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Epilepsy, cysticercosis, and toxocariasis

A population-based case-control study in rural Bolivia

From the Institute of Neurological Science (Drs. Nicoletti, Reggio, and Sofia), University of Catania, Institute of Infectious Diseases (Drs. Bartoloni, Bartalesi, Roselli, and Paradisi), University of Florence, and Institute of Parasitology (Dr. Cancrini), University "La Sapienza," Rome, Italy; Health District (Drs. Rosado Chavez and Gamboa Barahona), Cordillera Province, Camiri, Bolivia; Centers for Disease Control and Prevention (Dr. Tsang), Atlanta, GA; and London School of Hygiene and Tropical Medicine (Dr. Hall), United Kingdom.

Address correspondence and reprint requests to Dr. Alessandra Nicoletti, Istituto di Scienze Neurologiche, Università di Catania, Via S. Sofia no. 78, 95125 Catania, Italy; e-mail: anicol{at}dimtel.nti.it

Objective: To assess the relationship between epilepsy and infection with Taenia solium and Toxocara canis with a case-control study, in the rural area of the Cordillera Province, Bolivia.

Methods: A preliminary two-phase door-to-door prevalence survey determined the prevalence of epilepsy and identified cases and control subjects. At least two control subjects per case were selected, matching on sex, age, and community of residence. Cases and control subjects were assessed serologically for antibodies against T. canis by ELISA and against T. solium by enzyme-linked immunoelectrotransfer blot (EITB).

Results: The prevalence survey found 130 confirmed cases of epilepsy, of which 113 were eligible for the case-control study (59 partial seizures and 54 generalized seizures). Two hundred thirty-three control subjects were selected. Multivariable analysis for a matched case-control study was carried out. There was an association between EITB positivity for T. solium and epilepsy with an OR of 1.85 (95% CI 0.99 to 3.4) for all cases. A stronger association was found in those with partial epilepsy with a late onset of disease (15 years and older), where the OR was 3.66 (95% CI 1.10 to 12.10). A positive association was also found with T. canis for all cases with an OR of 2.70 (95% CI 1.41 to 5.19). This increased for those with late-onset partial epilepsy to an OR of 18.22 (95% CI 2.10 to 158.10).

Conclusion: This finding suggests that both neurocysticercosis and toxocariasis may in part explain the higher prevalence of epilepsy, particularly partial epilepsy, in developing countries.

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