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
Background: There is anecdotal evidence that ivermectin may decrease seizure frequency in <i>Onchocerca volvulus</i>-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-asso...
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| Language: | English |
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MDPI AG
2020-03-01
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| Series: | Pathogens |
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| Online Access: | https://www.mdpi.com/2076-0817/9/3/205 |
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| author | Michel Mandro Joseph Nelson Siewe Fodjo Alfred Dusabimana Deby Mukendi Steven Haesendonckx Richard Lokonda Swabra Nakato Francoise Nyisi Germain Abhafule D Wonya’rossi An Hotterbeekx Steven Abrams Robert Colebunders |
| author_facet | Michel Mandro Joseph Nelson Siewe Fodjo Alfred Dusabimana Deby Mukendi Steven Haesendonckx Richard Lokonda Swabra Nakato Francoise Nyisi Germain Abhafule D Wonya’rossi An Hotterbeekx Steven Abrams Robert Colebunders |
| author_sort | Michel Mandro |
| collection | DOAJ |
| description | Background: There is anecdotal evidence that ivermectin may decrease seizure frequency in <i>Onchocerca volvulus</i>-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; <i>p</i> = 0.018) and twice (OR: 2.471, 95% CI: 0.944−6.769; <i>p</i> = 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 (<i>p</i> = 0.027). Conclusions: Increasing the number of ivermectin treatments was found to suppress both microfilarial density and seizure frequency in OIPWE, suggesting that <i>O. volvulus</i> infection plays an etiological role in causing seizures. |
| first_indexed | 2024-12-10T06:27:11Z |
| format | Article |
| id | doaj.art-c9aafd4168bb4686866bb4d61bded83e |
| institution | Directory Open Access Journal |
| issn | 2076-0817 |
| language | English |
| last_indexed | 2024-12-10T06:27:11Z |
| publishDate | 2020-03-01 |
| publisher | MDPI AG |
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| series | Pathogens |
| spelling | doaj.art-c9aafd4168bb4686866bb4d61bded83e2022-12-22T01:59:11ZengMDPI AGPathogens2076-08172020-03-019320510.3390/pathogens9030205pathogens9030205Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of CongoMichel Mandro0Joseph Nelson Siewe Fodjo1Alfred Dusabimana2Deby Mukendi3Steven Haesendonckx4Richard Lokonda5Swabra Nakato6Francoise Nyisi7Germain Abhafule8D Wonya’rossi9An Hotterbeekx10Steven Abrams11Robert Colebunders12Provincial Health Division Ituri, Ministry of Health, P.O. Box 57 Ituri, CongoGlobal Health Institute, University of Antwerp, 2610 Antwerp, BelgiumGlobal Health Institute, University of Antwerp, 2610 Antwerp, BelgiumCentre Neuro-Psycho Pathologique, University of Kinshasa, P.O. Box 127 Kinshasa, CongoInteruniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, 3590 Diepenbeek, BelgiumCentre Neuro-Psycho Pathologique, University of Kinshasa, P.O. Box 127 Kinshasa, CongoGlobal Health Institute, University of Antwerp, 2610 Antwerp, BelgiumCentre de Recherche en Maladies Tropicales de l’Ituri, Rethy, P.O. Box 143 Bunia, CongoCentre de Recherche en Maladies Tropicales de l’Ituri, Rethy, P.O. Box 143 Bunia, CongoProgramme National de Lutte contre l’Onchocercose, P.O. Box 185 Bunia, CongoGlobal Health Institute, University of Antwerp, 2610 Antwerp, BelgiumGlobal Health Institute, University of Antwerp, 2610 Antwerp, BelgiumGlobal Health Institute, University of Antwerp, 2610 Antwerp, BelgiumBackground: There is anecdotal evidence that ivermectin may decrease seizure frequency in <i>Onchocerca volvulus</i>-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; <i>p</i> = 0.018) and twice (OR: 2.471, 95% CI: 0.944−6.769; <i>p</i> = 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 (<i>p</i> = 0.027). Conclusions: Increasing the number of ivermectin treatments was found to suppress both microfilarial density and seizure frequency in OIPWE, suggesting that <i>O. volvulus</i> infection plays an etiological role in causing seizures.https://www.mdpi.com/2076-0817/9/3/205onchocerciasisepilepsyivermectintrialseizures |
| spellingShingle | Michel Mandro Joseph Nelson Siewe Fodjo Alfred Dusabimana Deby Mukendi Steven Haesendonckx Richard Lokonda Swabra Nakato Francoise Nyisi Germain Abhafule D Wonya’rossi An Hotterbeekx Steven Abrams Robert Colebunders 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 onchocerciasis epilepsy ivermectin trial seizures |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | onchocerciasis epilepsy ivermectin trial seizures |
| url | https://www.mdpi.com/2076-0817/9/3/205 |
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