International Journal of Epidemiology, Vol 28, 799-803, Copyright © 1999 by International Epidemiological Association
ME Cruz, PM Schantz, I Cruz, P Espinosa, PM Preux, A Cruz, W Benitez, VC Tsang, J Fermoso and M Dumas
BACKGROUND: Taenia solium neurocysticercosis (NCC) has been documented as
one of the major causes of epilepsy in developing countries. However,
methodological limitations have hindered the evaluation of the
epidemiological relationship between cysticercosis and epilepsy at the
community level. METHODS: We used the WHO protocol for epidemiological
evaluation of neurological disorders to conduct a door-to-door survey among
2723 residents of San Pablo del Lago, an Ecuadorean rural community in
which T. solium taeniasis/cysticercosis was known to be endemic. The WHO
protocol was complemented by neuroimaging and immunological tests to
confirm the diagnosis of this infection. RESULTS: In all 31 people
suffering from active epilepsy were detected (prevalence 11.4 per 1000, 95%
CI:7.7-15.4); 26 agreed to undergo a computer tomography (CT) examination,
and 28 agreed to have blood drawn for serodiagnosis. Fourteen of the 26
(53.8%) had CT changes compatible with NCC and six of the 28 (21.4%) tested
positive in the enzyme-linked immunoelectro-transfer blot (EITB) assay. In
a seizure-free random sample of this population, 17 of 118 (144 per 1000)
subjects examined by CT and 10 out of 96 (104 per 1000) examined by EITB
had evidence of this infection. The differences between the epilepsy group
and the random sample of the population were statistically significant (OR
= 6.93, 95% CI: 2.7-17.5, P < 0.001) for CT diagnosis, but not for EITB
results (OR = 2.75, 95% CI: 0.8-7.1, P > 0.12, NS). CONCLUSIONS: These
findings confirm that T. solium NCC is a significant cause of epilepsy at
the community level in Andean villages of Ecuador. It is important to
initiate effective public health interventions to eliminate this infection,
which may be responsible for at least half of the cases of reported
epilepsy in Ecuador.
ARTICLES
Epilepsy and neurocysticercosis in an Andean community
Institute for Tropical Neurology, Unit of Neurosciences, Central University School of Medicine, Quito, Ecuador.
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