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Objective To assess the contribution of neurocysticercosis (NCC) to the burden of epilepsy in a rural Tanzanian population. Methods We identified adult people with epilepsy (PWE) in a door-to-door study in an established demographic surveillance site. PWE and community controls were tested for antibodies to Taenia solium, the causative agent of NCC, and all PWE were offered a computed tomography (CT) head scan. Data on household occupancy and sanitation, pig-keeping and pork consumption were collected from PWE and controls and associations with epilepsy were assessed using chi-square or Fisher's exact tests. Results Six of 218 PWE had antibodies to T. solium (2.8%; 95% CI 0.6–4.9), compared to none of 174 controls (Fisher's exact test, P = 0.04). Lesions compatible with NCC were seen in eight of 200 CT scans (4.0%; 95% CI 1.3–6.7). A total of 176 PWE had both investigations of whom two had positive serology along with NCC-compatible lesions on CT (1.1%; 95% 0.3–4.0). No associations between epilepsy and any risk factors for NCC were identified. Conclusions Neurocysticercosis is present in this population but at a lower prevalence than elsewhere in Tanzania and sub-Saharan Africa. Insights from low-prevalence areas may inform public health interventions designed to reduce the burden of preventable epilepsy. Objectif Evaluer la contribution de la neurocysticercose (NCC) a la charge de l’epilepsie dans une population rurale de la Tanzanie. Methodes Nous avons identifie les personnes adultes souffrant d’epilepsie (PSE) dans une etude de porte-a-porte dans un site etabli de surveillance demographique. Les PSE et des temoins communautaires ont ete testes pour les anticorps de Taenia solium, l'agent causal de la NCC et toutes les PSE ont ete offertes une tomodensitometrie (TDM) de la tete. Les donnees sur l'occupation des menages et l'assainissement, l’elevage et la consommation de porc ont ete recueillies chez les PSE et les temoins et les associations avec l’epilepsie ont ete evaluees en utilisant les tests Exacts de Fisher ou de Chi-carre. Resultats Six des 218 PSE avaient des anticorps de T. Solium (2,8%; IC95%: 0,6 a 4,9) compares a aucun des 174 temoins (test Exact de Fisher, p = 0,04). Les lesions compatibles avec la NCC ont ete observees dans 8 des 200 TDM (4,0%; IC95%: 1,3 a 6,7). Les deux investigations ont ete menees chez 176 PSE, dont deux avaient une serologie positive ainsi que des lesions compatibles avec la NCC sur la TDM (1,1%; IC95%: 0,3 a 4,0). Aucune association entre l’epilepsie et les facteurs de risque categorises pour la NCC n'a ete identifiee. Conclusions La NCC est presente dans cette population, mais a un taux de prevalence plus faible qu'ailleurs en Tanzanie et en Afrique subsaharienne. Les donnees des zones a faible prevalence pourraient eclairer les interventions de sante publique visant a reduire la charge evitable de l’epilepsie. Objetivo Evaluar la contribucion de la neurocisticercosis (NCC) a la carga de epilepsia entre la poblacion rural de Tanzania. Metodos Identificamos a adultos con epilepsia (ACE) en un estudio puerta-a-puerta, en un lugar con vigilancia demografica establecida. A los ACE y a los controles comunitarios se les realizaron pruebas en busca de anticuerpos contra Taenia solium, el agente causal de la NCC, y a todos los ACE se les ofrecio una tomografia computarizada de la cabeza (TC). Se recolectaron los datos sobre ocupacion del hogar y saneamiento, la crianza y consumo del cerdo de los ACE y de los controles, y se evaluaron las asociaciones con la epilepsia utilizando las pruebas del Chi-cuadrado y de Fisher. Resultados Seis de 218 PCE tenian anticuerpos contra T. solium (2.8%; IC 95% 0.6 a 4.9), comparado con ninguno de los 174 controles (prueba de Fisher, p=0.04). Las lesiones compatibles con la NCC se observaron en ocho de 200 TC (4.0%; IC95% 1.3 a 6.7). A 176 ACE se les realizaron ambas pruebas, y de estos, dos tenian una serologia positiva junto con lesiones compatibles con NCC en la TC (1.1%; 95% 0.3 a 4.0). No se identificaron asociaciones entre la epilepsia y factores de riesgo categoricos para NCC. Conclusiones La NCC esta presente en esta poblacion, pero en una menor prevalencia que en cualquier otro lugar en Tanzania y Africa subsahariana. La comprension de lo que sucede en areas de baja prevalencia podria informar intervenciones de salud publica disenadas para reducir la carga de epilepsia prevenible.

Aim: This cross-sectional study examined whether growth parameters were associated with epilepsy in children living in a rural community in sub-Saharan Africa (SSA). Materials and methods: A cross-sectional study was performed in the Hai District Demographic Surveillance Site (HDSS), Tanzania in which 6-14 year old children with epilepsy (CWE) were identified. Age matched controls were randomly selected from the Hai census database for comparison. Anthropometric measurements were used to assess the nutritional status of the children and body mass index (BMI) calculated. Associations between social, demographic and nutritional factors and epilepsy were assessed using multivariable logistic regression. Results: 112 CWE were identified and were compared with 113 controls. There was no significant difference in the BMI between cases and controls ( T-test, p-value of 0.117). Amongst cases, there were no significant associations between BMI and motor difficulties, antiepileptic drug use, cognitive or behavioural problems, early-onset epilepsy or seizure frequency. In the whole group, BMI was significantly associated with socio-economic status ( p = 0.037) and age. Discussion: There was no significant difference found between CWE and matched controls with respect to nutritional status. This suggests that there is no causal association between under nutrition and epilepsy in this community. Nutritional assessment is still important as part of the comprehensive care of CWE. © 2014 Elsevier B.V.

Purpose: To define the prevalence and risk factors for epilepsy in children in a rural district of Tanzania by conducting a community-based case - control study. Methods: Children aged 6-14 years with active epilepsy (at least two unprovoked seizures in the last 5 years) were identified in a cross-sectional survey in Tanzania. Cases were compared with age-matched controls. Key Findings: Overall 112 children with epilepsy (CWE) were identified; the unadjusted prevalence of epilepsy was 2.91 per 1,000 (95% confidence interval [95% CI] 2.4-3.5). The main seizure types were focal motor with secondary generalization in 73 (65.2%) of 112 and generalized convulsive seizures in 19 (16.9%) of 112. Adverse perinatal events were present in 16 (14%) of 112 cases but in no controls. In multivariate analysis, epilepsy was associated with number of parents who were resident at home (odds ratio [OR] 6.2 for none vs. both resident, 95% CI 1.5-25.5), history of adverse perinatal events (OR 14.9, 95% CI 1.4-151.3), family history of afebrile seizures (OR 5.7, 95% CI 1.0-27.5), and poor scholastic attainment (OR 8.6, 95% CI 4.0-18.4). Electroencephalography (EEG) and computed tomography (CT) scans were abnormal in 44 (44%) of 101 and 26 (29%) of 90 cases, respectively. Overall, 98 (88%) of 112 cases had focal features on assessment. Significance: In this study from sub-Saharan Africa, CWE predominantly had focal features that support the suggestion that most epilepsy in this region has a symptomatic etiology. Adverse perinatal events were strongly associated with epilepsy. Genetic and social factors may also be important. Epilepsy may be preventable in a significant proportion of children with better antenatal and perinatal care. ©2012 International League Against Epilepsy.

Purpose: To define the prevalence and associations of co-morbidity and school attendance in older children with epilepsy (CWE) from a rural district of Tanzania by conducting a community-based case-control study. Methods: Children aged 6-14 years old with active epilepsy (at least two unprovoked seizures in the last five years) were identified in a cross-sectional survey in Tanzania. Co-morbidities were assessed and cases were compared with age-matched controls. Results: Co-morbidity was very common amongst cases (95/112, 85%), with 62/112 (55%) having multiple co-morbidities. Co-morbidities consisted of cognitive impairment (72/112, 64%), behaviour disorder 68/112 (61%), motor difficulties 29/112 (26%), burns and other previous injuries (29/112, 26%). These complications were significantly more common in cases than in controls (odds ratio 14.8, 95%CI 7.6-28.6, p < 0.001). Co-morbidity in CWE was associated with structural cause, abnormal electroencephalogram and early onset seizures. Cognitive impairment was very common in CWE (64%) and was not associated with Phenobarbital use but was associated with motor difficulties, early onset and recurrent seizures. Poor school attendance was found in 56/112 (50%) of CWE, but not in the controls: it was associated with the presence of multiple co-morbidities, especially with motor difficulties in CWE. Conclusion: Children with epilepsy in a rural area of sub-Saharan Africa had a high level of co-morbidity. Cognitive impairment and poor school attendance were very common. These associated difficulties in CWE in the region need to be addressed to reduce the negative impact of epilepsy on these children. Crown Copyright © 2011 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.