What causes epilepsy? In Africa: Parasites, Trauma, Birth Complications

Parasites, Trauma Causes of Epilepsy

What causes epilepsy? In Africa, the burden of epilepsy is substantial. Read more and listen to VOA report on this problem. JR

by Joe DeCapua

A new study said it’s possible to substantially reduce the number of epilepsy cases in Africa. The neurological disorder, which is characterized by seizures, is much more common in poor countries and rural areas.


The study is the largest ever done on epilepsy in Sub-Saharan Africa. Nearly 600,000 people were evaluated in five countries: Kenya, South Africa, Uganda, Tanzania and Ghana.

“Epilepsy is an abnormal discharge within the brain, such that the person who has it experiences abnormal convulsive movements as a result of this abnormal discharge. There’s a strong genetic component to it. In some cases a strong family history. There are genes which have been associated with it,” said Psychiatry Professor Charles Newton of the Welcome Trust and Oxford University, who led the research.

Epilepsy can cause not only physical suffering, but emotional pain as well.

“In many African communities the cause is attributed to ancestors, spiritual causes and even witchcraft. There’s a lot of stigma attached to epilepsy. The people who have epilepsy are less likely to go to school; are less likely to marry; are less likely to get jobs,” he said.

Newton and his team said the study is the “first to reveal the true extent of the problem and the impact of different risk factors.” And it’s not just genetics. One big risk factor is parasites. The study found that adults, who had been exposed to a parasitic disease, were up to three times more likely to develop epilepsy.

“The ones that we identified were onchocerciasis, which is a parasite associated with river blindness; Toxocara and taxoplasmosis – both of which are transmitted by cats; neurocysticercosis, which is transmitted by pigs. And we have some evidence to suggest that malaria may also be contributing to this,” he said.

The adults were actually exposed to parasitic diseases during childhood. However, it took many years for the parasites to damage the brain enough to trigger epilepsy.

As for children, the study cited different factors

“In the children under 18 years of age, we found that although the parasitic causes were there they weren’t as important as the abnormal pregnancies of their mothers – and particularly events that occurred around their birth. So it looks like that these children are suffering from birth trauma. So, for example, if the mother has a prolonged second-stage labor or if the child comes out and is not breathing and hasn’t got any oxygen going to the brain, these may be responsible or factors in the pathway for developing brain damage,” said Newton....

Article and report here

Benefits of hypothermia for infants continue through early childhood

NIH study shows increased survival from treatment for oxygen deficiency at birth.  I have set up these protocols.   The data is clear that  The treatment  works  and  and I have seen remarkable outcomes.   The protocols need to involve neurology because of the high risk of  subtle seizures and the need for cervical examinations by expert.  One needs to ask if this is a standard of care in 2012.  JR

Benefits of hypothermia for infants continue through early childhood

A treatment to reduce the body temperatures of infants who experience oxygen deficiency at birth has benefits into early childhood, according to a follow-up study by a National Institutes of Health research network.

Children who received the hypothermia treatment as infants were more likely to have survived to ages 6 and 7, when they were evaluated again, than were children who received routine care, the study found. They were no more likely than the routine care group to experience a physical or cognitive impairment, it said. The report appears in the New England Journal of Medicine.

“The findings show that the use of this cooling technique after birth increases the chances of survival, without increasing the risk of long-term disability,” said senior author Rosemary D. Higgins, M.D., of the Pregnancy and Perinatology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The study was conducted by Seetha Shankaran, M.D., of Wayne State University in Detroit, Dr. Higgins, and 25 other researchers in the NICHD Neonatal Research Network. In addition to NICHD, funding was also provided by the NIH's National Center for Research Resources and the National Center for Advancing Translational Sciences.

Infants born at term may fail to get enough oxygen, from blood loss or other birth complications. Oxygen deprivation during the birth process is called hypoxic-ischemic encephalopathy, or HIE. In severe cases of HIE, death rates can reach 50 percent. Survivors often sustain brain damage, which can result in cerebral palsy, cognitive impairment, or hearing and vision loss. Even if they do not experience detectable brain damage, children who experience HIE at birth are at higher risk for learning disabilities, language delays, and memory deficits. Severe oxygen deficiency at birth is also known as birth asphyxia.

The current study was in follow up to an earlier study, conducted when the children were newborns and had received the body cooling treatment shortly after birth. That earlier study found that infants who received the cooling treatment were less likely to die or to develop moderate or severe disability than were the infants who received routine care. The original study assessed children's movement and cognitive abilities, hearing, and vision when they were 18 to 22 months old.

The study authors noted that neonatal intensive care units around the world have adopted this cooling technique to reduce the risk of death and disability among full-term infants who show signs of the brain dysfunction indicating oxygen deficiency.

“Testing at 18 months can identify major delays in a toddler's growth or brain development, but can't identify some of the more subtle cognitive or physical impairments that might become apparent in an older child,” Dr. Higgins said. “This follow-up study confirms the original finding, showing that children who received the cooling treatment were more likely to survive, and that the survivors were no more likely to have a disability than the children in the untreated group.”

The 208 children in the study were diagnosed with HIE within 6 hours of birth and treated in newborn intensive care units in the network. They were given the usual intensive care or treated with the body cooling technique. With this technique, cool water circulates inside a waterproof blanket beneath the infant. The cool water reduces the infant's temperature as low as 91.4 degrees Fahrenheit, and maintains it there 72 hours, after which caregivers allow the infant's body temperature to return to a normal.

To conduct the current study, the researchers analyzed data from follow-up visits conducted when these infants had turned 6 or 7 years old. The researchers compared rates of death and disability among those who got the cooling therapy and those who had received the usual intensive care. Mortality rates reflected the number of children who died between birth and age 7. The study found a 28 percent mortality rate in the hypothermia group, compared with 44 percent rate in the usual care group.

The researchers calculated the number of deaths and cases of severe disability as a single combined outcome. In the cooling group, the combined rate was 41 percent, compared with 60 percent in the usual care group. Severe disability involved motor function, cognitive ability, and vision. Rates of cerebral palsy, blindness, and epilepsy were similar between the two groups.

“Before the advent of this cooling treatment in 2005, doctors couldn't treat HIE