Systematic review and meta-analysis estimating association of cysticercosis and neurocysticercosis with epilepsy.

Gabrielle Debacq (1) , Luz Maria Moyano (1, 2, 3) , Héctor H Garcia (3, 4) , Farid Boumédiène (1) , Benoît Marin (1) , Edgard Brice Ngoungou (1, 5) , Pierre-Marie Preux (1, 6)

1 NET - Neuroépidémiologie Tropicale
2 Hospital Regional II-2 Tumbes
3 UPCH - Universidad Peruana Cayetano Heredia
4 Instituto Nacional de Ciencias Neurológicas
5 USS - Université des sciences de la santé
6 CEBIMER - Plate forme de bioinformatique et biostatistique

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 <0.001). Three subgroup analyses performed gave odds ratios as: 2.2 (EITB-based studies), 3.2 (CT-based studies), 1.9 (neurologist-confirmed epilepsy; door-to-door survey and at least one matched control per case). Etiologic fraction was estimated to be 63% in the exposed group among the population. Significance: Despite differences in findings, this meta-analysis suggests that cysticercosis is a significant contributor to late-onset epilepsy in tropical regions around the world, and its impact may vary depending on transmission intensity.

Domaines: Santé publique et épidémiologie; Maladies infectieuses

Gabrielle Debacq, Luz Maria Moyano, Héctor H Garcia, Farid Boumédiène, Benoît Marin, et al.. Systematic review and meta-analysis estimating association of cysticercosis and neurocysticercosis with epilepsy.. PLoS Neglected Tropical Diseases, 2017, 11 (3), pp.e0005153. ⟨10.1371/journal.pntd.0005153⟩. ⟨hal-01485042⟩