Characteristics of people with epilepsy and Neurocysticercosis in three eastern African countries–A pooled analysis.

Background: Neurocysticercosis (NCC), a zoonotic disease caused by the pork tapeworm T. solium, represents one of the most common causes of secondary epilepsy but remains often undiagnosed due to lack of awareness and diagnostic facilities. Methodology: We pooled data from four cross-sectional studies on epilepsy and NCC in eastern Africa. Study sites were in Uganda, Malawi and in Tanzania (Dar es Salaam and Haydom). The study in Uganda and Malawi were community-based, the two studies in Tanzania were hospital-based. The same questionnaire was used for assessment of clinical characteristics of patients with epilepsy. Computed tomography (CT) scans and serological testing were performed in order to diagnose NCC. Results: Overall, 1,179 people with epilepsy were included in our analysis. Of those, 941 PWE underwent CT scanning and were pooled for NCC analysis. Seventy patients were diagnosed with NCC, but NCC prevalence differed considerably between sites ranging from 2.0% (95%CI 0.4% to 3.6%) in Dar es Salaam to 17.5% (95%CI 12.4% to 22.6%) in Haydom. NCC prevalence did not show any association with sex but increased with age and was higher in rural than urban settings. In addition, being a farmer, non-Muslim, eating pork and living with pigs close by was associated with a higher NCC prevalence. PWE with NCC experienced their first epileptic seizure around 3 years later in life compared to PWE without NCC and their epileptic seizures seemed to be better controlled (p<0.001). There was no difference between focal onset seizures and focal signs on neurological examination in both groups (p = 0.49 and p = 0.92, respectively). The rT24H-EITB had a sensitivity for the detection of NCC of 70% (95% confidence interval [CI] 51 to 84%), the LLGP of 76% (95%CI 58 to 89%) and the antigen ELISA of 36% (95% CI 20 to 55%). Conclusions: NCC is prevalent among PWE in eastern Africa, although it may not be as common as previously stated. Demographic characteristics of PWE with NCC differed from those without NCC, but semiological characteristics and results on neurological examination did not differ compared to PWE without NCC. Interestingly, seizures seemed to be less frequent in PWE with NCC. Being aware of those differences and similarities may help triaging PWE for neuroimaging in order to establish a diagnosis of NCC. Author summary: Neurocysticercosis is a neglected zoonotic disease caused by the pork tapeworm Taenia solium. Patients with neurocysticercosis show a wide range of symptoms, from asymptomatic to severely affected by epileptic seizures, progressive headache or focal neurological deficits. Epileptic seizures are particularly common and up to 30% of people with epilepsy have neurocysticercosis in areas endemic for Taenia solium. The disease is often undiagnosed in Africa because of a lack of diagnostic opportunities (serological tests and neuroimaging). Furthermore, symptoms are too unspecific to diagnose patients solely based on clinical characteristics. Moreover, radiological features of neurocysticercosis differ between continents and have not been described yet for African populations. In this study, for the first time, we describe radiological but also clinical features of patients with epilepsy and neurocysticercosis in eastern Africa. We found that in Tanzania, Malawi and Uganda, neurocysticercosis is common in people with epilepsy although less common than previously reported. Also, most patients with neurocysticercosis have multiple parenchymal lesions and clinical features of people with epilepsy and neurocysticercosis do not differ substantially from people with epilepsy without neurocysticercosis. [ABSTRACT FROM AUTHOR]