Onchocerciasis-associated epilepsy (OAE) is a unique childhood-onset epilepsy that occurs predominantly in several regions of sub-Saharan Africa and in limited areas in South America and in Yemen in the Middle East. OAE may be grouped into 1) Epilepsy without other associated neurological abnormalities 2) Epilepsy associated with other neurological abnormalities (focal neurological deficits, intellectual delay, etc.) 3) Nodding syndrome (with characteristic head nodding seizures) and 4) Nakalanga syndrome (severe growth retardation). OAE is a neuroinflammatory disorder associated with Onchocerca volvulus or its co-symbiotic bacteria, Wolbachia induced immune response and possible cross-reactivity with host neuron surface proteins. OAE occurs clustered in certain families and villages close to rapid-flowing black-fly-infested rivers with seizure onset between 3 and 18 years. MRI abnormalities reported include cerebral and cerebellar atrophy, hippocampal sclerosis, gliotic lesions and subcortical signal abnormalities in the parietal, occipital, parieto-occipital, frontal, fronto-parietal > temporal head regions. Herein, we describe OAE in three children immigrated to the United States. Two of the patients were siblings (9- and 13-year-old girls) immigrated from Burundi and presented with focal epilepsy, normal exam and characteristic brain MRI findings (figure 1; 1a-1e and 2a-2e) who can be classified into group 1. One patient (15-year-old boy) born in Eritrea and later moved to Ethiopia, presented with focal with secondarily generalized epilepsy, suspected autism, intellectual delay and typical brain MRI findings (figure 1; 3a -3e) and can be classified into group 2. With international travel and global immigration, clinicians even in non-endemic countries should consider OAE in their differential diagnosis.

Mahesh Chikkannaiah
Dayton Children's Hospital/ Wright State University
United States

Laura Fonseca
Dayton Children's Hospital
United States

Rajkumar Agarwal
Dayton Children's Hospital/ Wright State University
United States

Samuel Dzodzomenyo
Dayton Children's Hospital/ Wright State University
United States

Gogi Kumar
Dayton Children's Hospital/ Wright State University
United States