Onchocerciasis-associated epilepsy in Western Equatoria State, South Sudan

Onchocerciasis-associated epilepsy (OAE) is a neglected public health problem in remote African regions endemic to onchocerciasis with suboptimal elimination programmes. OAE manifests in previously healthy children aged 3-18 years in the absence of any obvious cause for epilepsy and is marked by a diverse range of seizure types, including head nodding seizures (nodding syndrome). This paper reviews recent studies investigating the association between onchocerciasis and epilepsy in South Sudan. Surveys in Maridi, Mundri West, and Mvolo Counties demonstrated a very high prevalence (3-6%) and incidence of epilepsy, as well as substantial onchocerciasis serological prevalence (12-34%) in young children. However, a longitudinal population-based study conducted in Maridi and Mvolo showed that strengthening onchocerciasis elimination programmes was followed by a significant and consistent reduction in the incidence of epilepsy. Despite this progress, a large epilepsy treatment gap and a high level of misconceptions about epilepsy and epilepsy-related stigma were observed. Treating epilepsy in onchocerciasis-endemic regions is challenging. More advocacy is needed to provide uninterrupted access to free anti-seizure medication and promote community awareness programmes for improving the lives of persons with epilepsy and their families in these impoverished areas.