Distribution and Potential Indicators of Hospitalized Cases of Neurocysticercosis and Epilepsy in Ecuador from 1996 to 2008

PLoS Negl Trop Dis. 2015 Nov 18;9(11):e0004236. doi: 10.1371/journal.pntd.0004236. eCollection 2015 Nov.

Abstract

Background: Epilepsy is one of the most common signs of Neurocysticercosis (NCC). In this study, spatial and temporal variations in the incidence of hospitalized cases (IHC) of epilepsy and NCC in Ecuadorian municipalities were analyzed. Additionally, potential socio-economic and landscape indicators were evaluated in order to understand in part the macro-epidemiology of the Taenia solium taeniasis/cysticercosis complex.

Methodology: Data on the number of hospitalized epilepsy and NCC cases by municipality of residence were obtained from morbidity-hospital systems in Ecuador. SatScan software was used to determine whether variations in the IHC of epilepsy and NCC in space and time. In addition, several socio-economic and landscape variables at municipality level were used to study factors intervening in the macro-epidemiology of these diseases. Negative Binomial regression models through stepwise selection and Bayesian Model Averaging (BMA) were used to explain the variations in the IHC of epilepsy and NCC.

Principal findings: Different clusters were identified through space and time. Traditional endemic zones for NCC and epilepsy, recognized in other studies were confirmed in our study. However, for both disorders more recent clusters were identified. Among municipalities, an increasing tendency for IHC of epilepsy, and a decreasing tendency for the IHC of NCC were observed over time. In contrast, within municipalities a positive linear relationship between both disorders was found. An increase in the implementation of systems for eliminating excrements would help to reduce the IHC of epilepsy by 1.00% (IC95%; 0.2%-1.8%) and by 5.12% (IC95%; 3.63%-6.59%) for the IHC of NCC. The presence of pig production was related to IHC of NCC.

Conclusion/significance: Both disorders were related to the lack of an efficient system for eliminating excrements. Given the appearance of recent epilepsy clusters, these locations should be studied in depth to discriminate epilepsies due to NCC from epilepsies due to other causes. Field studies are needed to evaluate the true prevalence of cysticercosis in humans and pigs in different zones of the country in order to better implement and manage prevention and/or control campaigns.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ecuador / epidemiology
  • Environmental Exposure
  • Epilepsy / epidemiology*
  • Epilepsy / etiology*
  • Hospitalization
  • Humans
  • Incidence
  • Neurocysticercosis / epidemiology*
  • Prevalence
  • Risk Factors
  • Socioeconomic Factors
  • Spatio-Temporal Analysis
  • Topography, Medical*

Grants and funding

This work was financially supported by the Belgian Cooperation in the framework of the Institutional Collaboration between the Institute of Tropical Medicine in Antwerp, Belgium and the Centro Internacional de Zoonosis of the Central University of Ecuador. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.