{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:30:38Z","timestamp":1790400638526,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,7,28]],"date-time":"2020-07-28T00:00:00Z","timestamp":1595894400000},"content-version":"vor","delay-in-days":57,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epileptic Disorders"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:italic>Aims<\/jats:italic>. Following previous reports of very high epilepsy prevalence in the onchocerciasis\u2010endemic villages in Maridi County, South Sudan, a study was conducted to investigate the association between the level of <jats:italic>Onchocerca volvulus<\/jats:italic> infection, epilepsy, and related outcomes.<\/jats:p><jats:p><jats:italic>Methods<\/jats:italic>. In December 2018, persons with epilepsy (PWE) were recruited from villages where an epilepsy prevalence of 4.4% (range: 3.5\u201311.9%) was documented. We enrolled 318 participants from whom two skin snips were taken for microscopic detection of <jats:italic>O. volvulus<\/jats:italic> microfilariae (mf). Seizure history was obtained for all PWE and their degree of disability assessed using the modified Rankin scale.<\/jats:p><jats:p><jats:italic>Results<\/jats:italic>. Almost all (84.9%) PWE had detectable mf in their skin snips. Onchocerciasis\u2010infected PWE experienced nodding seizures more often than uninfected PWE (<jats:italic>p<\/jats:italic>=0.034). Moreover, persons with nodding seizures had more frequent seizures (<jats:italic>p<\/jats:italic>&lt;0.001) and higher disability scores (<jats:italic>p<\/jats:italic>&lt;0.001), and were more often cognitively impaired and younger at the time of their first epileptic seizure (nine years vs 12 years, <jats:italic>p<\/jats:italic>&lt;0.001) compared to PWE without nodding seizures. Based on multivariate models, nodding seizures were associated with higher mf densities (aOR: 1.022; 95% CI: 1.005\u20131.041). Epilepsy onset at a younger age was associated with a worse outcome. Higher frequency of seizures, longer duration of epilepsy and younger age were associated with increased disability. Regular antiepileptic drug use was associated with better cognitive and disability outcomes.<\/jats:p><jats:p><jats:italic>Conclusion<\/jats:italic>. PWE with nodding seizures have a more severe form of onchocerciasis\u2010associated epilepsy, with earlier seizure onset and higher levels of <jats:italic>O. volvulus<\/jats:italic> infection. Younger PWE were prone to worse epilepsy outcomes, which would be prevented with regular antiepileptic treatment.<\/jats:p>","DOI":"10.1684\/epd.2020.1164","type":"journal-article","created":{"date-parts":[[2020,6,29]],"date-time":"2020-06-29T13:01:14Z","timestamp":1593435674000},"page":"301-308","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Persons with onchocerciasis\u2010associated epilepsy and nodding seizures have a more severe form of epilepsy with more cognitive impairment and higher levels of <i>Onchocerca volvulus<\/i> infection"],"prefix":"10.1002","volume":"22","author":[{"given":"Gasim","family":"Abd\u2010Elfarag","sequence":"first","affiliation":[{"name":"Global Child Health Group, Department of Paediatrics and Department of Global Health, Academic Medical Center University of Amsterdam  The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane Y.","family":"Carter","sequence":"additional","affiliation":[{"name":"Amref International University  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Raimon","sequence":"additional","affiliation":[{"name":"Maridi State Hospital  Maridi Republic of South Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson","family":"Sebit","sequence":"additional","affiliation":[{"name":"National Public Health Laboratory  Republic of South Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abozer","family":"Suliman","sequence":"additional","affiliation":[{"name":"Maridi Health Sciences Institute  Maridi Republic of South Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph Nelson Siewe","family":"Fodjo","sequence":"additional","affiliation":[{"name":"Global Health Institute University of Antwerp  Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Claver","family":"Olore","sequence":"additional","affiliation":[{"name":"Amref Health Africa  Juba Republic of South Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai Puok","family":"Biel","sequence":"additional","affiliation":[{"name":"Maridi Health Sciences Institute  Maridi Republic of South Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morrish","family":"Ojok","sequence":"additional","affiliation":[{"name":"Amref Health Africa  Juba Republic of South Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoy Yibi","family":"Logora","sequence":"additional","affiliation":[{"name":"Neglected Tropical Diseases Unit Ministry of Health  Juba Republic of South Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Colebunders","sequence":"additional","affiliation":[{"name":"Global Health Institute University of Antwerp  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