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Volume 10
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10.3390/pathogens10010021
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Article

Effect of Ivermectin Treatment on the Frequency of Seizures in Persons with Epilepsy Infected with Onchocerca volvulus

by
Alfred Dusabimana
1,*,†,
Solomon Tsebeni Wafula
1,2,†,
Stephen Jada Raimon
3,
Joseph Nelson Siewe Fodjo
1,
Dan Bhwana
4,
Floribert Tepage
5,
Gasim Abd-Elfarag
6,
An Hotterbeekx
1,
Steven Abrams
1,7 and
Robert Colebunders
1,*
1
Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium
2
Department of Disease Control and Environmental Health, Makerere University, Kampala P.O. Box 7072, Uganda
3
Amref Health Africa, Juba P.O. Box 30125, South Sudan
4
National Institute of Medical Research, Tanga Centre, Tanga P.O. Box 5004, Tanzania
5
Ministry of Health, Bas Uélé Province, Buta B.P. 105, Democratic Republic of Congo
6
Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, The Netherlands
7
Data Science Institute, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, 3590 Diepenbeek, Belgium
*
Authors to whom correspondence should be addressed.
†
Contributed equally.
Pathogens 2021, 10(1), 21; https://doi.org/10.3390/pathogens10010021
Submission received: 10 November 2020 / Revised: 24 December 2020 / Accepted: 28 December 2020 / Published: 31 December 2020
(This article belongs to the Special Issue Onchocerciasis and River Epilepsy)
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Abstract

A clinical trial performed in the Democratic Republic of Congo (DRC), among persons with epilepsy (PWE) infected with Onchocerca volvulus treated with anti-seizure medication suggested that ivermectin reduces the seizure frequency. We assessed the effect of ivermectin treatment on seizure frequency in PWE with and without anti-seizure medication in three onchocerciasis endemic areas (Maridi, South Sudan; Aketi, DRC; and Mahenge, Tanzania). Pre- and 3–5 months post-ivermectin microfilariae densities in skin snips and seizure frequency were assessed. After ivermectin, the median (IQR) percentage reduction in seizure frequency in the study sites ranged from 73.4% (26.0–90.0) to 100% (50.0–100.0). A negative binomial mixed model showed that ivermectin significantly reduced the seizure frequency, with a larger decrease in PWE with a high baseline seizure frequency. Mediation analysis showed that ivermectin reduced the seizure frequencies indirectly through reduction in microfilariae densities but also that ivermectin may have a direct anti-seizure effect. However, given the short half-life of ivermectin and the fact that ivermectin does not penetrate the healthy brain, such a direct anti-seizure effect is unlikely. A randomized controlled trial assessing the ivermectin effect in people infected with O. volvulus who are also PWE on a stable anti-seizure regimen may be needed to clarify the causal relationship between ivermectin and seizure frequency.
Keywords: epilepsy; ivermectin; onchocerciasis; seizures epilepsy; ivermectin; onchocerciasis; seizures

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MDPI and ACS Style

Dusabimana, A.; Tsebeni Wafula, S.; Raimon, S.J.; Fodjo, J.N.S.; Bhwana, D.; Tepage, F.; Abd-Elfarag, G.; Hotterbeekx, A.; Abrams, S.; Colebunders, R. Effect of Ivermectin Treatment on the Frequency of Seizures in Persons with Epilepsy Infected with Onchocerca volvulus. Pathogens 2021, 10, 21. https://doi.org/10.3390/pathogens10010021

AMA Style

Dusabimana A, Tsebeni Wafula S, Raimon SJ, Fodjo JNS, Bhwana D, Tepage F, Abd-Elfarag G, Hotterbeekx A, Abrams S, Colebunders R. Effect of Ivermectin Treatment on the Frequency of Seizures in Persons with Epilepsy Infected with Onchocerca volvulus. Pathogens. 2021; 10(1):21. https://doi.org/10.3390/pathogens10010021

Chicago/Turabian Style

Dusabimana, Alfred, Solomon Tsebeni Wafula, Stephen Jada Raimon, Joseph Nelson Siewe Fodjo, Dan Bhwana, Floribert Tepage, Gasim Abd-Elfarag, An Hotterbeekx, Steven Abrams, and Robert Colebunders. 2021. "Effect of Ivermectin Treatment on the Frequency of Seizures in Persons with Epilepsy Infected with Onchocerca volvulus" Pathogens 10, no. 1: 21. https://doi.org/10.3390/pathogens10010021

APA Style

Dusabimana, A., Tsebeni Wafula, S., Raimon, S. J., Fodjo, J. N. S., Bhwana, D., Tepage, F., Abd-Elfarag, G., Hotterbeekx, A., Abrams, S., & Colebunders, R. (2021). Effect of Ivermectin Treatment on the Frequency of Seizures in Persons with Epilepsy Infected with Onchocerca volvulus. Pathogens, 10(1), 21. https://doi.org/10.3390/pathogens10010021

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