Comprehensive management of epilepsy in onchocerciasis-endemic areas: lessons learnt from community-based surveys

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Term Occurence Count Dictionary
onchocerciasis 53 infectiousdiseases
abscess 1 infectiousdiseases
doxycycline 1 infectiousdiseasesdrugs
infectious disease 1 infectiousdiseases
ivermectin 14 infectiousdiseasesdrugs

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Select Drug Character Offset Drug Term Instance
doxycycline 38962 frequency of seizures in persons with OAE?Clinical trials to assess the effect of ivermectin [[67]] and doxycycline [[68]] on seizures are ongoingStrengthening onchocerciasis elimination programsIs it safe to give ivermectin
ivermectin 1772 Finally, strengthening onchocerciasis elimination programs by optimizing community-directed treatment with ivermectin (CDTI) and considering alternative treatment strategies might reduce the incidence of epilepsy.ConclusionsA
ivermectin 20916 and also as a specific treatment measure, PWE residing in onchocerciasis-endemic areas should receive ivermectin at least once a year [[49]] at the recommended dosage of 150 μg/kg alongside all other inhabitants
ivermectin 21282 volvulus or macrofilaria after repeated consecutive doses [[50]]. The once or twice annual treatment with ivermectin is needed for 15 years or more to achieve elimination [[51]]. Although current guidelines exclude
ivermectin 21453 [[51]]. Although current guidelines exclude pregnant women and children under five years from receiving ivermectin , we recommend that the safety of ivermectin should be investigated in children under five years [[52]]
ivermectin 21497 pregnant women and children under five years from receiving ivermectin, we recommend that the safety of ivermectin should be investigated in children under five years [[52]] because the accumulation O. volvulus microfilaria
ivermectin 28214 in hospital settings. It has been suggested that instead of CHW, community-directed distributors of ivermectin (CDD) could be trained for epilepsy screening, follow-up and surveillance in onchocerciasis-endemic
ivermectin 33169 frequent sensitization of the population in general and PWE in particular about the importance of taking ivermectin , advocacy is needed in favour of biannual ivermectin distribution in endemic communities. Where transmission
ivermectin 33222 PWE in particular about the importance of taking ivermectin, advocacy is needed in favour of biannual ivermectin distribution in endemic communities. Where transmission remains very high, alternative treatment strategies
ivermectin 36160 importance of onchocerciasis elimination; make use of unpaid village volunteers for CDTI.Sub-optimal ivermectin intake by the populationSensitization of the population about the importance of ivermectin to prevent
ivermectin 36251 CDTI.Sub-optimal ivermectin intake by the populationSensitization of the population about the importance of ivermectin to prevent epilepsy; better timing of distribution campaigns (avoid periods of intensive farming activity
ivermectin 36932 ranking local elites who value the village and the populationsCDTI Community-directed treatment with ivermectin , AED Anti-epileptic drugs, CHW Community health workersDirections for further researchKnowledge gaps
ivermectin 38940 able to reduce the frequency of seizures in persons with OAE?Clinical trials to assess the effect of ivermectin [[67]] and doxycycline [[68]] on seizures are ongoingStrengthening onchocerciasis elimination programsIs
ivermectin 39072 doxycycline [[68]] on seizures are ongoingStrengthening onchocerciasis elimination programsIs it safe to give ivermectin to children < 5 years with onchocerciasis and possibly OAE?- Clinical trials to obtain safety data
ivermectin 39192 children < 5 years with onchocerciasis and possibly OAE?- Clinical trials to obtain safety data about ivermectin use in children < 5 years [[52]]- Development of safer drugs for onchocerciasis which can be used
Select Disease Character Offset Disease Term Instance
abscess 15331 temporary loss of awareness (due to syncope or transient ischaemic attack), focal brain lesions (due to an abscess , hematoma or ischaemia), and psychiatric disorders including psychogenic non-epileptic seizures (PNES)
infectious disease 29925 seizure. Everyone should be aware of the following notions [[26], [43]]:Epilepsy is not transmissible like infectious disease sDo not panic or run away, abandoning the personProtect the person from injury: make sure they are in
onchocerciasis 77 Title: Infectious Diseases of PovertyComprehensive management of epilepsy in onchocerciasis -endemic areas: lessons learnt from community-based surveysJoseph Nelson Siewe FodjoMarieke C. J. DekkerRichard
onchocerciasis 801 Recent community-based surveys highlight the need for epilepsy management strategies suitable for remote onchocerciasis -endemic villages to ensure better health outcomes for PWE. In this paper, we propose a feasible approach
onchocerciasis 991 we propose a feasible approach to manage PWE in such settings.Main textImproved management of PWE in onchocerciasis -endemic areas may be achieved by decentralizing epilepsy care. Simplified approaches for the diagnosis
onchocerciasis 1340 treatment gap, a regular supply of subsidized anti-epileptic drugs (AED) appropriate for different types of onchocerciasis -associated epilepsy should be instituted. Setting up a community-based epilepsy surveillance system
onchocerciasis 1688 implemented to reduce stigma and facilitate the social rehabilitation of PWE. Finally, strengthening onchocerciasis elimination programs by optimizing community-directed treatment with ivermectin (CDTI) and considering
onchocerciasis 2254 cost-effective chronic care model for epilepsy that will significantly improve the quality of life of PWE in onchocerciasis -endemic regions.Electronic supplementary materialThe online version of this article (10.1186/s40249-019-0523-y)
onchocerciasis 2639 the five official working languages of the United Nations.BackgroundEpilepsy is highly prevalent in onchocerciasis -endemic regions, particularly in areas where the intensity of infection is high [[1]–[3]]. The relationship
onchocerciasis 2772 particularly in areas where the intensity of infection is high [[1]–[3]]. The relationship between onchocerciasis and epilepsy has further been underlined by two meta-analyses [[4], [5]] as well as recent community-based
onchocerciasis 2911 been underlined by two meta-analyses [[4], [5]] as well as recent community-based surveys in rural onchocerciasis -endemic villages, where 3.5–7.8% of the population have epilepsy [[6]–[9]]. Although onchocerciasis
onchocerciasis 3015 onchocerciasis-endemic villages, where 3.5–7.8% of the population have epilepsy [[6]–[9]]. Although onchocerciasis is classically known to only cause skin and eye disease, there is accumulating evidence suggesting that
onchocerciasis 3180 disease, there is accumulating evidence suggesting that Onchocerca volvulus (the parasite that causes onchocerciasis ), may directly or indirectly, be causing a wide spectrum of seizure disorders now described as onchocerciasis-associated
onchocerciasis 3290 onchocerciasis), may directly or indirectly, be causing a wide spectrum of seizure disorders now described as onchocerciasis -associated epilepsy (OAE) [[10], [11]] (Fig. 1). Indeed, childhood infection with O. volvulus was shown
onchocerciasis 4038 individuals currently suffer from OAE [[15]]; however the exact pathophysiological mechanism by which onchocerciasis may cause epilepsy is yet to be determined and treatment of affected persons remains sub-optimal.Fig.
onchocerciasis 4168 epilepsy is yet to be determined and treatment of affected persons remains sub-optimal.Fig. 1Map showing onchocerciasis endemic areas. The dots indicate countries where different forms of OAE have been reported [[13], [18]]Nearly
onchocerciasis 4452 middle-income countries [[16]] including sub-Saharan Africa, which also harbours more than 99% of cases of onchocerciasis [[17], [18]]. The epilepsy treatment gap in these regions is wide, with an estimated 75% of PWE not
onchocerciasis 5133 leading to late diagnosis of the condition and frequent complications. Mortality amongst PWE living in onchocerciasis -endemic areas is 6.2 to 7.2 times higher than in the general population [[23], [24]], compared to only
onchocerciasis 6009 PubMed for relevant articles focusing on epilepsy management in resource-limited settings, including onchocerciasis -endemic areas. We also took into account recommendations from the World Health Organization (WHO) [[26]]
onchocerciasis 6323 international workshop on OAE [[27]].Current epilepsy management and difficulties encounteredIn remote onchocerciasis -endemic villages in Africa, access to healthcare and anti-epileptic drugs (AED) is generally difficult
onchocerciasis 7280 not narrow the treatment gap and produces poor health outcomes for PWE.During our recent surveys in onchocerciasis -endemic villages [[6]–[9]], we noted some common factors which must be considered before designing
onchocerciasis 7455 which must be considered before designing an epilepsy intervention. These include: remoteness of the onchocerciasis -endemic villages, poor accessibility, general poverty, inadequate healthcare services (little or no
onchocerciasis 8062 stigma [[11], [19], [30]].Proposed plan for comprehensive epilepsy managementIt is expedient that PWE in onchocerciasis -endemic areas receive appropriate treatment and that new cases of OAE be prevented by strengthening
onchocerciasis 8177 onchocerciasis-endemic areas receive appropriate treatment and that new cases of OAE be prevented by strengthening onchocerciasis elimination in endemic areas [[11], [14]]. Epilepsy is a condition that necessitates a chronic disease
onchocerciasis 8664 epilepsy care has been shown to be feasible and cost-effective in sub-Saharan Africa [[31]] including onchocerciasis -endemic settings [[32]]. Procedures for epilepsy diagnosis and management must be simplified for easy
onchocerciasis 14282 least two unprovoked epileptic seizures 24 h apart; (ii) Person living for at least three years in an onchocerciasis -endemic region; (iii) A high prevalence of epilepsy in the village and families having more than one
onchocerciasis 14737 (vi) Normal psycho-motor development before the onset of epilepsy. Local health personnel working in onchocerciasis -endemic settings are encouraged to check for exposure to O. volvulus in PWE either clinically (presence
onchocerciasis 15955 AED are available and/or affordable in low resource settings [[42]]. AED that are routinely used in onchocerciasis -endemic regions include phenobarbital, carbamazepine, phenytoin, and valproate [[7], [28], [32]]. Their
onchocerciasis 20872 [[48]].Additional therapiesFor public health reasons and also as a specific treatment measure, PWE residing in onchocerciasis -endemic areas should receive ivermectin at least once a year [[49]] at the recommended dosage of 150 μg/kg
onchocerciasis 22279 monitoring during bathing, sports, or when using open fires or the oven. Applying these guidelines in onchocerciasis -endemic settings would imply that PWE should not go to the well or river alone, nor go to the farm or
onchocerciasis 28302 distributors of ivermectin (CDD) could be trained for epilepsy screening, follow-up and surveillance in onchocerciasis -endemic areas [[11]].CHW equally have to ensure community follow-up of PWE via home visits, ensuring
onchocerciasis 30800 schools, churches, markets and other public gatherings to sensitize the population about epilepsy. In onchocerciasis -endemic villages, clustering of PWE within some households fosters the wrong belief that epilepsy is
onchocerciasis 31146 epilepsy and its non-mystical origin. Proper community education about epilepsy and the possible role of onchocerciasis in the clustering of PWE in some households will reduce epilepsy-related stigma and increase treatment
onchocerciasis 32685 their families are encouraged to form, to serve as support action and advocacy groups.Strengthening onchocerciasis elimination programsThere is strong epidemiological evidence suggesting an association between epilepsy
onchocerciasis 32808 elimination programsThere is strong epidemiological evidence suggesting an association between epilepsy and onchocerciasis , with increasing onchocerciasis transmission resulting in increased epilepsy prevalence [[3], [4], [10]].
onchocerciasis 32840 epidemiological evidence suggesting an association between epilepsy and onchocerciasis, with increasing onchocerciasis transmission resulting in increased epilepsy prevalence [[3], [4], [10]]. Therefore, strengthening onchocerciasis
onchocerciasis 32954 transmission resulting in increased epilepsy prevalence [[3], [4], [10]]. Therefore, strengthening onchocerciasis elimination programs is important to decrease the incidence of epilepsy [[14]]. In addition to frequent
onchocerciasis 34739 constraintProposed solutionDecentralizing epilepsy careShortages in AED availabilityAdvocacy to prioritize onchocerciasis -endemic areas for AED delivery; work with multiple AED suppliers; advocacy with pharmaceutical firms
onchocerciasis 35877 reported in some health systems.Propose an epilepsy reporting form to be used in health structures in onchocerciasis -endemic areasStrengthening onchocerciasis elimination programsInsufficient public funds for bi-annual
onchocerciasis 35919 epilepsy reporting form to be used in health structures in onchocerciasis-endemic areasStrengthening onchocerciasis elimination programsInsufficient public funds for bi-annual CDTI or alternative strategiesAdvocacy to
onchocerciasis 36073 funds for bi-annual CDTI or alternative strategiesAdvocacy to stakeholders about the importance of onchocerciasis elimination; make use of unpaid village volunteers for CDTI.Sub-optimal ivermectin intake by the populationSensitization
onchocerciasis 36647 and/or resources- Advocacy for stakeholders to include epilepsy programs among priority interventions in onchocerciasis -endemic regions- Integrate the national onchocerciasis and epilepsy programs to share resources and
onchocerciasis 36702 epilepsy programs among priority interventions in onchocerciasis-endemic regions- Integrate the national onchocerciasis and epilepsy programs to share resources and reduces wasteAdministrative bottlenecks and corruption-
onchocerciasis 37114 further researchKnowledge gaps still exist in the domain of prevention and management of epilepsy in onchocerciasis -endemic regions. Performing research in these regions however is difficult because of their remoteness,
onchocerciasis 37514 care in these regions are outlined in Table 4.Table 4Research priorities on epilepsy management in onchocerciasis -endemic regionsAspectResearch questionPossible research directionEpilepsy screeningWhat is the optimal
onchocerciasis 38003 volvulus-infected person after a first seizure?Prospective study to follow up healthy children in highly endemic onchocerciasis settings. If recurrence risk is found to be ≥60%, then one seizure in the presence of onchocerciasis
onchocerciasis 38106 onchocerciasis settings. If recurrence risk is found to be ≥60%, then one seizure in the presence of onchocerciasis would be considered as epilepsy [[33]]How can OAE be predicted or diagnosed in an early phase?Prospective
onchocerciasis 38236 considered as epilepsy [[33]]How can OAE be predicted or diagnosed in an early phase?Prospective study in onchocerciasis -exposed children with regular clinical, electrophysiological and brain imaging assessment; evaluation
onchocerciasis 38814 possible clinical trials to evaluate the efficacy and safety of different treatment regimensIs anti- onchocerciasis treatment able to reduce the frequency of seizures in persons with OAE?Clinical trials to assess the
onchocerciasis 39018 assess the effect of ivermectin [[67]] and doxycycline [[68]] on seizures are ongoingStrengthening onchocerciasis elimination programsIs it safe to give ivermectin to children < 5 years with onchocerciasis and
onchocerciasis 39114 ongoingStrengthening onchocerciasis elimination programsIs it safe to give ivermectin to children < 5 years with onchocerciasis and possibly OAE?- Clinical trials to obtain safety data about ivermectin use in children < 5 years
onchocerciasis 39272 obtain safety data about ivermectin use in children < 5 years [[52]]- Development of safer drugs for onchocerciasis which can be used in children < 5 yearsSustainability of the epilepsy care programWhat is the impact
onchocerciasis 40080 PWE Person with epilepsyConclusionEpilepsy remains a major neglected public health problem in many onchocerciasis -endemic regions with sub-optimal control measures. Compared with HIV, another chronic stigmatizing condition,
onchocerciasis 40335 treatment and care services available for PWE. In these regions, epilepsy stigma is further compounded by onchocerciasis stigma, thus limiting treatment-seeking behaviour. Establishing a comprehensive, decentralized community-based
onchocerciasis 40810 companies to provide cheap/free AED – and a strong political commitment for its implementation. Finally, onchocerciasis elimination programs should be reinforced to prevent future cases of OAE.Additional filesAdditional

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