Neuroinfections Are a Growing Cause of Epilepsy Worldwide

A panel of five world experts claims that neurologists are seeing more infectious and parasitic disorders than ever before, and are facing the challenge of treating epilepsy in what appears to be mystifying symptomatology.

The panel, organized by the International League Against Epilepsy (ILAE; Brussels, Belgium), provided delegates at the American Epilepsy Society (AES) 62nd annual meeting, held during December 2008 in Seattle (WA, USA) with an overview of neuroinfections around the world, and offered their insights on treatment.

Hector Hugo Garcia, M.D., from the Universidad Peruana Cayetano Heredia (Lima, Peru), pointed out that the study of neurocysticerosis--reportedly the leading cause of epilepsy in the developing world--provides a unique opportunity to understand the mechanisms of epilepsy and ways they might eventually be altered. Dr. Garcia recommended that neurologists treat the symptoms of epilepsy first and consider anti-parasitic agents only after the patient is well controlled.

Shichuo Li, M.D., from Beijing University (China), president of the Chinese Association Against Epilepsy, and who has held various positions with the World Health Organization (WHO; Geneva, Switzerland), discussed central nervous system infections and their growing role in epilepsy. He also outlined the way these infections are increasing internationally and contributing to the global burden of epilepsy.

Angelina Kakooza-Mwesige, M.D., from Makerere University (Kampala, Uganda), discussed seizures in the context of HIV and AIDS; she confirmed that 7,400 new HIV infections occur daily, 1,000 of these in children younger than 15 years. Most of these cases (68%) are in Africa and the remaining 32% occur in the rest of the world; an estimated 30% of people with HIV or AIDS develop seizures. Treating epilepsy in patients on antiretroviral agents is complex, she noted, and further complicated by the lack of access to drugs in many parts of Africa, leaving physicians with only older-generation options. She explained that the social implications are also difficult for patients since HIV patients who also have epilepsy have two highly stigmatizing conditions, adding that "most patients are more comfortable telling their loved ones they have epilepsy than HIV, but they have both to deal with and it is hard.”

Prof. Charles Newton, from the Kenya Medical Research Institute (KEMRI; Kilifi), described the link between malaria and epilepsy. Given the epileptogenic potential of Plasmodium falciparum, a cause of malaria in humans, and that an estimated two billion people are exposed to malaria each year, Prof. Newton reported that the relationship between the two "is a problem with enormous healthcare implications.”

William Theodore, M.D., chief of clinical epilepsy at the U.S. National Institute of Neurological Disorders and Stroke (Bethesda, MD, USA), described other neuroinfections that can play a role in epilepsy, such as meningitis and encephalitis. He also outlined the epileptogenic mechanisms of these infections and described efforts to define, on a molecular level, how certain viruses overcome the body's defense mechanism and interact with target cells.

"There are very few treatment guidelines in this area. This makes it difficult for neurologists,” said session co-chair Samuel Wiebe, M.D., from the Foothills Medical Center (Calgary, Canada). "Early diagnosis and treatment are important and efforts to predict who may develop neurological sequelae will also be helpful.”

Related Links:
International League Against Epilepsy
Universidad Peruana Cayetano Heredia
Makerere University
Kenya Medical Research Institute
U.S. National Institute of Neurological Disorders and Stroke