{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T04:28:05Z","timestamp":1786422485342,"version":"build-2736575974"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.17049.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000}},{"DOI":"10.12688\/wellcomeopenres.17049.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000}}],"reference-count":20,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011705","name":"MQ: Transforming Mental Health","doi-asserted-by":"publisher","award":["MQF17-18"],"award-info":[{"award-number":["MQF17-18"]}],"id":[{"id":"10.13039\/100011705","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["107769"],"award-info":[{"award-number":["107769"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"publisher","award":["TMA2017CDF-1903"],"award-info":[{"award-number":["TMA2017CDF-1903"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100013986","name":"Government of the United Kingdom","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013986","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011858","name":"African Academy of Sciences","doi-asserted-by":"publisher","award":["DEL-15-003"],"award-info":[{"award-number":["DEL-15-003"]}],"id":[{"id":"10.13039\/501100011858","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"crossref","award":["083744"],"award-info":[{"award-number":["083744"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"crossref","award":["099782"],"award-info":[{"award-number":["099782"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns5:p>\n                    Background Epilepsy affects 70 million people worldwide, 80% of whom are in low-and-middle income countries (LMICs). Parasitic infections contribute considerably to the burden of epilepsy in LMICs, but the nature and presentation of epilepsy following these infections is not fully understood. We examined if epilepsy outcomes are associated with the exposure to parasitic infections. Methods This was a case-comparison study nested in a cross-sectional survey of people with active convulsive epilepsy, with cases as those exposed to parasitic infections, and comparison as those unexposed. Associations of exposure to parasites with clinical and electroencephalographic features of epilepsy were done using a modified mixed effects Poisson regression model across five sites in Africa. Multiplicative and additive scale (RERI) interactions were explored to determine the effect of co-infections on epilepsy features. Population attributable fractions (PAF) were calculated to determine the proportion of severe clinical and electroencephalographic features of epilepsy attributable to parasitic infections. Results A total of 997 participants with active convulsive epilepsy from the five African sites were analyzed, 51% of whom were males. Exposure to parasitic infections was associated with more frequent seizures in adult epilepsy (relative risk (RR)\u00a0=\u00a02.58, 95% confidence interval (95%CI): 1.71\u20133.89). In children, exposure to any parasite was associated with convulsive status epilepticus (RR\u00a0=\u00a04.68, (95%CI, 3.79\u20135.78), intellectual disabilities (RR\u00a0=\u00a02.13, 95%CI: 1.35\u20133.34) and neurological deficits (RR\u00a0=\u00a01.92, 95%CI: 1.42\u20132.61).\n                    <ns5:italic>Toxoplasma gondii<\/ns5:italic>\n                    and\n                    <ns5:italic>Onchocerca volvulus<\/ns5:italic>\n                    interacted synergistically to increase the risk of status epilepticus (RERI\u00a0=\u00a00.91, 95%CI\u00a0=\u00a00.48\u20131.35) in the data pooled across the sites. Exposure to parasitic infections contributed to 30% of severe features of epilepsy as shown by PAF. Conclusions Parasitic infections may be associated with features and phenotypes of epilepsy through synergistic or antagonistic interactions, which can be different in children and adults. Interventions to control or manage infections may reduce complications and improve prognosis in people with epilepsy.\n                  <\/ns5:p>","DOI":"10.12688\/wellcomeopenres.17049.3","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:24:10Z","timestamp":1786353850000},"page":"200","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exposure to parasitic infections is associated with features and phenotypes of active convulsive epilepsy in Africa"],"prefix":"10.12688","volume":"6","author":[{"given":"Nelson K.","family":"Langat","sequence":"first","affiliation":[{"name":"Clinical-Neurosciences Kilifi Kenya Medical Research Institute (KEMRI)\/Wellcome Trust Research Programme"},{"name":"Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3934-5132","authenticated-orcid":false,"given":"Symon M.","family":"Kariuki","sequence":"additional","affiliation":[{"name":"Oxford Department of Psychiatry, University of Oxford"},{"name":"Clinical-Neurosciences Kilifi Kenya Medical Research Institute (KEMRI)\/Wellcome Trust Research Programme"},{"name":"Kilifi Department of Public health, Pwani University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gathoni","family":"Kamuyu","sequence":"additional","affiliation":[{"name":"Clinical-Neurosciences Kilifi Kenya Medical Research Institute (KEMRI)\/Wellcome Trust Research Programme"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1189-3671","authenticated-orcid":false,"given":"Angelina","family":"Kakooza-Mwesige","sequence":"additional","affiliation":[{"name":"Kampala Department of Paediatrics and Child Health, MakerereUniversity College of Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth","family":"Owusu-Agyei","sequence":"additional","affiliation":[{"name":"Ho Institute of Health Research, University of Health and Allied Sciences"},{"name":"Kintampo Kintampo Health Research Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5638-4814","authenticated-orcid":false,"given":"Kenneth","family":"Ae-Ngibise","sequence":"additional","affiliation":[{"name":"Kintampo Kintampo Health Research Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Wang'ombe","sequence":"additional","affiliation":[{"name":"Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony K.","family":"Ngugi","sequence":"additional","affiliation":[{"name":"Nairobi Department of Population Health, Medical College (East Africa), Aga Khan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honorati","family":"Masaja","sequence":"additional","affiliation":[{"name":"Ifakara Ifakara Health Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan G.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Johannesburg MRC\/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6999-5507","authenticated-orcid":false,"given":"Charles R.J.C.","family":"Newton","sequence":"additional","affiliation":[{"name":"Clinical-Neurosciences Kilifi Kenya Medical Research Institute (KEMRI)\/Wellcome Trust Research Programme"},{"name":"Kilifi Department of Public health, Pwani University"},{"name":"Oxford Department of Psychiatry, University of Oxford"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Study of Epidemiology of Epilepsy in Demographic Sites (SEEDS) group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"476-481","DOI":"10.1136\/jnnp.2004.043893","article-title":"Persistent neurocognitive impairments associated with severe falciparum malaria in Kenyan children.","volume":"76","author":"J Carter","year":"2005","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"978-981","DOI":"10.1111\/j.0013-9580.2004.65103.x","article-title":"Increased prevalence of epilepsy associated with severe falciparum malaria in children.","volume":"45","author":"J 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Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/6-200\/v3\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/6-200\/v3\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/6-200\/v3\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T03:39:11Z","timestamp":1786419551000},"score":1,"resource":{"primary":{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/6-200\/v3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":20,"URL":"https:\/\/doi.org\/10.12688\/wellcomeopenres.17049.3","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/wellcomeopenres.17049.2","asserted-by":"subject"},{"id-type":"doi","id":"10.12688\/wellcomeopenres.17049.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.21956\/wellcomeopenres.30210.r163977","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.30210.r163977","asserted-by":"object"}]},"ISSN":["2398-502X"],"issn-type":[{"value":"2398-502X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"assertion":[{"value":"Indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/6-200\/v3#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.30210.r163977, Yuelian Sun, Department of Neurology, Aarhus University Hospital, Aarhus, 11 Aug 2026, version 3, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/6-200\/v3#referee-response-163977","order":0,"name":"referee-response-163977","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.18830.r50872, Hui Jan Tan, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, 13 Jun 2022, version 1, 1 approved, 1 not approved","URL":"https:\/\/wellcomeopenresearch.org\/articles\/6-200\/v1#referee-response-50872","order":1,"name":"referee-response-50872","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Symon Kariuki<\/b>; \n<i>Posted: 16 Jun 2022<\/i>; The article is well written and addresses the objectives succinctly. The authors provided good analytical data for the work. The data presented provided valuable insight to the gravity of the problems encountered. \n<b>Reply: Thank you very much for positively appraising our manuscript. The useful concerns you raised are addressed below.<\/b>  Was the multilogistic regression analysis done for the predictors?  \n<b><u>Reply:<\/u><\/b>\n<b> Yes, a multivariable regression models were built, with all predictors, and exposure to infections as the response or outcome variable. Since exposure to infections was common in our sample, the odds ratios from a logistic regression model would overestimate the relative risks. This prompted use of multivariable modified Poisson regression models that produces accurate relative risks when outcomes are common in the population.<\/b> \n<b>&nbsp;<\/b>  Was there any active clinical infection for the seropositivity serology?  \n<b><u>Reply:<\/u><\/b>\n<b> The samples for these assays were collected when all participants reported to have been clinically well. However, it is possible that persistent exposure to the infections e.g. falciparum malaria could lead to active infections given that previous hospitalizations with clinical malaria was reported in 5.3% persons with epilepsy from the primary epidemiological study that generated these samples<\/b>\n<sup><b>1<\/b><\/sup>\n<b>.<\/b> \n<b>&nbsp;<\/b>  For the neurophysiology features: apart from focal seizures, was generalised seizures analysed?  \n<b><u>Response:<\/u><\/b>\n<b> Both focal and generalized electroencephalographic seizures were documented. The analyses considers both focal and generalized electroencephalographic seizures, whereby the variables \u201cfocal seizures\u201d has those with focal features coded as \u201c1\u201d and those with generalized features as \u201c0\u201d<\/b>\n<b><sup>2<\/sup>.  References<\/b> 1.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Ngugi AK, Bottomley C, Kleinschmidt I, et al. Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: cross-sectional and case-control studies. \n<i>The Lancet Neurology<\/i> 2013; \n<b>12<\/b>(3): 253-63. 2.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Kariuki SM, Matuja W, Akpalu A, et al. Clinical features, proximate causes, and consequences of active convulsive epilepsy in Africa. \n<i>Epilepsia<\/i> 2014; \n<b>55<\/b>(1): 76-85.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/6-200\/v3#referee-comment-5036","order":2,"name":"referee-comment-5036","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by the Wellcome Trust [083744, <a href=https:\/\/doi.org\/10.35802\/083744>https:\/\/doi.org\/10.35802\/083744<\/a>, 099782; <a href=https:\/\/doi.org\/10.35802\/099782>https:\/\/doi.org\/10.35802\/099782<\/a>, Wellcome Trust Senior Fellowships in Clinical Tropical Medicine to CRN and  Research Training Fellowship to SMK, respectively]. SMK is supported by MQ: Transforming Mental Health (MQF17-18) and by the EDCTP2 programme supported by the European Union (TMA2017CDF-1903). This work was also supported by the African Academy of Sciences (AAS) through a DELTAS Africa Initiative grant awarded to Nelson Langat [DEL-15-003]. The DELTAS Africa Initiative is an independent funding scheme of the AAS\u2019s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa\u2019s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [107769] and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}