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Distribution and potential indicators of hospitalized cases of neurocysticercosis and epilepsy in Ecuador from 1996 to 2008

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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.
Keywords
DISEASE BURDEN, PREVALENCE, AFRICA, CEREBRAL MALARIA, DIAGNOSTIC-CRITERIA, TAENIA-SOLIUM CYSTICERCOSIS, PORCINE CYSTICERCOSIS, AREA, INTERVENTION, MEXICO

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Chicago
Ron-Garrido, Lenin, Marco Coral Almeida, Sarah Gabriël, Washington Benitez-Ortiz, Claude Saegerman, Pierre Dorny, Dirk Berkvens, and Emmanuel Abatih. 2015. “Distribution and Potential Indicators of Hospitalized Cases of Neurocysticercosis and Epilepsy in Ecuador from 1996 to 2008.” Plos Neglected Tropical Diseases 9 (11).
APA
Ron-Garrido, L., Coral Almeida, M., Gabriël, S., Benitez-Ortiz, W., Saegerman, C., Dorny, P., Berkvens, D., et al. (2015). Distribution and potential indicators of hospitalized cases of neurocysticercosis and epilepsy in Ecuador from 1996 to 2008. PLOS NEGLECTED TROPICAL DISEASES, 9(11).
Vancouver
1.
Ron-Garrido L, Coral Almeida M, Gabriël S, Benitez-Ortiz W, Saegerman C, Dorny P, et al. Distribution and potential indicators of hospitalized cases of neurocysticercosis and epilepsy in Ecuador from 1996 to 2008. PLOS NEGLECTED TROPICAL DISEASES. 2015;9(11).
MLA
Ron-Garrido, Lenin, Marco Coral Almeida, Sarah Gabriël, et al. “Distribution and Potential Indicators of Hospitalized Cases of Neurocysticercosis and Epilepsy in Ecuador from 1996 to 2008.” PLOS NEGLECTED TROPICAL DISEASES 9.11 (2015): n. pag. Print.
@article{7093067,
  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.},
  articleno    = {e0004236},
  author       = {Ron-Garrido, Lenin and Coral Almeida, Marco and Gabri{\"e}l, Sarah and Benitez-Ortiz, Washington and Saegerman, Claude and Dorny, Pierre and Berkvens, Dirk and Abatih, Emmanuel},
  issn         = {1935-2735},
  journal      = {PLOS NEGLECTED TROPICAL DISEASES},
  keyword      = {DISEASE BURDEN,PREVALENCE,AFRICA,CEREBRAL MALARIA,DIAGNOSTIC-CRITERIA,TAENIA-SOLIUM CYSTICERCOSIS,PORCINE CYSTICERCOSIS,AREA,INTERVENTION,MEXICO},
  language     = {eng},
  number       = {11},
  pages        = {21},
  title        = {Distribution and potential indicators of hospitalized cases of neurocysticercosis and epilepsy in Ecuador from 1996 to 2008},
  url          = {http://dx.doi.org/10.1371/journal.pntd.0004236},
  volume       = {9},
  year         = {2015},
}

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