutto O et al., 2001. Proposed diagnostic criteria for neurocysticercosis. Neurology 57: 177–183.
Mmbando BP et al., 2018. High prevalence of epilepsy in two rural onchocerciasis endemic villages in the Mahenge area, Tanzania, after 20 years of community directed treatment with ivermectin. Infect Dis Poverty 7: 64.
Sebera F et al., 2015. Addressing the treatment gap and societal impact of epilepsy in Rwanda–Results of a survey conducted in 2005 and subsequent actions. Epilepsy Behav 46: 126–132.
Lenaerts E et al., 2018. High prevalence of epilepsy in onchocerciasis endemic health areas in Democratic Republic of the Congo. Infect Dis Poverty 7: 68.
Kariuki SM et al., 2015. Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy. Neurology 84: 1838–1845.
Ngugi AK , Bottomley C , Kleinschmidt I , Sander JW , Newton CR , 2010. Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia 51: 883–890.
Hunter E et al., 2012. Prevalence of active epilepsy in rural Tanzania: a large community-based survey in an adult population. Seizure 21: 691–698.
Ezeala-Adikaibe BA et al., 2016. Prevalence of active convulsive epilepsy in an urban slum in Enugu South East Nigeria. Seizure 35: 100–105.
Wagner RG et al., 2014. Prevalence and risk factors for active convulsive epilepsy in rural northeast South Africa. Epilepsy Res 108: 782–791.
Ae-Ngibise KA et al., 2015. Prevalence and risk factors for active convulsive epilepsy in Kintampo, Ghana. Pan Afr Med J 21: 29.
Meyer AC , Dua T , Boscardin J , Escarce JJ , Saxena S , Birbeck GL , 2012. Critical determinants of the epilepsy treatment gap: a cross-national analysis in resource-limited settings. Epilepsia 53: 2178–2185.
Koba Bora B et al., 2015. Living with epilepsy in Lubumbashi (Democratic Republic of Congo): epidemiology, risk factors and treatment gap. Pan Afr Med J 21: 303.
Nwani PO , Nwosu MC , Enwereji KO , Asomugha AL , Arinzechi EO , Ogunniyi AO , 2013. Epilepsy treatment gap: prevalence and associated factors in southeast Nigeria. Acta Neurol Scand 128: 83–90.
Kakooza-Mwesige A et al., 2017. Adverse perinatal events, treatment gap, and positive family history linked to the high burden of active convulsive epilepsy in Uganda: a population-based study. Epilepsia Open 2: 188–198.
Winkler AS , Blocher J , Auer H , Gotwald T , Matuja W , Schmutzhard E , 2009. Epilepsy and neurocysticercosis in rural Tanzania—an imaging study. Epilepsia 50: 987–993.
Rottbeck R et al., 2013. High prevalence of cysticercosis in people with epilepsy in southern Rwanda. PLoS Negl Trop Dis 14: e2558.
Thys S et al., 2016. Why pigs are free-roaming: communities’ perceptions, knowledge and practices regarding pig management and taeniosis/cysticercosis in a Taenia solium endemic rural area in eastern Zambia. Vet Parasitol 225: 33–42.
Komba EV et al., 2013. Prevalence of porcine cysticercosis and associated risk factors in smallholder pig production systems in Mbeya region, southern highlands of Tanzania. Vet Parasitol 198: 284–291.
Carabin H et al., 2015. Prevalence of and factors associated with human cysticercosis in 60 villages in three provinces of Burkina Faso. PLoS Negl Trop Dis 29: e0004248.
Jayashi CM , Arroyo G , Lightowlers MW , García HH , Rodríguez S , Gonzalez AE , 2012. Seroprevalence and risk factors for Taenia solium cysticercosis in rural pigs of northern Peru. PLoS Negl Trop Dis 6: e1733.
Thomas LF, de Glanville WA, Cook EA, Fèvre EM, 2013. The spatial ecology of free-ranging domestic pigs (Sus scrofa) in western Kenya. BMC Vet Res 9: 46.
Assana E , Lightowlers MW , Zoli AP , Geerts S , 2013. Taenia solium taeniosis/cysticercosis in Africa: risk factors, epidemiology and prospects for control using vaccination. Vet Parasitol 195: 14–23.
Garcia HH et al., 2016. Elimination of Taenia solium transmission in northern Peru. N Engl J Med 374: 2335–2344.
Gauci CG et al., 2019. Accurate diagnosis of lesions suspected of being caused by Taenia solium in body organs of pigs with naturally acquired porcine cysticercosis. PLoS Negl Trop Dis 13: e0007408.
Thurman DJ et al., 2011. Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia 52 (Suppl 7): 2–26.
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Cysticercosis is the leading cause of acquired epilepsy worldwide and has been shown to be highly prevalent in pig populations in western Kenya. We conducted a community-based door-to-door survey in a region of western Kenya with a high proportion of pig-keeping households. Persons with epilepsy (PWE) were determined using a screening questionnaire followed by a neurologist evaluation. Cysticercosis serum apDia antigen ELISAs and Western blot for LLGP and rT24h antigen were performed on all PWE and 2% of screen-negative patients. All PWE or people with positive apDia underwent contrast-enhanced brain computed tomography (CT). Of a sample of 810 village residents, 660 (81%) were present in the homestead, of whom 648 (98%) participated. Of these, 17 were confirmed to have lifetime epilepsy, an estimated crude prevalence of 2.6%. No humans with (N = 17) or without (N = 12) epilepsy had serological evidence of cysticercosis infection. Fourteen PWE and one individual with borderline positive apDia antigen ELISA underwent brain CT; none had radiographic findings consistent with neurocysticercosis. Nearly 30% of households kept pigs, with 69% always tethered in both wet and dry seasons. More than 8% (6/72) of pigs had palpable lingual cysts; these pigs all originated from homesteads with latrines, one-third of which were free-ranging at least some of the time. Epilepsy prevalence in our study was greater than the national prevalence, but we found no individuals with epilepsy attributable to cysticercosis. Additional studies are required to identify causes of epilepsy, human and porcine cysticercosis, the role of spatial clustering, and protective factors like host-pathogen immunity.
These authors are co-senior authors.
Financial support: This study was supported by the Global Health Equity Scholars Program (R25TW009338) and Consultative Group for International Agricultural Research (CGIAR) Program on Agriculture for Nutrition and Health (A4NH) led by International Food Policy Research Institute (IFPRI) (Fèvre). M. M. D. was additionally supported by the Fogarty International Center at the National Institutes of Health (D43TW009343) and by the Alzheimer’s Disease Resource Center for advancing Minority Aging Research at the University of California, San Diego (P30AG059299, National Institute on Aging). D. S. was additionally supported by the International League Against Epilepsy, UK Chapter, Association of British Neurologists, Epilepsy Research UK. L. M. was additionally supported by Fogarty International Center of the National Institutes of Health (K01TW008764).
Authors’ addresses: Monica M. Diaz, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, E-mail: monica.diaz@neurology.unc.edu. Dilraj Sokhi, International Livestock Research Institute, Nairobi, Kenya, E-mail: doxoki@gmail.com. John Noh, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: jxn1@cdc.gov. Anthony K. Ngugi, Aga Khan University East Africa, Nairobi, Kenya, E-mail: anthony.ngugi@aku.edu. Frank J. Minja, Emory School of Medicine, Atlanta, GA, E-mail: frank.minja@emory.edu. Prabhakar Reddi, Aga Khan University East Africa, Nairobi, Kenya, E-mail: prabhakar93@yahoo.com. Eric M. Fèvre, University of Liverpool, Liverpool, UK, and International Livestock Research Institute, Kenya, E-mail: eric.fevre@liverpool.ac.uk. Ana-Claire L. Meyer, Johns Hopkins University School of Medicine, Baltimore, MD, E-mail: ameyer31@jhu.edu.
World Health Organization , 2005. Atlas: Epilepsy Care in the World. Geneva, Switzerland: WHO.
Meyer AC , Dua T , Ma J , Saxena S , Birbeck G , 2010. Global disparities in the epilepsy treatment gap: a systematic review. Bull World Health Organ 88: 260–266.
Ngugi AK , Bottomley C , Kleinschmidt I , Sander JW , Newton CR , 2010. Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia 51: 883–890.
Mbuba CK , Ngugi AK , Newton CR , Carter JA , 2008. The epilepsy treatment gap in developing countries: a systematic review of the magnitude, causes, and intervention strategies. Epilepsia 49: 1491–1503.
Carpio A et al., 2005. Mortality of epilepsy in developing countries. Epilepsia 46: 28–32.
2017. GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol 16: 877–897.
Ngugi AK et al., 2013. Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: cross-sectional and case-control studies. Lancet Neurol 12: 253–263.
Edwards T et al., 2008. Active convulsive epilepsy in a rural district of Kenya: a study of prevalence and possible risk factors. Lancet Neurol 7: 50–56.
Garcia HH , Nash TE , Del Brutto OH , 2014. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol 13: 1202–1215.
Montano SM et al., 2005. Neurocysticercosis: association between seizures, serology, and brain CT in rural Peru. Neurology 65: 229–233.
Ndimubanzi PC et al., 2010. A systematic review of the frequency of neurocyticercosis with a focus on people with epilepsy. PLoS Negl Trop Dis 4: e870.
Mwape KE et al., 2015. Prevalence of neurocysticercosis in people with epilepsy in the Eastern Province of Zambia. PLoS Negl Trop Dis 9: e0003972.
Hunter E et al., 2015. Cysticercosis and epilepsy in rural Tanzania: a community-based case-control and imaging study. Trop Med Int Health 20: 1171–1179.
Kamuyu G et al., 2014. Exposure to multiple parasites is associated with the prevalence of active convulsive epilepsy in sub-Saharan Africa. PLoS Negl Trop Dis 8: e2908.
Eshitera E et al., 2012. Prevalence of porcine cysticercosis and associated risk factors in Homa Bay District, Kenya. BMC Vet Res 8: 234.
Thomas LF et al., 2016. Prevalence of Taenia solium cysticercosis in pigs entering the food chain in western Kenya. Trop Anim Health Prod 48: 233–238.
Phiri IK et al., 2003. The emergence of Taenia solium cysticercosis in eastern and southern Africa as a serious agricultural problem and public health risk. Acta Trop 87: 13–23.
Fèvre EM , de Glanville WA , Thomas LF , Cook EAJ , Kariuki S , Wamae CN , 2017. An integrated study of human and animal infectious disease in the Lake Victoria crescent small-holder crop-livestock production system, Kenya. BMC Infect Dis 17: 457.
Wardrop NA et al., 2015. The influence of socio-economic, behavioural and environmental factors on Taenia spp. transmission in western Kenya: evidence from a cross-sectional survey in humans and pigs. PLoS Negl Trop Dis 9: e0004223.
Ngowi HA et al., 2010. Spatial clustering of porcine cysticercosis in Mbulu district, northern Tanzania. PLoS Negl Trop Dis 4: e652.
Madinga J et al., 2017. Geospatial and age-related patterns of Taenia solium taeniasis in the rural health zone of Kimpese, Democratic Republic of Congo. Acta Trop 165: 100–109.
Lescano AG et al., 2018. Clustering of necropsy-confirmed porcine cysticercosis surrounding Taenia solium tapeworm carriers in Peru. Am J Trop Med Hyg 100: 314–322.
Placencia M et al., 1992. Epileptic Seizures in an Andean Region of Ecuador. Brain 115: 771–782.
Mbuba CK et al., 2012. Risk factors associated with the epilepsy treatment gap in Kilifi, Kenya: a cross-sectional study. Lancet Neurol 11: 688–696.
Lhatoo SD , Sander JW , 2005. Cause-specific mortality in epilepsy. Epilepsia 46: 36–39.
Muirhead MR , 1981. Blood sampling in pigs. In Pract 3: 18–20.
Tsang V , Brand J , Boyer A , 1989. An enzyme-linked immunoelectrotransfer blot assay and glycoprotein antigens for diagnosing human cysticercosis (Taenia solium). J Infect Dis 159: 50.
Noh J et al., 2014. Recombinant protein- and synthetic peptide-based immunoblot test for diagnosis of neurocysticercosis. J Clin Microbiol 52: 1429–1434.
Wilkins PP , Wilson M , Allan JC , Tsang VCW , 2002. Taenia solium cysticercosis: immunodiagnosis of neurocysticercosis and taeniasis. In: Singh SP , ed. Taenia solium Cystciercosis: From Basic to Clinical Science. Wallingford, UK: CABI Publishing, 329–341.
Commission on Epidemiology and Prognosis ILAE , 1993. Guidelines for epidemiologic studies on epilepsy. Epilepsia 34: 592–596.
Kale R , 2002. Global Campaign Against Epilepsy: the treatment gap. Epilepsia 43 (Suppl 6): 31–33.
Garcia H , Del Brutto O , Cysticercosis Working Group in Peru , 2005. Neurocysticercosis: updated concepts about an old disease. Lancet Neurol 4: 653–661.
Del Brutto O et al., 2001. Proposed diagnostic criteria for neurocysticercosis. Neurology 57: 177–183.
Mmbando BP et al., 2018. High prevalence of epilepsy in two rural onchocerciasis endemic villages in the Mahenge area, Tanzania, after 20 years of community directed treatment with ivermectin. Infect Dis Poverty 7: 64.
Sebera F et al., 2015. Addressing the treatment gap and societal impact of epilepsy in Rwanda–Results of a survey conducted in 2005 and subsequent actions. Epilepsy Behav 46: 126–132.
Lenaerts E et al., 2018. High prevalence of epilepsy in onchocerciasis endemic health areas in Democratic Republic of the Congo. Infect Dis Poverty 7: 68.
Kariuki SM et al., 2015. Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy. Neurology 84: 1838–1845.
Ngugi AK , Bottomley C , Kleinschmidt I , Sander JW , Newton CR , 2010. Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia 51: 883–890.
Hunter E et al., 2012. Prevalence of active epilepsy in rural Tanzania: a large community-based survey in an adult population. Seizure 21: 691–698.
Ezeala-Adikaibe BA et al., 2016. Prevalence of active convulsive epilepsy in an urban slum in Enugu South East Nigeria. Seizure 35: 100–105.
Wagner RG et al., 2014. Prevalence and risk factors for active convulsive epilepsy in rural northeast South Africa. Epilepsy Res 108: 782–791.
Ae-Ngibise KA et al., 2015. Prevalence and risk factors for active convulsive epilepsy in Kintampo, Ghana. Pan Afr Med J 21: 29.
Meyer AC , Dua T , Boscardin J , Escarce JJ , Saxena S , Birbeck GL , 2012. Critical determinants of the epilepsy treatment gap: a cross-national analysis in resource-limited settings. Epilepsia 53: 2178–2185.
Koba Bora B et al., 2015. Living with epilepsy in Lubumbashi (Democratic Republic of Congo): epidemiology, risk factors and treatment gap. Pan Afr Med J 21: 303.
Nwani PO , Nwosu MC , Enwereji KO , Asomugha AL , Arinzechi EO , Ogunniyi AO , 2013. Epilepsy treatment gap: prevalence and associated factors in southeast Nigeria. Acta Neurol Scand 128: 83–90.
Kakooza-Mwesige A et al., 2017. Adverse perinatal events, treatment gap, and positive family history linked to the high burden of active convulsive epilepsy in Uganda: a population-based study. Epilepsia Open 2: 188–198.
Winkler AS , Blocher J , Auer H , Gotwald T , Matuja W , Schmutzhard E , 2009. Epilepsy and neurocysticercosis in rural Tanzania—an imaging study. Epilepsia 50: 987–993.
Rottbeck R et al., 2013. High prevalence of cysticercosis in people with epilepsy in southern Rwanda. PLoS Negl Trop Dis 14: e2558.
Thys S et al., 2016. Why pigs are free-roaming: communities’ perceptions, knowledge and practices regarding pig management and taeniosis/cysticercosis in a Taenia solium endemic rural area in eastern Zambia. Vet Parasitol 225: 33–42.
Komba EV et al., 2013. Prevalence of porcine cysticercosis and associated risk factors in smallholder pig production systems in Mbeya region, southern highlands of Tanzania. Vet Parasitol 198: 284–291.
Carabin H et al., 2015. Prevalence of and factors associated with human cysticercosis in 60 villages in three provinces of Burkina Faso. PLoS Negl Trop Dis 29: e0004248.
Jayashi CM , Arroyo G , Lightowlers MW , García HH , Rodríguez S , Gonzalez AE , 2012. Seroprevalence and risk factors for Taenia solium cysticercosis in rural pigs of northern Peru. PLoS Negl Trop Dis 6: e1733.
Thomas LF, de Glanville WA, Cook EA, Fèvre EM, 2013. The spatial ecology of free-ranging domestic pigs (Sus scrofa) in western Kenya. BMC Vet Res 9: 46.
Assana E , Lightowlers MW , Zoli AP , Geerts S , 2013. Taenia solium taeniosis/cysticercosis in Africa: risk factors, epidemiology and prospects for control using vaccination. Vet Parasitol 195: 14–23.
Garcia HH et al., 2016. Elimination of Taenia solium transmission in northern Peru. N Engl J Med 374: 2335–2344.
Gauci CG et al., 2019. Accurate diagnosis of lesions suspected of being caused by Taenia solium in body organs of pigs with naturally acquired porcine cysticercosis. PLoS Negl Trop Dis 13: e0007408.
Thurman DJ et al., 2011. Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia 52 (Suppl 7): 2–26.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 2727 | 1733 | 123 |
Full Text Views | 146 | 13 | 0 |
PDF Downloads | 101 | 11 | 0 |