Prevalence of Neurocysticercosis in People with Epilepsy in the Eastern Province of Zambia.
Zambia is endemic for Taenia solium taeniosis and cysticercosis. In this single-centered, cross-sectional, community-based study, the role of neurocysticercosis (NCC) as a cause of epilepsy was examined. People with epilepsy (PWE, n = 56) were identified in an endemic area using a screening questionnaire followed by in-depth interviews and neurological examination. Computed tomography (CT) was performed on 49 people with active epilepsy (PWAE) and their sera (specific antibody and antigen detection, n = 56) and stools (copro-antigen detection, n = 54) were analyzed. The CT scan findings were compared to a group of 40 CT scan controls. Of the PWE, 39.3% and 23.2% were positive for cysticercal antibodies and antigens, respectively, and 14.8% for coproantigens (taeniosis). Lesions highly suggestive of NCC were detected in 24.5% and definite NCC lesions in 4.1% of CT scans of PWAE. This compares to 2.5% and 0%, respectively, in the control CT scans. Using the Del Brutto diagnostic criteria, 51.8% of the PWAE were diagnosed with probable or definitive NCC and this rose to 57.1% when the adapted criteria, as proposed by Gabriël et al. (adding the sero-antigen ELISA test as a major criterion), were used. There was no statistically significant relationship between NCC, current age, age at first seizure and gender. This study suggests that NCC is the single most important cause of epilepsy in the study area. Additional large-scale studies, combining a community based prevalence study for epilepsy with neuroimaging and serological analysis in different areas are needed to estimate the true impact of neurocysticercosis in endemic regions and efforts should be instituted to the control of T. solium.
Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia.
Kabemba E
KE
Mwape
Department of Neurology, Medical University Center Göttingen, Göttingen, Germany; Department of Neurology, Elbe-Kliniken Stade/Buxtehude GmbH, Stade, Germany.
Joachim
J
Blocher
Europe-University of Flensburg, Flensburg, Germany.
Jasmin
J
Wiefek
Department of Neuroradiology, Medical University Center Göttingen, Göttingen, Germany.
Kathie
K
Schmidt
Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Pierre
P
Dorny
Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Nicolas
N
Praet
Levy Mwanawasa General Hospital, Lusaka, Zambia.
Clarance
C
Chiluba
Department of Neurology, Elbe-Kliniken Stade/Buxtehude GmbH, Stade, Germany.
Holger
H
Schmidt
Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia.
Isaac K
IK
Phiri
Department of Neurology, Technical University Munich, Munich, Germany.
Andrea S
AS
Winkler
Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Sarah
S
Gabriël
D000293:Adolescent; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020019:Neurocysticercosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology