**5. Conclusions**

*Overview on Echinococcosis*

confirmed with epilepsy by CT scan and 20 were diagnosed with definitive NCC (for a proportion of 45.5–46.9% in two of the study villages). The third study [37] showed that 39 of 70 positive were confirmed with epilepsy for a lifetime prevalence of 4.5% and epilepsy was associated with cysticercosis by Ag-ELISA (POR = 3.1, 95% BCI = 1.0; 8.3). All three studies confirmed epilepsy by ILAE definition/physician. In Senegal, a study [42] showed that one of 10 CT-scan positives individual by Ag-ELISA and EITB was reported to have epileptic seizures, and cerebral CT-scans showed that 23.3% of the seropositive were affected by neurocysticercosis. In Togo, a previous study [57] showed that cysticercosis (confirmed by ELISA, anatomopathological examination, cranial or muscle X-ray) caused 29.5% epilepsy in sufferers. A study by [40] in five Health and Demographic Surveillance System centeres in Kintampo Ghana and four other countries (Kenya, South Africa, Uganda and Tanzania) showed that epilepsy was significantly associated with exposure to *T. solium* (odds ratios 7·03, *P* = 0·002), in adults epilepsy confirmed by questionnaire/clinician and cysticercosis was confirmed by detection antibody by Western Blot, while active convulsive epilepsy in the study was defined as two or more unprovoked convulsive seizures (occurring

at least 24 h apart, with at least one seizure in the preceding 12 months).

The stigmatization and marginalization of epilepsy is also enormous *n* many African countries, epileptic patients are cast out because it is considered a contagious or shameful disease [28, 43, 69, 77]. Those affected go through social seclusion and people will not marry PWE unless both parties have epilepsy. For example, consanguineous marriage is forbidden by culture in South East Nigeria [43], and may potentially force them to intermarry thereby promoting genetic transmission of epilepsy [43, 44]. Other beliefs include that inheriting properties from PWE will get one infected but if a medicine man performs burial rites for the dead person and takes away their properties and burn it then it stops. Burial of PWE far away from home prevents people from getting epilepsy. Eating, sleeping together or wearing same clothes with PWE is said to be a source of infection [43, 44]. Eating of pork by someone with epilepsy promotes cysticercosis and corroborates with a study that found a significant link between cysticercosis occurrence and epilepsy [78]. In West Africa, *T. solium* cysticercosis in pigs and man has been reported and reports have shown the prevalence's of porcine cysticercosis across the west African countries varies from 0.05 to 46% for both carcass inspection and serological studies and prevalence of taeniid eggs were found to be between 8.6 and 40% based on stool microscopy while copro-antigen ELISA gave a prevalence of 30% [65] as shown in **Tables 1** and **2**. Difference in severity of infection caused by *T. solium* could also explain the differences in prevalence of epilepsy. In addition, the extent of the presence of other environmental factors such as use of bad hygiene practices, close contact of humans and pigs and consumption of inadequately cooked pork affects the differences in prevalence of epilepsy [31] including free roaming pigs [43]. Abattoirs and approved slabs are the only approved places for slaughter and inspection of pork meat for consumption, however most carcasses are sold uninspected hence, lack of inspection and large scale clandestine slaughter of pigs promote spread of cysticercosis [32, 34]. The poor knowledge of *T. solium*, poor hand washing practices, not treating drinking water and handling of raw pork with bare hands promote spread of cysticercosis [65]. Reports in the region indicate that home slaughter conditions were normally substandard because they are makeshift and not constructed to actually meet the requirements of ideal slaughter premises [48]. There was also strong association between knowledge of cysticercosis and occupation and could be attributed to the fact that people in certain occupations are considered to be more knowledgeable

**38**

about the disease than others [48].

The high prevalence of porcine and human cysticercosis and epilepsy in the region indicates that there is a need to get more updated prevalence data of cysticercosis in rural areas where epilepsy is suspected to be more prevalent, compared to urban regions due to parasitic infection. Studies determining the association between epilepsy and cysticercosis should be carried out in countries where it has not been done. The conditions necessary for the parasite to thrive and be transmitted in the region is present in West Africa. Interventions studies including Health education has only been done recently in Burkina Faso, such intervention measures should be carried out in other parts of the region so as to enlighten the populace on the menace caused by the parasite and how it could be prevented.
