title: Systematic review and meta-analysis estimating association of cysticercosis and neurocysticercosis with epilepsy.
abstract: We reviewed studies that analyzed cysticercosis (CC), neurocysticercosis (NCC) and epilepsy across Latin America, Asia and Sub-Saharan Africa, to estimate the odds ratio and etiologic fraction of epilepsy due to CC in tropical regions.
  
  
  
  We conducted a systematic review of the literature on cysticercosis and epilepsy in the tropics, collecting data from case-control and cross-sectional studies. Exposure criteria for CC included one or more of the following: serum ELISA or EITB positivity, presence of subcutaneous cysts (both not verified and unverified by histology), histology consistent with calcified cysts, and brain CT scan consistent with NCC. A common odds-ratio was then estimated using meta-analysis.
  
  
  
  37 studies from 23 countries were included (n = 24,646 subjects, 14,934 with epilepsy and 9,712 without epilepsy). Of these, 29 were case-control (14 matched). The association between CC and epilepsy was significant in 19 scientific articles. Odds ratios ranged from 0.2 to 25.4 (a posteriori power 4.5-100%) and the common odds ratio was 2.7 (95% CI 2.1-3.6, p <0.001). Three subgroup analyses performed gave odds ratios as: 2.2 (EITB-based studies), 3.2 (CT-based studies), 1.9 (neurologist-confirmed epilepsy; door-to-door survey and at least one matched control per case). Etiologic fraction was estimated to be 63% in the exposed group among the population.
  
  
  
  Despite differences in findings, this meta-analysis suggests that cysticercosis is a significant contributor to late-onset epilepsy in tropical regions around the world, and its impact may vary depending on transmission intensity.
authors.affiliation: INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Debacq
authors.affiliation: INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.|Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Perú.|Epidemiology Unit. Hospital Regional II-2 Tumbes, Perú.
authors.forename: Luz M
authors.identifier: 0000-0002-5878-5782
authors.initials: LM
authors.lastname: Moyano
authors.affiliation: Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Perú.|Instituto Nacional de Ciencias Neurológicas. Unidad de Cisticercosis. Lima, Perú.
authors.forename: Héctor H
authors.initials: HH
authors.lastname: Garcia
authors.affiliation: INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.
authors.forename: Farid
authors.initials: F
authors.lastname: Boumediene
authors.affiliation: INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Marin
authors.affiliation: INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.|Université des Sciences de la Santé, EA NEMIT, Faculté de Médecine, Libreville, Gabon.
authors.forename: Edgard B
authors.initials: EB
authors.lastname: Ngoungou
authors.affiliation: INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.|CHU, CEBIMER, Limoges, France.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Preux
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003551:Cysticercosis / Q000150:complications*; D004827:Epilepsy / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007843:Latin America / Q000453:epidemiology