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Pathogens
Volume 9
Issue 3
10.3390/pathogens9030205
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Article

Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo

by
Michel Mandro
1,
Joseph Nelson Siewe Fodjo
2,
Alfred Dusabimana
2,
Deby Mukendi
3,
Steven Haesendonckx
4,
Richard Lokonda
3,
Swabra Nakato
2,
Francoise Nyisi
5,
Germain Abhafule
5,
D Wonya’rossi
6,
An Hotterbeekx
2,
Steven Abrams
2,4 and
Robert Colebunders
2,*
1
Provincial Health Division Ituri, Ministry of Health, P.O. Box 57 Ituri, Congo
2
Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium
3
Centre Neuro-Psycho Pathologique, University of Kinshasa, P.O. Box 127 Kinshasa, Congo
4
Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, 3590 Diepenbeek, Belgium
5
Centre de Recherche en Maladies Tropicales de l’Ituri, Rethy, P.O. Box 143 Bunia, Congo
6
Programme National de Lutte contre l’Onchocercose, P.O. Box 185 Bunia, Congo
*
Author to whom correspondence should be addressed.
Pathogens 2020, 9(3), 205; https://doi.org/10.3390/pathogens9030205
Submission received: 21 January 2020 / Revised: 25 February 2020 / Accepted: 7 March 2020 / Published: 10 March 2020
(This article belongs to the Special Issue Onchocerciasis and River Epilepsy)
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Abstract

Background: There is anecdotal evidence that ivermectin may decrease seizure frequency in Onchocerca volvulus-infected persons with epilepsy (PWE). Methods: In October 2017, a 12-month clinical trial was initiated in rural Democratic Republic of Congo. PWE with onchocerciasis-associated epilepsy experiencing ≥2 seizures/month were randomly allocated to receive, over a one-year period, ivermectin once or thrice (group 1), while other onchocerciasis-infected PWE (OIPWE) were randomized to ivermectin twice or thrice (group 2). All participants also received anti-epileptic drugs. Data was analyzed using multiple logistic regression. Results: We enrolled 197 participants. In an intent-to-treat analysis (data from group 1 and 2 combined), seizure freedom was more likely among OIPWE treated with ivermectin thrice (OR: 5.087, 95% CI: 1.378–19.749; p = 0.018) and twice (OR: 2.471, 95% CI: 0.944–6.769; p = 0.075) than in those treated once. Similarly, >50% seizure reduction was more likely among those treated with ivermectin twice (OR: 4.469, 95% CI: 1.250–16.620) and thrice (OR: 2.693, 95% CI: 1.077–6.998). Absence of microfilariae during the last 4 months increased the odds of seizure freedom (p = 0.027). Conclusions: Increasing the number of ivermectin treatments was found to suppress both microfilarial density and seizure frequency in OIPWE, suggesting that O. volvulus infection plays an etiological role in causing seizures.
Keywords: onchocerciasis; epilepsy; ivermectin; trial; seizures onchocerciasis; epilepsy; ivermectin; trial; seizures

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MDPI and ACS Style

Mandro, M.; Siewe Fodjo, J.N.; Dusabimana, A.; Mukendi, D.; Haesendonckx, S.; Lokonda, R.; Nakato, S.; Nyisi, F.; Abhafule, G.; Wonya’rossi, D.; et al. Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo. Pathogens 2020, 9, 205. https://doi.org/10.3390/pathogens9030205

AMA Style

Mandro M, Siewe Fodjo JN, Dusabimana A, Mukendi D, Haesendonckx S, Lokonda R, Nakato S, Nyisi F, Abhafule G, Wonya’rossi D, et al. Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo. Pathogens. 2020; 9(3):205. https://doi.org/10.3390/pathogens9030205

Chicago/Turabian Style

Mandro, Michel, Joseph Nelson Siewe Fodjo, Alfred Dusabimana, Deby Mukendi, Steven Haesendonckx, Richard Lokonda, Swabra Nakato, Francoise Nyisi, Germain Abhafule, D Wonya’rossi, and et al. 2020. "Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo" Pathogens 9, no. 3: 205. https://doi.org/10.3390/pathogens9030205

APA Style

Mandro, M., Siewe Fodjo, J. N., Dusabimana, A., Mukendi, D., Haesendonckx, S., Lokonda, R., Nakato, S., Nyisi, F., Abhafule, G., Wonya’rossi, D., Hotterbeekx, A., Abrams, S., & Colebunders, R. (2020). Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo. Pathogens, 9(3), 205. https://doi.org/10.3390/pathogens9030205

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