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Introduction: Neurological disorders (ND) have a high incidence in sub-Saharan Africa (SSA). In this region, systemic challenges of conventional medicine (CM) and cultural beliefs have contributed to a large utilization of traditional medicine (TM). Yet, data on TM and those who use it in the treatment of ND in SSA are scarce. Here, we systematically analyze its role as a therapy modality for ND in Mali, the socio-demographic characteristics of its users, and propose next steps to optimize the dual usages of TM and CM for patients with ND. Methods: We conducted a questionnaire study in two phases. In phase one, patients with ND answered questions on their usage of and attitudes towards TM. In phase two, the TM therapists who provided care to the patients in phase one answered questions regarding their own practices for treating ND. Patients were recruited from the country's two university neurology departments. Results: 3,534 of the 4,532 patients seen in the Departments of Neurology in 2019 met the inclusion criteria. Among these 3,534 patients, 2,430 (68.8%) had previously consulted TM for their present ND. Patients over 60 years of age most often used TM (83.1%). By education, illiterate patients utilized TM the most (85.5%) while those with more than a secondary education used TM the least (48.6%). An income greater than the minimum guaranteed salary was associated with decreased use of traditional medicine (OR 0.29, CI 0.25–0.35, p < 0.001). Among those using TM, it was overwhelmingly thought to be more effective than CM (84.6%). Linking illness to supernatural causes and believing TM therapists had a better understanding of illnesses were the most common reasons patients used traditional medicine (82.3% and 80.5%, respectively). We then interviewed 171 TM therapists who had provided care to the patients in phase one. These providers most commonly "sometimes" (62.6%) referred patients to CM and 4.1% never had. A majority of TM providers (62.6%) believed collaboration with CM could be improved by having doctor "take into account" our existence. Conclusion: Our work shows that TM plays a central role in the provision of care for patients with ND in SSA with certain cohorts using it at higher rates. Future development of treatment of ND in SSA will require optimizing TM with CM and needs buy-in from all stakeholders including conventional medicine clinicians, traditional medicine therapists, researchers, politicians, and most importantly, patients. [ABSTRACT FROM AUTHOR]

Background: Epilepsy remains a significant public health concern in Tanzania, with affected individuals enduring stigma, whether through actions or perceptions. Myths, misunderstandings, and misconceptions about epilepsy have persisted due to a multitude of factors. Here, we assessed attitudes and perceptions toward epilepsy in Mahenge. Methods: A cross-sectional study utilising a mixed-methods approach was undertaken in eight villages in the Ulanga district of Mahenge, integrating a semi-structured questionnaire and focus group discussions (FGDs). The questionnaire involved 778 community members, and 15 FGDs were conducted (seven groups with people with epilepsy and eight without). Descriptive statistics, chi-square, and logistic regression were used for quantitative analysis, while we used NVivo version 14 for thematic analysis of qualitative data. Results: Of 778 participants, over half were women (425, 54.6%) with a median age of 41 years (IQR: 30–55) and most had completed primary education (79.9%). The majority of participants were aware of epilepsy (96.8%), yet they displayed low knowledge (51%), negative attitudes (45.5%), and perceptions (42.1%) towards the disorder. A low level of understanding was significantly associated with negative attitudes (Adjusted Odds Ratio [AOR] = 1.89, 95%CI: 1.41–2.53) and perceptions (AOR = 3.22, 95%CI: 2.05–5.04) towards epilepsy. In the qualitative analysis, often hereditary factors and infections were named as causes of epilepsy, along with misconceptions involving witchcraft and divine punishment. There was also a misconception about the contagiousness of epilepsy. Traditional healers were often the initial point of treatment. Epilepsy-related stigma was evident, with individuals with epilepsy facing derogatory labels, social isolation, and barriers to education. Lastly, there was a lack of understanding regarding a possible association between epilepsy and onchocerciasis. Conclusions: Despite high awareness of epilepsy, there is insufficient understanding, negative attitudes, and perceptions, including misconceptions and stigma about this neurologic condition. Community-based education programmes are essential for promoting proper healthcare-seeking behaviour and dispelling myths. [ABSTRACT FROM AUTHOR]

In Malawi, there is a high prevalence of mental disorders in children and adolescents. However, access to specialized care is scarce due to a lack of public policies, resources, and cultural factors. In this context, the aim of this research is to understand how child and adolescent mental health is conceptualized by key stakeholders in Malawi. The participants were 117 stakeholders (59 female and 58 male) involved with children's mental health from different roles. They participated in workshops, focus groups, and open interviews. The data were processed following the steps of thematic analysis. The results show agreement between the different stakeholders in conceptualizations of child and adolescent mental health in Malawi, where symptoms and signs are not necessarily related to the Western vision, as well as the interaction between natural and supernatural sources in the genesis of mental disorders. Likewise, a pattern of help-seeking is described in which traditional healers stand out over hospitals. Finally, the results allow us to highlight the suggestions made by practitioners, policymakers, community leaders, and academics to improve access to and provision of mental health for children and adolescents in Malawi. [ABSTRACT FROM AUTHOR]

Background: Acute and transient psychotic disorder (ATPD) was recognized as separate from other psychotic disorders and described in the International Classification of Diseases (ICD) tenth revision for the first time. A lot of research on ATPD has been conducted in India over the last six decades, but a review focusing exclusively on Indian research on ATPD is not available. Aim: This paper aims to review the literature on ATPD emerging from India. Methodology: A combination of search terms "Acute and Transient Psychosis," "acute psychosis," "non-affective psychosis," "non-affective psychotic disorder," "reactive psychosis," "first-episode psychosis," and "India" were searched on various search engines like PUBMED, Medknow, Hinari, and Google Scholar. We also did a hand search for additional relevant articles, including published abstracts of the Indian Journal of Psychiatry from 2007 to 2023. Relevant papers were selected. Results: The prevalence of ATPD varies across different study settings, and it tends to have an abrupt to acute onset, and is primarily associated with stress. Few studies have assessed the subtypes of ATPD, and symptom profile has been inconsistently reported. There is a lack of trials on the effectiveness or efficacy of antipsychotics in ATPD patients. In a large proportion of patients initially diagnosed with ATPD, the diagnosis remains stable, with recurrence varying from 10% to 46.6% based on the duration of follow-up. Conclusion: There is a need for more multicentric studies, studies with larger sample sizes, and consistency in data about risk factors. There is a need to evaluate symptom profile, course, outcome, and treatment outcomes in patients with ATPD using validated instruments to improve our understanding. Further, there is a need for comparative studies to evaluate the risk factors for ATPD. [ABSTRACT FROM AUTHOR]

Objective: This systematic review and meta‐analysis aims to show the pooled prevalence of unfavorable public attitude toward people with epilepsy (UPATPWE) as well as the effect estimates of associated factors in Ethiopia. Methods: Between December 1 and 31, 2022, we searched for the English version of published research reports on public attitude toward epilepsy in Ethiopia in PubMed/Medline, Science Direct, Cochrane Library, Google Scholar, and PsycINFO. The research reports' quality was assessed using the Newcastle‐Ottawa Scale. We extracted the relevant information from the searched papers in a Microsoft Excel format and imported it to STATA version 15.0, for analysis. The Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) reports guideline was used. A random‐effects meta‐analysis model was used to estimate the Der Simonian and Laird's pooled prevalence of unfavorable public attitude and its associated factors. Results: Nine out of the accessed 104 research papers meeting the pre‐specified criteria were included in this study. The overall pooled prevalence of UPATPWE in Ethiopia is 52.06 (95% CI: 37.54, 66.59), resulting in excommunication, physical punishments, and assaults against people with epilepsy as well as frequent lack of diagnosis and proper treatment. The pooled effect estimates for witnessing a seizure episode were done and it was (AOR = 2.70 [95% CI: 1.13, 6.46]). Significance: As interventions and new strategies to change attitudes and facilitate a supportive, positive, and socially inclusive environment for PWE may root in education and scientific research outputs, our result hopefully evokes the policy makers' attention for building a well‐designed and comprehensive health education and campaign strategy. [ABSTRACT FROM AUTHOR]

The tau hypothesis is that the cause of NS is unknown but that the pathophysiology of the disease results in tau pathology, which explains the seizures and other clinical hallmarks of NS. Nodding syndrome (NS) was first described in the Mahenge mountains in Tanzania, where it exists in an endemic form of epilepsy [[1]]. More specifically, the presence of tau pathology in NS does not exclude OV as a cofactor in NS. The OV hypothesis suggests that OV somehow causes seizures, and the seizures secondarily result in tau deposition in the brain (Fig 1B). [Extracted from the article]

Previous studies have described the association of onchocerciasis (caused by Onchocerca volvulus) with epilepsy, including nodding syndrome, although a clear etiological link is still missing. Cases are found in different African countries (Tanzania, South Sudan, Uganda, Democratic Republic of the Congo, Central African Republic and Cameroon). In our study we investigated immunological parameters (cytokine, chemokine, immunoglobulin levels) in individuals from the Mahenge area, Tanzania, presenting with either epilepsy or nodding syndrome with or without O. volvulus infection and compared them to O. volvulus negative individuals from the same endemic area lacking neurological disorders. Additionally, cell differentiation was performed using blood smears and systemic levels of neurodegeneration markers, leiomodin-1 and N-acetyltyramine-O, β-glucuronide (NATOG) were determined. Our findings revealed that cytokines, most chemokines and neurodegeneration markers were comparable between both groups presenting with epilepsy or nodding syndrome. However, we observed elevated eosinophil percentages within the O. volvulus positive epilepsy/nodding syndrome patients accompanied with increased eosinophilic cationic protein (ECP) and antigen-specific IgG levels in comparison to those without an O. volvulus infection. Furthermore, highest levels of NATOG were found in O. volvulus positive nodding syndrome patients. These findings highlight that the detection of distinct biomarkers might be useful for a differential diagnosis of epilepsy and nodding syndrome in O. volvulus endemic areas. Trial-registration:NCT03653975. Author summary: A lot of epidemiological studies suggest that an infection with the filarial nematode Onchocerca volvulus is a risk factor for a certain form of epilepsy which includes the nodding syndrome. The seizures occur suddenly in previously healthy children between the ages of 3 and 18 years and the disease is an important public health problem in onchocerciasis-endemic regions with inadequate or lacking onchocerciasis elimination programmes. So far, no exact pathophysiological mechanisms were detected that shed light on how the parasite can trigger the seizures, although many factors have been investigated. However, most studies lack an accurate determination of an active/chronic O. volvulus infection; rather, they rely on the presence of circulating antibodies, which is only evidence of previous exposure to the parasite (and therefore positive in most people living in endemic areas. Within our study, we included participants from the Mahenge area, Tanzania, who were displaying epilepsy/nodding syndrome in absence or presence of a PCR-determined O. volvulus infection. We could show that the group of O. volvulus infected patients displayed higher levels of eosinophils, antigen-specific immunoglobulin levels as well as increased levels of a worm-related metabolic product (NATOG), which might be used as a potential diagnostic biomarker of the disease in future studies. [ABSTRACT FROM AUTHOR]

Background: Nodding syndrome (NS) has been consistently associated with onchocerciasis. Nevertheless, a positive association between NS and a Mansonella perstans infection was found in South Sudan. We aimed to determine whether the latter parasite could be a risk factor for NS in Mahenge. Methods: Cases of epilepsy were identified in villages affected by NS in Mahenge, Tanzania, and matched with controls without epilepsy of the same sex, age and village. We examined blood films of cases and controls to identify M. perstans infections. The participants were also asked for sociodemographic and epilepsy information, examined for palpable onchocercal nodules and onchocerciasis-related skin lesions and tested for anti-Onchocerca volvulus antibodies (Ov16 IgG4) by ELISA. Clinical characteristics of cases and controls, O. volvulus exposure status and relevant sociodemographic variables were assessed by a conditional logistic regression model for NS and epilepsy status matched for age, sex and village. Results: A total of 113 epilepsy cases and 132 controls were enrolled, of which, respectively, 56 (49.6%) and 64 (48.5%) were men. The median age in cases and controls was 28.0 (IQR: 22.0–35.0) and 27.0 (IQR: 21.0–33.3) years. Of the persons with epilepsy, 43 (38.1%) met the probable NS criteria and 106 (93.8%) had onchocerciasis-associated epilepsy (OAE). M. perstans infection was absent in all participants, while Ov16 seroprevalence was positively associated with probable NS (odds ratio (OR): 5.05, 95%CI: 1.79–14.27) and overall epilepsy (OR: 2.03, 95%CI: 1–07–3.86). Moreover, onchocerciasis-related skin manifestations were only found in the cases (n = 7, p = 0.0040), including persons with probable NS (n = 4, p = 0.0033). Residing longer in the village and having a family history of seizures were positively correlated with Ov16 status and made persons at higher odds for epilepsy, including probable NS. Conclusion: In contrast to O. volvulus, M. perstans is most likely not endemic to Mahenge and, therefore, cannot be a co-factor for NS in the area. Hence, this filaria is unlikely to be the primary and sole causal factor in the development of NS. The main risk factor for NS remains onchocerciasis. Author summary: Nodding syndrome (NS) is a rare and severe form of epilepsy that mainly affects children. The syndrome has only been found in onchocerciasis-endemic areas, and epidemiological studies suggest that it may be one of the forms of onchocerciasis-associated epilepsy caused by the parasite Onchocerca volvulus. Nevertheless, other causes have been considered, such as an infection with Mansonella perstans. To identify a main causal factor for NS, it needs to be present in all sites where the syndrome is found. Hence, our team explored 113 people with epilepsy and 132 healthy controls in Mahenge, Tanzania, to determine if M. perstans could be behind the epidemic of NS in the area. Over a third of the epilepsy cases in the study met the criteria for probable NS. None of the participants was diagnosed with an M. perstans infection. However, those exposed to onchocerciasis and with onchocerciasis-associated skin lesions were more likely to have epilepsy, including probable NS. In conclusion, onchocerciasis remains the most likely main risk factor for NS. [ABSTRACT FROM AUTHOR]

Nodding syndrome is an enigmatic recurrent epidemic neurologic disease that affects children in East Africa. The illness begins with vertical nodding of the head and can progress to grand mal seizures and death after several years. The most recent outbreak of nodding syndrome occurred in northern Uganda. We now describe the clinicopathologic spectrum of nodding syndrome in northern Uganda. The neuropathologic findings of 16 children or young adults with fatal nodding syndrome were correlated with the onset, duration and progression of their neurological illness. The affected individuals ranged in age from 14 to 25 years at the time of death with a duration of illness ranging from 6–15 years. All 16 cases had chronic seizures. In 10 cases, detailed clinical histories were available and showed that three individuals had a clinical course that was predominantly characterized by epilepsy, whereas the other seven individuals had progressive cognitive, behavioural and motor decline, in addition to epilepsy. The main neuropathologic findings included: tau pathology (16/16 cases), cerebellar degeneration (11/16 cases) and white matter degeneration (7/16 cases). The tau pathology was characterized by filamentous tau-positive deposits in the form of neurofibrillary tangles, pre-tangles and dot-like grains and threads in the neuropil. All cases showed some degree of tau pathology in the neocortex and in the locus coeruleus with frequent involvement of the substantia nigra and tegmental nuclei and lesser involvement of other grey matter sites, but there was a lack of glial tau pathology. The tau pathology in the neocortex showed a multifocal superficial laminar pattern. We conclude that nodding syndrome is a clinicopathological entity associated consistently with tau pathology, but our observations did not establish the cause of the disease, or an explanation for the tau pathology. [ABSTRACT FROM AUTHOR]

This article aims to provide a historical overview of the relationship between epilepsy and religiosity. Although the link between epilepsy and religiosity has been observed since ancient times, empirical research has not supported the direct relationship between epilepsy and religiosity in any unequivocal way. The rich reference to the historical relationship between epilepsy and religiosity often served as a kind of evidence in itself, even though observations of epileptic religiosity were far less detailed as modern scholars referred to them. A detailed analysis of the connection between epilepsy and religiosity only emerged in the 20th century. By introducing a symbolic level of interpretation, psychoanalysis significantly contributed to the psychological theory of the epileptic personality in general and epileptic religiosity in particular. The older concept of the epileptic personality (and religiosity) mixed with psychoanalytic interpretation was preserved in the Szondi Test. Based on the present historical analysis, the author concludes that the connection between epilepsy and increased religiosity was overstated in the 20th century. [ABSTRACT FROM AUTHOR]

We conducted a house-to-house survey in the Mundri, Western Equatoria state of South Sudan to investigate the clinical characteristics, risk factors, access to treatment and perceptions about nodding syndrome (NS). In total, 224 NS cases with median age of seizure onset of 10 years were identified. Head nodding only was reported in 50 (22.3%) cases, and head nodding plus other types of seizures in 174 (77.7%) cases. Wasting, stunted growth, delayed sexual development and speech and behavioral abnormalities were observed in 17 (23.6%), 16 (22.2%), 9 (17.3%), 14 (19.4%) and 4 (5.6%) cases, respectively. The consumption of rat meat, but not other bushmeat was associated with an increased risk of NS (OR 9.31, 95% CI 1.27–406.51). Children with NS were more likely to have taken ivermectin in the last 5 years (OR 2.40, 95% CI 1.33–4.43). NS cases were less likely to share a bedroom with other children (OR 0.06, 95% CI 0.02–0.16) or adults (OR 0.27, 95% CI 0.13–0.56). In conclusion, rat meat consumption is an unlikely risk factor for NS, and ivermectin intake was more common among NS cases than controls. Importantly, we documented that children with NS are stigmatized because of the misconception that NS is transmitted through direct contact. [ABSTRACT FROM AUTHOR]

The aim of this article is to look at the phenomenon of the social distribution of health in terms of differences in the relative perception of diseases, including their symptoms. The author presents this phenomenon using the example of ngamuk illness. It is considered to be characteristic of Javanese culture, similar to amok, characterised by extreme physical aggression (including homicide). The empirical basis for this article is the results of an ethnographic field study conducted in the grounded theory strand in Yogyakarta, Indonesia, in 2019-2020. The data come from 31 individual in-depth, semi-structured interviews on the cultural image of mental illnesses. Western medical practitioners, traditional healers and students participated in the interviews. What emerges from the Indonesians' statements is the social image of largely the mentally ill person as one who displays aggressive behaviour towards others, including murder. The results indicate that although none of the interviewees used the word ngamuk when describing mental illness, the symptoms cited were close to the symptomatology of the disorder. Juxtaposing the results with other studies in the field of cultural perceptions of illness, the author concludes that the social perception of mental illnesses is strongly culturally-relativised. This also means that the view of illnesses is socially distributed, as exemplified by ngamuk. [ABSTRACT FROM AUTHOR]

Background: Epilepsy is not only one of the oldest known neurological disorder but also one of the most prevalent chronic brain disorder worldwide. The social pathology associated with epilepsy drives the people with epilepsy (PWE) and their families into the shadows and widens epilepsy treatment gap. How much the social aspects of epilepsy and epilepsy care has changed in rural African communities in the globalized world is yet to be fully elucidated. Objectives: This study aims to determine the level of knowledge and attitude towards epilepsy and the people living with epilepsy (PWE) by adult inhabitants of a rural southeastern Nigerian community. Methodology: This was a cross sectional door-to-door population survey. Interview on select aspects of knowledge and attitude to epilepsy was conducted using a pretested semi-structured questionnaire. Results: Three hundred and seven (90.3%) of the respondents reported awareness of epilepsy, 61(18%) had good knowledge on epilepsy but attitude towards epilepsy was negative. The key source of information on epilepsy for 133 (43.3%) respondents was health workers, while 125 (40.7%) reported that epilepsy was a medical disease. Associations existed between level of knowledge on epilepsy and gender (p=0.0023); marital status (p=0.0012) and educational attainment (p= 0.0476). Conclusions: Awareness of epilepsy though high among the rural inhabitants yet a wide gap still exist regarding the knowledge and attitude towards epilepsy. It is hoped that with adequate culturally appropriate educational programs, channelled through the media and health workers in rural communities the existing gap in knowledge and treatment will be bridged. [ABSTRACT FROM AUTHOR]

In the Democratic Republic of Congo, the desire of the Ministry of Health to integrate Traditional African Medicine into the Official Health System remains limited by the lack of reliable data on several aspects of this medicine. This study aims to determine the perceptions of the Lubumbashi population towards Traditional African Medicine and the contexts of recourse to these therapeutic modalities. We conducted semi-structured interviews of population samples in each of the 7 Lubumbashi municipalities, which were semi-randomly selected in proportions to each population size, from January to June 2017 and from February to July 2018. A total of 4278 people (average age, 32.1 ± 10.4 years; 36.5% of women) have been surveyed. Among them, 75.8% define "Traditional African Medicine" as "herbal-based treatments"; 79.4% have resorted to traditional medicine, for several pathologies and social problems. This medicine was preferred for efficiency, speed of healing and low cost, as well as the presence of the diseases against which it would be the only one used. Most, (52.1%) have started with Conventional Medicine, then resorted to Traditional African Medicine, 34.7% started directly with Traditional African Medicine, while 13.2% combined these two medicines. From those who have resorted to Traditional African Medicine (n = 3396), 55% declare no concern towards traditional medicine, while 42.5% fear looseness, overdose, intoxication, and lack of hygiene; from those who have not resorted to Traditional African Medicine (n = 882), 78% are fearful of fear looseness, witchcraft, and fetishism. Traditional African Medicine remains an important health care resource for the Lubumbashi people. It is essential that decision-makers consider the importance of this health sector for the population, but also the reported fears and hindrances, and work towards the regulation, sanitization, and control of this medicine to ensure its safe use. [ABSTRACT FROM AUTHOR]

Nodding Syndrome (NS) occurs within a wide spectrum of epilepsies seen in onchocerciasis endemic areas of sub-Saharan Africa. It has debilitating consequences on affected individuals and increases the socio-economic, physical and psychological burden on care-givers and their households, diminishing their standing within the community. Social science research on the disproportionate burden of the disease on females is limited. Based on ethnographic research over 3 years in northern Uganda, we explored the burden of being ill and care-giving for persons with NS from a gendered perspective. We found that NS-affected females were at greater risk of physical and psychological abuse, sexual violence, unwanted pregnancies, sexually transmitted infections and stigma, in a context of deteriorating socio-economic conditions. Primary care-givers of the NS-affected, mostly women, struggled to make ends meet and were subjected to stigma and abandonment. Targeted interventions, including legal protection for affected females, stigma reduction, and psycho-social and financial support are needed. [ABSTRACT FROM AUTHOR]

Background: Nodding syndrome (NS) is a progressive neurological disease that has been described in several sub-Saharan African counties, but South Sudan is considered the most affected. However, knowledge about the exact burden and the epidemiological risk factors of NS in South Sudan is lacking. Objective: To determine the prevalence, distribution and epidemiological risk factors of NS in the Greater Mundri area, the epicenter of NS in South Sudan. Methods: A NS prevalence house-to-house survey was conducted in multiple villages between February 2018 and November 2019. Geographical distribution and clustering of NS cases was identified using spatial and binomial regression analysis. Epidemiological risk factors of NS were identified using univariate and multivariate models. Results: Of the 22,411 persons surveyed in 92 villages, 607 (2.7%) persons with NS were identified, of which 114 (19%) were new-onset cases. The highest prevalence was found in Diko village with a prevalence of 13.7%. NS showed a significant spatial pattern with clustering of cases between adjacent households and along rivers. Risks factors for NS include all behaviors around rivers (drinking, cooking, handwashing and bathing) and exposure to poultry. On the other hand, ownership of mobile phone decreased the risk of NS. Many other factors, including prior ivermectin treatment and internal displacement were not associated with NS. Conclusion: Our study demonstrates a very high burden of the NS disease in the Greater Mundri area, strengthens the association with rivers, and identified possible new clues for an underlying cause. Author summary: Nodding syndrome (NS) is a neglected and progressive neurological disorder that is disabling and of unknown cause. The Greater Mundri area in South Sudan is currently considered to be the epicenter of new cases. In this study, we evaluated the prevalence, spatial pattern and epidemiological risks of NS. We found that the prevalence of NS is very high–more than one in five households affected–in the Greater Mundri area, which is comparable with the previously reported rates within smaller populations in the same area, but higher than the rates reported in all the other NS-endemic countries. We found that NS cases significantly cluster between adjacent households but we could not find clustering within the same household. In addition, we prove that living near the rivers, as well as using river water for drinking, cooking, handwashing and bathing strongly increased the risk of having a NS case in households. We further identified a new association of NS with ownership of poultry. [ABSTRACT FROM AUTHOR]

A two-phase survey of epilepsy was conducted in selected villages in Mundri West and East Counties (26 June–8 July, 2021), an onchocerciasis-endemic area in Western Equatoria State in South Sudan. In the first phase, households were visited by a trained research team to identify persons suspected to have epilepsy. In the second phase, persons suspected to have epilepsy were interviewed and examined by a clinician to confirm the diagnosis. A total of 364 households agreed to participate in the survey, amounting to 2588 individuals. The epilepsy screening questionnaire identified 91 (3.5%) persons with suspected epilepsy, of whom the diagnosis of epilepsy was confirmed by a clinician in 86 (94.5%). The overall prevalence of confirmed epilepsy was 3.3% (95% CI: 2.7–4.1%), and of nodding syndrome was 0.9% (95% CI: 0.6–1.4%). In 61 (16.8%) households there was at least one person with epilepsy. Only 1212 (46.9%) of 2583 people took ivermectin during the last distribution round in 2021. The annual epilepsy incidence was 77.3/100,000 (95% CI: 9.4–278.9/100,000) and the annual epilepsy mortality was 251.2/100,000 (95% CI: 133.8–428.7/100,000). In conclusion, a high prevalence and incidence of epilepsy was observed in villages in Mundri. Urgent action is needed to prevent children from developing onchocerciasis-associated epilepsy by strengthening the local onchocerciasis-elimination programme. [ABSTRACT FROM AUTHOR]

Purpose of the review: Neurocysticercosis (NCC) has been well recognized as a leading cause of epilepsy. More recently, studies of other parasitic diseases such as cerebral malaria (CM) and onchocerciasis are yielding novel insights into the pathogenesis of parasite-associated epilepsy. We compare the clinical and electrophysiological findings in epilepsy associated with these highly prevalent parasites and discuss the mechanisms involved in epileptogenesis. Recent Findings: Electrophysiological and imaging biomarkers continue to emerge, and individuals who are at-risk of developing parasite-associated epilepsies are being identified with greater reliability. While both Taenia solium and Plasmodium falciparum directly affect the brain parenchyma, Onchocerca volvulus is not known to invade the central nervous system. Thus, the causal association between O. volvulus and epilepsy remains controversial. Summary: Both NCC and CM have a well-defined acute phase when the parasites directly or indirectly invade the brain parenchyma and lead to local inflammatory changes. This is followed by a chronic phase marked by recurrent seizures. However, these stages of epileptogenic process have not been identified in the case of O. volvulus. [ABSTRACT FROM AUTHOR]

The direct impact and sequelae of infections in children and adults result in significant morbidity and mortality especially when they involve the central (CNS) or peripheral nervous system (PNS). The historical understanding of the pathophysiology has been mostly focused on the direct impact of the various pathogens through neural tissue invasion. However, with the better understanding of neuroimmunology, there is a rapidly growing realization of the contribution of the innate and adaptive host immune responses in the pathogenesis of many CNS and PNS diseases. The balance between the protective and pathologic sequelae of immunity is fragile and can easily be tipped towards harm for the host. The matter of immune privilege and surveillance of the CNS/PNS compartments and the role of the blood-brain barrier (BBB) and blood nerve barrier (BNB) makes this even more complex. Our understanding of the pathogenesis of many post-infectious manifestations of various microbial agents remains elusive, especially in the diverse African setting. Our exploration and better understanding of the neuroimmunology of some of the infectious diseases that we encounter in the continent will go a long way into helping us to improve their management and therefore lessen the burden. Africa is diverse and uniquely poised because of the mix of the classic, well described, autoimmune disease entities and the specifically "tropical" conditions. This review explores the current understanding of some of the para- and post-infectious autoimmune manifestations of CNS and PNS diseases in the African context. We highlight the clinical presentations, diagnosis and treatment of these neurological disorders and underscore the knowledge gaps and perspectives for future research using disease models of conditions that we see in the continent, some of which are not uniquely African and, where relevant, include discussion of the proposed mechanisms underlying pathogen-induced autoimmunity. This review covers the following conditions as models and highlight those in which a relationship with COVID-19 infection has been reported: a) Acute Necrotizing Encephalopathy; b) Measles-associated encephalopathies; c) Human Immunodeficiency Virus (HIV) neuroimmune disorders, and particularly the difficulties associated with classical post-infectious autoimmune disorders such as the Guillain-Barré syndrome in the context of HIV and other infections. Finally, we describe NMDA-R encephalitis, which can be post-HSV encephalitis, summarise other antibody-mediated CNS diseases and describe myasthenia gravis as the classic antibody-mediated disease but with special features in Africa. [ABSTRACT FROM AUTHOR]

INTRODUCTION The study aimed to assess the levels of Quality of Life (QoL) and to identify the associated factors in users of two different health services (monk healers and health centers) in Thailand. METHODS In a cross-sectional design, 1251 patients were systematically (consecutively) recruited from three monk healers and three health centers and were assessed with questions on sociodemographic and clinical information, and QoL. Qol was measured using the World Health Organization Quality of Life (WHOQol)-8, for four QoL subdomains: psychological, physical, social and environmental. RESULTS The overall QoL mean of 68.9 was significantly higher in primary care attendees than in monk healer attenders (mean of 66.6) (p<0.01). The social QoL domain had the highest scores, 72.5 and 72.1, in attendees of primary care and monk healers, respectively, followed by physical with 69.6 and 69.4, psychological with 66.1 and 62.9, and environmental with 67.3 and 62.2. In adjusted linear regression analyses in the monk setting, higher education (p<0.05), married (p<0.01), and increasing age (p<0.001) were associated with greater overall QoL, and having chronic conditions (p<0.001) was negatively associated with all QoL indicators. Furthermore, in the primary care setting, higher formal education (p<0.05) was associated with overall QoL and psychological (p<0.05), physical (p<0.05), and environmental QoL (p<0.01). Having a smoking disorder was inversely associated with environmental QoL (p<0.05). Having multiple chronic conditions was negatively associated with the psychological (p<0.001) and environmental (p<0.001) QoL subdomains as well as overall QoL (p<0.05). CONCLUSIONS Sociodemographic characteristics such as younger age and lower education level, and clinical factors such as having chronic conditions, were associated with lower QoL in both monk and primary care treatment settings. Actions are indicated to improve QoL in both treatment settings in Thailand. [ABSTRACT FROM AUTHOR]

Epidemiological studies suggest a link between onchocerciasis and various forms of epilepsy, including nodding syndrome (NS). The aetiopathology of onchocerciasis associated epilepsy remains unknown. This case-control study investigated potential risk factors that may lead to NS and other forms of non-nodding epilepsy (OFE) in northern Uganda. We consecutively recruited 154 persons with NS (aged between 8 and 20 years), and age-frequency matched them with 154 with OFE and 154 healthy community controls. Participants' socio-demography, medical, family, and migration histories were recorded. We tested participants for O. volvulus serum antibodies. The 154 controls were used for both OFE and NS separately to determine associations. We recruited 462 people with a median age of 15 years (IQR 14, 17); 260 (56.4%) were males. Independent risk factors associated with the development of NS were the presence of O. volvulus antibodies [aOR 8.79, 95% CI (4.15–18.65), p-value < 0.001] and preterm birth [aOR 2.54, 95% CI (1.02–6.33), p-value = 0.046]. Risk factors for developing OFE were the presence of O. volvulus antibodies [aOR 8.83, 95% CI (4.48–17.86), p-value < 0.001] and being born in the period before migration to IDP camps [aOR 4.28, 95% CI (1.20–15.15), p-value = 0.024]. In conclusion, O. volvulus seropositivity was a risk factor to develop NS and OFE; premature birth was a potential co-factor. Living in IDP camps was not a risk factor for developing NS or OFE. [ABSTRACT FROM AUTHOR]