Recognising the neurological burden of onchocerciasis: the need to include onchocerciasis-associated epilepsy in onchocerciasis global health metrics
File(s)
Published version
Author(s)
Amaral, Luís-Jorge
Colebunders, Robert
Type
Journal Article
Abstract
Background
Historically, onchocerciasis has been recognised for its dermatological and ophthalmological manifestations, such as blindness. However, growing epidemiological evidence indicates that onchocerciasis is also associated with neurological complications, particularly onchocerciasis-associated epilepsy (OAE). These complications are not currently reflected in disease burden estimates and associated disability-adjusted life years (DALYs) for onchocerciasis.
Main text
The most recent global burden of disease estimates for onchocerciasis in 2019 reported 1.23 million DALYs without accounting for OAE. Yet, a preliminary study suggested that 128,000 years of life lost to disability (YLD, a key component of DALYs) may be attributable to epilepsy in onchocerciasis-endemic areas of East and Central Africa. This figure, which would represent over 13% of the total onchocerciasis morbidity burden and 10% of the global epilepsy morbidity burden, is likely still an underestimation. Current disability weights for epilepsy YLD estimation may not fully capture the spectrum of OAE, which often involves nodding syndrome, developmental delays, motor disabilities, cognitive impairments and stigma. In regions where access to antiseizure medication treatment is sparse, poorly controlled seizures can exacerbate disability and lead to premature mortality. Targeted integrated strategies—combining onchocerciasis control measures with improved epilepsy care—could help address these critical gaps.
Conclusions
Recognising OAE as part of the disease burden associated with onchocerciasis may encourage global health stakeholders to allocate resources for targeted interventions, thereby refining disease burden estimates, reducing disability, averting premature deaths and improving overall health outcomes.
Historically, onchocerciasis has been recognised for its dermatological and ophthalmological manifestations, such as blindness. However, growing epidemiological evidence indicates that onchocerciasis is also associated with neurological complications, particularly onchocerciasis-associated epilepsy (OAE). These complications are not currently reflected in disease burden estimates and associated disability-adjusted life years (DALYs) for onchocerciasis.
Main text
The most recent global burden of disease estimates for onchocerciasis in 2019 reported 1.23 million DALYs without accounting for OAE. Yet, a preliminary study suggested that 128,000 years of life lost to disability (YLD, a key component of DALYs) may be attributable to epilepsy in onchocerciasis-endemic areas of East and Central Africa. This figure, which would represent over 13% of the total onchocerciasis morbidity burden and 10% of the global epilepsy morbidity burden, is likely still an underestimation. Current disability weights for epilepsy YLD estimation may not fully capture the spectrum of OAE, which often involves nodding syndrome, developmental delays, motor disabilities, cognitive impairments and stigma. In regions where access to antiseizure medication treatment is sparse, poorly controlled seizures can exacerbate disability and lead to premature mortality. Targeted integrated strategies—combining onchocerciasis control measures with improved epilepsy care—could help address these critical gaps.
Conclusions
Recognising OAE as part of the disease burden associated with onchocerciasis may encourage global health stakeholders to allocate resources for targeted interventions, thereby refining disease burden estimates, reducing disability, averting premature deaths and improving overall health outcomes.
Date Issued
2025-03-28
Date Acceptance
2025-03-18
Citation
Infectious Diseases of Poverty, 2025, 14
ISSN
2049-9957
Publisher
BioMed Central
Journal / Book Title
Infectious Diseases of Poverty
Volume
14
Copyright Statement
© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40156070
PII: 10.1186/s40249-025-01297-6
Subjects
Burden of disease
Cost-effective
Disability-adjusted life years
Epilepsy
Mortality
Nodding syndrome
Onchocerciasis
Onchocerciasis-associated epilepsy
Prevention
Humans
Cost of Illness
Disability-Adjusted Life Years
Epilepsy
Global Burden of Disease
Global Health
Onchocerciasis
Publication Status
Published
Coverage Spatial
England
Article Number
26
Date Publish Online
2025-03-28