African Journal of Neurological Sciences, Vol. 21, No. 1, 2002, pp. 46

LETTER

KENYA : A NEW HUMAN CYSTICERCOSIS FOCUS

Macharia Waruingi, M.D.* , Bienvenue Ramanankandrasana**, Michel Druet-Cabanac**, M.D., Georges Nsengiyumva**, M.D., Bernard Bouteille**, Ph.D., Pierre Marie Preux**, M.D., Ph.D.**

* MGH Epilepsy Service, VBK 830, Massachusetts General Hospital 32 Fruit Street Boston MA 02114 USA, Email: wmacharia@bwh.bics.harvard.edu
** Institut d’Epidemiologie Neurologique  et de Neurologie Tropicale, Universite de Limoges, 87025 Limoges Cedex France, Email : preux@unilim.fr

Code Number: ns02010

When the larval form (Cysticercus cellulosae) of Taenia solium migrates to the brain, partial or secondarily generalized seizures may develop. In some countries in Africa (4) and the south American sub-continent (5) cysticercosis may be responsible for epilepsy in up to 50% of the cases.

Cases of human cysticercosis have not yet been described in Kenya to our knowledge in the literature. During the second half of 1998, patients with epilepsy were recruited in a rural and an urban region in non-governmental epilepsy care organization in Kenya. The rural region studied was Nyahururu and the urban region studied was Nairobi.

Epilepsy was classed as confirmed if the criteria of the Commission of Epidemiology and Prognosis of the International League Against Epilepsy in the guidelines for epidemiological studies on epilepsy were fulfilled (2).

All patients attending the epilepsy clinics in Nyahururu and Nairobi were interviewed and examined using the Questionnaire for Investigation of Epilepsy in Tropical Countries  (3)

Controls were defined as persons without epilepsy who lived in the same region as patients since birth. The control group was matched (age and sex) with the cases. The controls were interviewed using a separate questionnaire designed for that purpose. All those who included were required to give informed consent in order to participate in the study. The protocol was reviewed and approved by Kenyatta National and Nairobi University Ethical Committee. Ninety nine patients and 124 cases were recruited.

Serology for cysticercosis was realized by ELISA method using crude C. cellulosae antigen isolated from raw pork  (1)

The patients and the controls were similar in demographic characteristics: mean age was 20 years ± 10 and 58% were males. Five out of 99 patients (5.0%) and 3 out of 124 (2.4%) controls had positive serology for cysticercosis.

This finding of cysticercosis infected epileptic patients in Kenya has several important ramifications. Seropositivity for cysticercosis with higher frequency in patients with epilepsy is prove that the disease does exist in Kenya and may be the only factor responsible for the disease. This warrants close attention from health care personnel and the patient community, as cysticercosis is a practically preventable disease. It is possible that there exists more cases in endemic locations that were not reached by this study, especially in the semi-forested Savannah regions of the Rift Valley, and the wetter zones in the western part of Kenya.

It will be many years before Kenya acquires correct equipment for brain imaging that is accessible to the average man. Meanwhile, serology for cysticercosis may be a reasonable addition in the patient work up for seizure disorders in Kenya and should be done routinely.

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