02287nas a2200289   4500000000100000008004100001260001600042653002500058653001400083653002100097653001900118653001300137653001400150653001500164653001500179653002100194100001700215700001800232700001600250700001300266700001500279700001100294700001800305245006400323520159600387022001401983       2024                            d  bElsevier BV10aNeurology (clinical)10aNeurology10aGeneral Medicine10aonchocerciasis10aEpilepsy10aTreatment10aPrevention10aIvermectin10aNodding syndrome1 aVan Cutsem G1 aSiewe Fodjo J1 aHadermann A1 aAmaral L1 aTrevisan C1 aPion S1 aColebunders R00aOnchocerciasis-Associated Epilepsy: charting a path forward3 a<p>This narrative review intends to inform neurologists and public health professionals about Onchocerciasis-Associated Epilepsy (OAE), a neglected public health problem in many remote onchocerciasis-endemic areas. For epidemiological purposes, we define OAE as sudden-onset of convulsive and non-convulsive seizure types, including head nodding seizures (nodding syndrome) in a previously healthy child aged 3 to 18 years in the absence of any other obvious cause for epilepsy, all happening within an area with high ongoing&nbsp;<em>Onchocerca volvulus</em>&nbsp;transmission. Several OAE pathophysiological mechanisms have been proposed, but none has been proven yet. Recent population-based studies showed that strengthening onchocerciasis elimination programs was followed by a significant reduction in the incidence of OAE and nodding syndrome. Treating epilepsy in onchocerciasis-endemic regions is challenging. More advocacy is needed to provide uninterrupted, free access to anti-seizure medication to persons with epilepsy in these remote, impoverished areas. It is crucial to develop policies and increase funding for the prevention and treatment of OAE to reduce the associated burden of disease, notably via the establishment of morbidity management and disability prevention programs (MMDP). Moreover, effective collaboration between onchocerciasis elimination and mental health programs is imperative to alleviate the burden of OAE. This synergy promises reciprocal advantages and underscores the need for a comprehensive approach to address this multifaceted challenge.</p>
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