1. Systematic review and meta-analysis estimating association of cysticercosis and neurocysticercosis with epilepsy
- Author
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Edgard Brice Ngoungou, Luz Maria Moyano, Pierre-Marie Preux, Benoît Marin, Farid Boumédiène, Hector H. Garcia, Gabrielle Debacq, Neuroépidémiologie Tropicale (NET), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospital Regional II-2 Tumbes, Universidad Peruana Cayetana Heredia - UPCH (PERU), Instituto Nacional de Ciencias Neurológicas, Université des sciences de la santé, Plate forme de bioinformatique et biostatistique (CEBIMER), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Universidad Autonoma de Madrid (UAM), Equipe Accueil Neuroépidémiologie et maladies Infectieuses Tropicales (EA-NEMIT/DEBIM), Faculté de Médecine Libreville Gabon, FIC/NIH Training Grant TW001140, Neuroépidémiologie Tropicale ( NET ), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique ( GEIST ), Université de Limoges ( UNILIM ) -Université de Limoges ( UNILIM ) -CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Universidad Autonoma de Madrid ( UAM ), Laboratoire de Biostatistique et d'Informatique Médicale, Université de Limoges ( UNILIM ), Service de l'Information Médicale et de l'Évaluation [CHU Limoges] ( SIME ), CHU Limoges, Universidad Peruana Cayetano Heredia, Grelier, Elisabeth, Universidad Peruana Cayetano Heredia (UPCH), Douady, Claire, and Universidad Autónoma de Madrid (UAM)
- Subjects
Pathology ,Cross-sectional study ,Neurocysticercosis ,Diagnostic Radiology ,Geographical Locations ,Epilepsy ,Mathematical and Statistical Techniques ,0302 clinical medicine ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Medicine and Health Sciences ,computed axial tomography ,Enzyme-Linked Immunoassays ,Tomography ,education.field_of_study ,Sub-Saharan Africa ,Radiology and Imaging ,lcsh:Public aspects of medicine ,[ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie ,Cysticercosis ,3. Good health ,[ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Infectious Diseases ,Neurology ,Helminth Infections ,Meta-analysis ,Physical Sciences ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Statistics (Mathematics) ,Research Article ,Neglected Tropical Diseases ,medicine.medical_specialty ,lcsh:Arctic medicine. Tropical medicine ,Asia ,Imaging Techniques ,lcsh:RC955-962 ,030231 tropical medicine ,Population ,Neuroimaging ,Research and Analysis Methods ,03 medical and health sciences ,Peri-urban aera ,Diagnostic Medicine ,Internal medicine ,parasitic diseases ,Parasitic Diseases ,medicine ,Humans ,Central nervous system CNS ,Statistical Methods ,Immunoassays ,education ,Africa South of the Sahara ,business.industry ,Public Health, Environmental and Occupational Health ,Case-control study ,Biology and Life Sciences ,lcsh:RA1-1270 ,Odds ratio ,Tropical Diseases ,medicine.disease ,Cross-Sectional Studies ,Latin America ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Case-Control Studies ,People and Places ,Africa ,Immunologic Techniques ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,Mathematics ,030217 neurology & neurosurgery ,Neuroscience ,Meta-Analysis - Abstract
Background 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. Methodology 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. Principal findings 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, Author summary Cysticercosis is a helminthic infection of the central nervous system (CNS) and the leading cause of late onset epilepsy in low-and middle-income countries. This neurological disease is a public health problem in Sub-Saharan Africa, Asia and Latin America, affecting impoverished rural and peri-urban populations where sanitation is inadequate. Diagnostic criteria for NCC vary according to regional availability and access to imaging and serological tests. This systematic review highlights the lack of appropriate methodology in most observational studies, with few studies including control groups, a basic epidemiological criteria needed to demonstrate an association. EITB for cysticercosis was widely used to measure exposure, and brain CT scan was a non-invasive alternative used to identify cysts. Neurocysticercosis (NCC) is a preventable neurological condition in the tropics despite resource limitations in LMIC regions. Well-designed studies are needed to provide quality evidence to support control interventions and surveillance systems for this important zoonotic disease.
- Published
- 2017
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