We thank Spencer et al. for their interest in our study [1] and for the additional information about how the cases in Tanzania may differ from those with nodding syndrome… Click to show full abstract
We thank Spencer et al. for their interest in our study [1] and for the additional information about how the cases in Tanzania may differ from those with nodding syndrome in South Sudan and Uganda. As they point out, the epidemiological association between nodding syndrome and Onchocerca volvulus infection seems strong. Additional studies also show a strong association between O. volvulus infection and epilepsy in general (reviewed in [2]). However, due to the lack of evidence for direct invasion of the central nervous system by the O.
               
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