Onchocerciasis-Associated Epilepsy, an Additional Reason for Strengthening Onchocerciasis Elimination Programs

A high prevalence of epilepsy has been observed in onchocerciasis-endemic regions with high onchocerciasis transmission. Recent epidemiological studies suggest that Onchocerca volvulus infection is the trigger causing the seizures, which appear in previously healthy children between the ages of 3 and 18 years. Persons with onchocerciasis-associated epilepsy present with a wide spectrum of seizures, including atonic and myoclonic neck seizures; but also absences and most frequently generalized tonic-clonic seizures. Often individuals present with intellectual disabilities and psychiatric disorders and occasionally with ‘Nakalanga’ features such as severe stunting with delayed or absent external signs of sexual development. Onchocerciasis-associated epilepsy, because of its importance as a public health problem, is an additional reason for strengthening onchocerciasis elimination programs. Onchocerciasis-associated epilepsy is characterised by an onset of seizures between the ages of 3 and 18 years. Persons with onchocerciasis-associated epilepsy may present with a spectrum of epilepsy types that include absences, atonic and myoclonic neck seizures, and Nakalanga features. Community directed distribution of ivermectin is able to reduce the incidence of onchocerciasis-associated epilepsy but biannual ivermectin distribution should be preferred. A high incidence of epilepsy in an onchocerciasis-endemic region suggests suboptimal mass distribution of ivermectin. Onchocerciasis-elimination programs should be strengthened to prevent new cases of onchocerciasis associated epilepsy.