Ventricular injection of nerve growth factor increases dopamine content in the striata of MPTP-treated mice

Experimental depletion of dopaminergic striatal neurons was induced in mice with the neurotoxin MPTP. To investigate a possible effect of nerve growth factor on the damaged neurons, we injected 4 micrograms into the right cerebral ventricle of mice three days after the last administration of MPTP. We found a significant increase of dopamine and homovanillic acid in the striatum of MPTP treated mice after NGF administration when compared with dopamine and HVA levels in MPTP-treated control mice (p less than 0.001). The increase of dopamine and homovanillic acid seems to be related to a partial restorative effect of NGF on the damaged dopaminergic cells, since ventricular administration of NGF to normal mice did not increase dopamine or homovanillic acid contents above the levels measured in untreated controls. It appears that administration of nerve growth factor produces a beneficial effect on damaged dopaminergic neurons; this effect could be due to stimulation of neuron sprouting from neurons that survived the toxic effect of MPTP. The increase of dopamine levels was seen 8 days after injection of nerve growth factor and was maintained at least until day 25, showing a lasting persistence of the restorative effect.

The course of seizures after treatment for cerebral cysticercosis

BACKGROUND

Worldwide, cerebral cysticercosis is one of the most common causes of seizure disorders. Modern cysticidal drugs can usually eliminate the parasite from the brain, but there have been doubts as to whether such treatment improves the seizure disorder.

METHODS

We studied 240 patients with seizures and cysticercosis of the brain parenchyma. Of these patients, 118 received cysticidal therapy (albendazole, praziquantel, or both) for lesions without inflammation on imaging studies (group 1); 49 patients with similar lesions either were not offered or refused cysticidal medication (group 2). Another 58 patients with inflammation around cysts (making spontaneous resolution more likely) also did not receive cysticidal medication (group 3), whereas cysticerci were removed surgically in 15 patients (group 4). The 240 patients were followed for a mean (+/- SE) of 92 +/- 7 months.

RESULTS

In the patients treated with cysticidal medications, there was an 82 percent reduction in the mean number of brain cysts (from 5.0 to 0.9) and a 95 percent reduction in the mean frequency of seizures (from 11.3 to 0.6 per year; P less than 0.001). After three years of follow-up, 64 patients in group 1 (54 percent) were seizure-free. By contrast, the untreated patients (group 2) averaged 10.9 seizures per year; none were seizure-free. Among those with inflamed cysts (group 3), there was a 74 percent reduction in the frequency of seizures (from 7.5 to 2.7 per year), and 18 patients (31 percent) became seizure-free. After surgical treatment (group 4), there was an 87 percent reduction in the frequency of seizures (from 12.8 to 1.7 per year), and six patients (40 percent) became seizure-free.

CONCLUSIONS

After medical treatment of neurocysticercosis, there is usually remission or marked improvement in the associated seizure disorder.

Immunodiagnosis of neurocysticercosis. Disappointing performance of serology (enzyme-linked immunosorbent assay) in an unbiased sample of neurological patients

To ascertain the reliability of serological diagnosis of neurocysticercosis in the everyday a priori situation of neurological consultation, the enzyme-linked immunosorbent assay test was used to predict the eventual diagnosis of neurocysticercosis in an unselected sample of 1064 consecutive neurological cases. Results showed 69% sensitivity and 71% specificity of the enzyme-linked immunosorbent assay test for the diagnosis of neurocysticercosis. In sharp contrast with publications that have proclaimed the excellent diagnostic performance of immunodiagnostic tests, our results suggest that identification of serum antibodies with standard enzyme-linked immunosorbent assay techniques is of little value when applied to a large and heterogeneous group of neurological patients in an endemic area of cysticercosis, and our results urge a reevaluation of currently used immunodiagnostic tests that are practiced in the serum of suspected cases.

Albendazole therapy for giant subarachnoid cysticerci

Albendazole is considered to be the drug of choice for treatment of parenchymal brain cysticercosis. Its efficacy, however, for treatment of subarachnoid cysticerci has not been established, to our knowledge. In this study, we treated four patients who had giant subarachnoid cysticerci with albendazole at daily doses of 15 mg/kg of body weight for 8 days. Computed tomographic studies showed that all cysts disappeared 3 months after the end of treatment. This was associated with marked clinical improvement in every case. Our results indicated that albendazole is highly effective for treatment of this form of the disease.

Clinical pharmacokinetics of albendazole in patients with brain cysticercosis

Albendazole pharmacokinetics were studied in eight patients who were receiving albendazole in doses of 15 mg/kg per day for 8 days as treatment of brain cysticercosis. Albendazole was not detected in plasma, but its main metabolite albendazole sulphoxide could be measured. Maximum plasma levels for albendazole sulphoxide ranged from 0.45 to 2.96 micrograms/mL. The half-life of albendazole sulphoxide was between 10 and 15 hours. A double peak was found in three patients. Mean residence time values were from 14 to 20 hours. Plasma levels of albendazole sulphoxide at the steady state showed great intraindividual variability. The results suggest that albendazole can be administered twice daily rather than three times as is currently done.

A new complement fixation test for the diagnosis of neurocysticercosis in cerebrospinal fluid

As a modification of the classical complement fixation test, a new test for immunodiagnosis in cerebrospinal fluid (CSF) was developed. When the assay was used for the diagnosis of neurocysticercosis in 149 CSF samples from patients and 1036 from controls, results showed 93% concordance with positives and 97% with negatives when compared with the results obtained by ELISA; in addition, it was positive in 12 of 16 cases of neurocysticercosis in which negative results had been obtained by ELISA. The new complement fixation test is particularly useful in CSF because of the immunological peculiarities of the subarachnoid space, where local synthesis of oligoclonal antibodies is induced by infectious agents. Reagents used for the assay are easy to produce and preserve, and the test is inexpensive, reliable and easy to perform. As this test detects the immunobiological consequence of the antigen-antibody reaction, it can be used in conjunction with other assays, such as ELISA, that measure the reaction directly, thus increasing the diagnostic possibilities. It may also be used where financial or technical limitations hinder access to other immunodiagnostic tests.

Effect of dsRNA from phi 6 bacteriophage on herpetic infection in cell culture and an animal model

The double-stranded (ds) RNA from phi 6 bacteriophage inhibited herpes simplex virus type 1 (HSV-1) and HSV-2 infection in MA-104 cells but not in Vero cells. HSV-2 was more sensitive to this effect than HSV-1, with the HSV-2 ED50 being 0.25 micrograms/ml and the HSV-1 ED50 1.68 micrograms/ml. On genital infection by HSV-2 in guinea pigs, phi 6 dsRNA was more effective by intravaginal (P less than 0.05) than by intraperitoneal administration. A single dose of dsRNA of 600 micrograms/kg by intravaginal route modified favorably the natural course of the genital herpes in the treated animals (p less than 0.001). Compared with the infected controls, they showed a faster recovery with better healing of lesions; and the number and severity of recurrence was low. No mortality was observed and the control infected animals showed a mortality of 39%. Sera from dsRNA-treated animals showed antiviral activity with a 50% plaque-depressing dose (PDD50) of 10(1.5)/150 microliters; no antiviral activity was found in sera either from control infected or uninfected animals. No adverse effect was observed on the rate of growth of uninfected dsRNA-treated controls.

Genetic pattern of the HLA system: HLA A, B, C, DR, and DQ antigens in Mexican patients with parenchymal brain cysticercosis

The distribution of HLA class I and class II determinants was investigated in 48 patients with parenchymal neurocysticercosis and in 295 healthy controls of the same ethnic group, the Mexican Mestizo population. Two antigens, A28 and DQw2, showed significantly differences in frequency between patients and controls; HLA A28 was increased (39.6% versus 15.6%; pc = 0.008), and HLA DQw2 was decreased (4.2% versus 31.7%; pc = 0.004) in neurocysticercosis patients. The relative risk for developing the disease in HLA A28 positive individuals was 3.55. Our results show that the major histocompatibility complex plays some role in the susceptibility and resistance to parenchymal neurocysticercosis, but the HLA genetic background of patients with neurocysticercosis does not seem to influence the severity of inflammatory response against cysticerci, nor is the disease sex related.

Plasma and CSF levels of albendazole and praziquantel in patients with neurocysticercosis

Albendazole or praziquantel were measured in plasma and cerebrospinal fluid (CSF) in 29 patients with neurocysticercosis. Mean levels of albendazole in plasma were 0.918 microgram/ml and in CSF were 0.392 microgram/ml and levels of praziquantel were 1.640 micrograms/ml in plasma and 0.398 microgram/ml in CSF, after doses of 15 and 50 mg/kg, respectively. Drug concentrations in CSF were 43% for albendazole and 24% for praziquantel. The drug levels obtained for both drugs showed ample individual variations that were not related to age, sex, presence of inflammation in the subarachnoid space, or therapeutic effectiveness; such variations seem to be due to individual differences in pharmacokinetics. Both drugs were effective and the doses currently used of each drug seem to be optimal for therapy of neurocysticercosis.

Immunodiagnosis of human cysticercosis in cerebrospinal fluid. Antigens from murine Taenia crassiceps cysticerci effectively substitute those from porcine Taenia solium

Tapeworm antigens from Taenia crassiceps performed as well as those antigens from Taenia solium in an enzyme-linked immunosorbent assay for the detection of Cysticercus antibodies in 96 cerebrospinal fluid samples from patients with neurocysticercosis and in 96 CSF samples from patients with other varied neurological ailments. Thus, this manageable murine model of experimental cysticercosis solved the problem of antigen supply for clinical and epidemiological applications, and it provided an immediate means of abundant production of antigens for the wide distribution and standardization of immunodiagnostic tests for cysticercosis.

Dexamethasone increases plasma levels of albendazole

Therapy of neurocysticercosis with cysticidal drugs is frequently complicated by the exacerbation of symptoms that follows the inflammation triggered by the acute destruction of cysticerci. Treatment of such adverse reactions with dexamethasone is highly effective. However, it has been shown that dexamethasone lowers the plasma levels of praziquantel, thus reducing its cysticidal efficacy. We measured plasma levels of albendazole, another strong cysticidal drug, when dexamethasone was given simultaneously. We found that dexamethasone increased the plasma levels of albendazole by about 50% (P less than 0.002); hence, it seems that cysticercosis and the ensuing inflammation can be treated simultaneously with albendazole and dexamethasone without diminishing the efficacy of the cysticidal drug.

Albendazole therapy for subarachnoid and ventricular cysticercosis. Case report

Medical or surgical therapy for subarachnoid or ventricular cysticercosis is a controversial issue. The authors report a patient with cysticercus larvae in both ventricular and subarachnoid locations, who was successfully treated with albendazole. Thus, medical therapy has a role in the treatment of these forms of neurocysticercosis.

Low serum levels of nerve growth factor in diabetic neuropathy

Several structural and functional similarities between nerve growth factor and insulin have been described. Diabetes mellitus, a disease with absolute or relative deficiency of insulin is frequently associated with peripheral neuropathy whose physiopathological mechanisms are obscure. In this study, we measured serum levels of NGF in 18 patients with diabetic neuropathy and 9 healthy controls; patients with diabetic neuropathy had lower levels of NGF than controls (p less than 0.01). When patients were separated in two groups according to degree of impairment of motor nerve conduction velocity, those with more than 10% of impairment, had lower levels of NGF than those with less than 10% of impairment, or controls. It was found a correlation between NGF levels and decrease of motor nerve conduction velocity; then, diabetic neuropathy seems to be associated to low serum levels of NGF, pointing out a possible role of NGF in the pathology of diabetic neuropathy.

Comparison of therapeutic regimen of anticysticercal drugs for parenchymal brain cysticercosis

The efficacy of different regimens of therapy for parenchymal brain cysticercosis either with praziquantel (PZQ) or with albendazole (ALB) was compared in 114 patients. Four schemes of treatment were used: PZQ 50 mg/kg per day for 15 days, PZQ 50 mg/kg per day for 8 days, ALB 15 mg/kg per day for 30 days, and ALB 15 mg/kg per day for 8 days. Three months after therapy, it was apparent that both PZQ and ALB were effective, as shown by the disappearance of cystic lesions in computed tomographic scans. Thirty-three control patients followed for a mean of 11 months had no spontaneous remission of lesions. When comparing PZQ with ALB, the latter was found to be more effective than the former for both the full and the short course of treatment: 85% vs 60% and 85% vs 48% disappearance of lesions, respectively (P less than 0.001). Comparison of the full vs the short course of PZQ showed that the short course had a further 12% reduction in drug effectiveness. In contrast, the length of ALB therapy could be shortened without lessening its efficacy. Based on these results, an 8-day course of ALB is recommended as treatment for parenchymal brain cysticercosis; a 15-day course of PZQ could be subsequently used in those patients who show only partial response to ALB.

Neurocysticercosis as the main cause of late-onset epilepsy in Mexico

We studied 100 consecutive Mexican patients with epilepsy that started after the age of 25 years. All patients underwent clinical evaluation, computed tomography, and electroencephalography; additionally, cerebrospinal fluid analysis was performed in 82 of them. Neurocysticercosis or its sequelae were diagnosed in 50 patients (50%); 36 of these patients had partial seizures, 41 had parenchymal calcifications, and 15 had two or more lesions. Our results are in contrast with those of most studies from countries with a low incidence of neurocysticercosis, where brain tumors, cerebrovascular disease, trauma, and alcoholism are the main causes of tardive epilepsy.

What is the significance of the presence of MHC molecules on the surface of parasites in human neurocysticercosis?

Sixteen cysticerci excised from 15 surgery patients were examined for the presence of HLA molecules on their surface, to confirm the role of these molecules in parasite damage and to investigate if HLA products are host specific or perhaps host-like antigens synthesized by the parasite. MoAbs against monomorphic and polymorphic HLA were chosen according to the patients HLA phenotypes. MoAbs against host and non-host antigens were selected and tested on cyst slides by indirect immunofluorescence assays. Host molecules were present in 43.7% of the cysts, but non-host antigens were also apparent in 62.5%. These results suggest mimicry as a possible mechanism to explain the presence of MHC products on the surface of the parasite; inflammation may also induce the expression of HLA that could become associated with the parasite. In vitro cellular immune response to specific antigens was also performed and positive responses correlated with the presence of HLA molecules on the cyst's surface. Moreover, damaged parasites had host molecules as well. Parasites from responder patients had all kind of HLA molecules or at least, antigenic determinants while the cysts from non-responders did not have molecules on their surface. These data support the role of HLA in cyst destruction.

Effect of chronic stress on ENU-induced tumors

The relation of stress to cancer is the subject of considerable controversy. We studied the possible influence of chronic stress on the time of development and frequency of tumors induced in rats after a single exposure to ethylnitrosourea during prenatal life. Time of development, localization, incidence, type, and size of tumors were similar in stressed rats and in controls. Our results in this paradigm do not support the hypothesis that chronic stress exerts a potentiating effect on carcinogenesis.

Influence of in vitro lactic acidosis on central nervous system neurons

Central nervous system (CNS) cultured neurons while exposed to different concentrations and pH of L-lactic acid exhibited in general chromatin clumping, vacuolization in the cytoplasm, appearance of lipid bodies, accumulation of polyribosomes, cytoplasmic lucency and swollen and aggregation of mitochondria. These alterations progressed with lower pH and longer exposure to lactic acid. At pH 7.4, there was no considerable pathologic changes in cultured neurons irrespective to concentrations of lactic acid added. Comparable results were obtained with the use of other weak acid (citric acid) indicating that the observed changes were due to acidic pH rather than lactate per se.

Antibodies against fetal muscle proteins in serum from patients with amyotrophic lateral sclerosis

The serum from 30 patients with amyotrophic lateral sclerosis and 30 controls was tested by immunoblot with protein extracts obtained from fetal muscle, adult muscle, and denervated muscle. Results with adult and denervated muscle confirm previous reports that show a lack of particular reactivity of ALS serum when compared with control serum. However, we found reacting bands 5 times more frequently with ALS than with controls in the immunoblot with protein extract from rat fetal muscle; we confirmed reactivity by immunoperoxidase staining in frozen sections of fetal muscle. Our results point to the possibility of an immune reaction in ALS patients against ephemeral proteins of muscle that are present in large quantities at early stages of muscle differentiation and innervation.

Snug tubular enclosures reduce extrafascicular axonal escape at peripheral nerve repair sites

A method of fascicular nerve repair utilizing silicone rubber tubes has been developed and tested in the dog whose nerves, like those of man, have a thick epineurial sheath. The closely fitting tubes provide a noncompressive enclosure which minimizes axonal escape and facilitates axon regeneration in at least two ways: First, they provide an impermeable conduit for endoneurial fluid whose constituents create an environment favoring the regeneration of axons and Schwann cells. Second, the biocompatible tube induces rapid development of a highly organized capsule which isolates the repair site, prevents adhesions, and strengthens the discontinuity. Enclosure of coapted fascicles also improves alignment of endoneurial components while providing space for the resolution of edema. The inert, noncompressive enclosures appear to minimize unregulated axonal growth at the site of injury by providing a qualitatively distinct environment from that in loose or open tubes.

Neurocysticercosis: an update

Cysticercosis is the commonest parasitic disease of the central nervous system and is endemic not only in developing countries but in industrialized nations with high rates of immigration from endemic areas. Clinical manifestations of neurocysticercosis are non-specific and depend mainly on the number and the topography of the lesions, the host immune response to the parasite, and the sequelae of previous infections. Diagnosis is difficult on clinical grounds, but integration of data from computed tomography and cerebrospinal fluid analysis permits accurate diagnosis of most cases. Therapy for neurocysticercosis is also varied and must be individualized according to the activity of the disease and location of cysticerci. In this paper, the experience of the authors with neurocysticercosis is summarized and current information on several controversial aspects of this disease is reviewed.

Short course of albendazole therapy for neurocysticercosis

Albendazole is now used for therapy of neurocysticercosis; however, duration of treatment has usually been empirically determined. In this study we shortened the length of therapy from one month in previous reports, to one week. Twelve patients with parenchymal brain cysticercosis were treated with albendazole for eight days at daily doses of 15 mg/kg of body weight. After three months of treatment the number of cysts on computed tomography had decreased from 185 to six; a 97% reduction in the number of lesions. Total remission of all cysts was seen in nine patients. Two cases had been unsuccessfully treated before with praziquantel, in both instances albendazole therapy was effective with 100% improvement. Our results indicated that a short course of albendazole is highly effective for treatment of neurocysticercosis.

Intrasellar cysticercosis

Eight patients with cysticerci located inside the sella turcica are presented, and the clinical and radiological features of this rare form of neurocysticercosis are discussed. Clinical features included nonspecific ophthalmological and endocrinological disturbances similar to those produced by other sellar lesions. Computerized tomography (CT) usually showed a hypodense mass that simulated either a cystic tumor or an arachnoid cyst. Cerebrospinal fluid (CSF) findings were also nonspecific, as immunological reactions to cysticercosis were most often negative when inflammation was limited to suprasellar and intrasellar regions. An incorrect diagnosis of tumor was frequent in these cases. In contrast, when intrasellar cysticercosis was associated with other forms of neurocysticercosis, proper integration of CT and CSF data permitted an accurate diagnosis. Cysticercosis should be suspected in patients with hypodense juxtasellar lesions living in geographical areas where this disease is endemic. Prompt surgical resection of cysticerci will avoid irreversible damage to visual function.

Albendazole vs praziquantel for therapy for neurocysticercosis. A controlled trial

Praziquantel and albendazole have been recently described as effective drugs for treating cysticercosis of the brain. In this study, effectiveness of each drug for therapy for parenchymal brain cysticercosis was compared. Twenty patients were treated either with albendazole or with praziquantel; in addition, five patients were taken as controls and treated only with symptomatic drugs. Three months after therapy, results showed that both drugs, albendazole and praziquantel, were highly effective, as seen by the disappearance of cystic lesions in computed tomographic scans. All lesions in control patients remained unchanged. Albendazole, when compared with praziquantel, showed a 76% vs 73% disappearance of lesions, respectively. It was concluded that both drugs have similar equivalent efficacy and greatly improve the therapeutics of cysticercosis.

Sex-related severity of inflammation in parenchymal brain cysticercosis

To determine sex-related differences in the severity of host inflammatory reaction to cysticercosis, we studied computed tomographic findings in 100 patients with parenchymal neurocysticercosis and cerebrospinal fluid results in 239 patients with subarachnoid neurocysticercosis. Computed tomographic and cerebrospinal fluid data in male subjects were compared with those obtained in female subjects. We found that when cysticerci are found in brain parenchyma, women develop a greater degree of inflammation; such differences disappear when cysticerci are found in the subarachnoid space. Our results point out the possibility of a factor located within brain parenchyma that accounts for the observed sex-related differences in the severity of immune response to the parasite; this factor could also play a role in the pathogenesis of other immunologically mediated diseases of the brain that may occur more frequently in women. To our knowledge, this study is the first in demonstrating that sex is a risk factor for the severity of inflammatory response within brain parenchyma to a parasitic disease.

Plasma levels of praziquantel decrease when dexamethasone is given simultaneously

Treatment with praziquantel for neurocysticercosis frequently induces adverse reactions due to acute destruction of parasites; these reactions are suppressed by dexamethasone therapy. However, there is controversy about the most appropriate regimen with praziquantel and dexamethasone. We studied plasma levels of praziquantel in eight patients given the drug alone or with dexamethasone. Plasma levels of praziquantel were 50% lower in the same patient when dexamethasone was given simultaneously. Dexamethasone should not be added to praziquantel therapy as preventive treatment, but should be reserved for transient therapy of adverse reactions.

Hydrocephalus secondary to cysticercotic arachnoiditis. A long-term follow-up review of 92 cases

Ninety-two patients with hydrocephalus secondary to cysticercotic meningitis were followed for a mean period of 8 years 11 months. The mortality rate was 50%, with most patients dying within the first 2 years after cerebrospinal fluid (CSF) shunting. The prognosis was worse in females than in males. Multiple surgical procedures for shunt obstruction were necessary in half of the patients. Complications such as bacterial meningitis and shunt obstruction were more frequent in the patients who died than in those who survived. The follow-up data revealed that the clinical status was satisfactory in 78% of survivors and unsatisfactory in 22%. Spontaneous remission of the cysticercotic arachnoiditis, as shown by the CSF findings, occurred in only 18% of the cases. In most patients, arachnoiditis and positive immune reactions persisted unchanged even after several years. The results demonstrate the poor outcome of these patients and indicate the need for better medical and surgical therapy.

Albendazole therapy for neurocysticercosis

Seven patients with chronic parenchymal brain cysticercosis were treated with albendazole for one month at daily doses of 15 mg/kg of body weight. Computed tomographic follow-up studies were made at the following times: a mean of 16 months before the trial; the beginning of treatment; the end of treatment; and three months afterward. Computed tomographic studies at the beginning of treatment showed a total of 157 cysts, the last day of treatment the number had decreased to 39 cysts, and three months later, the total number of lesions was 22; this represents 86% improvement in the number of cystic lesions. Control studies in the same group of patients had shown chronic persistence of lesions without spontaneous improvement in most cases. Two patients had been treated with praziquantel previously with partial response; in both cases albendazole therapy was effective with 100% and 77% improvement. We conclude that albendazole is highly effective for the treatment of parenchymal brain cysticercosis. It is also effective in patients who had shown poor therapeutic response to praziquantel.

Cysticercotic encephalitis: a severe form in young females

Clinical and computerized tomography findings in patients with miliary infestation of cysticerci in brain parenchyma are presented. Cysticercotic encephalitis produces a severe and frequently fatal neurological disorder. Although parenchymal cysticercosis is common in endemic areas, in the cases reported here, the pathology is induced by a severe inflammatory response in brain parenchyma rather than by the physical presence of multiple cysts. As a result of diffuse brain edema, all cases develop subacute severe intracranial hypertension and compromise of visual function. One important feature of this form of neurocysticercosis is that it particularly affects young women.

Therapy of neurocysticercosis

The different manifestations of neurocysticercosis are classified and the appropriate therapy in each group is described.

Freezing of infested pork muscle kills cysticerci

A method for culturing cysticerci that allows successful evagination and growth of scolexes from metacestodes of Taenia solium was used to study the survival of cysticerci subjected to low temperatures. Refrigeration of pork muscle infested with cysticerci at temperatures above 0 degrees C did not affect the parasites' survival in culture. Conversely, freezing of meat prevented survival of cysts. A practical procedure to kill cysticerci is the storage of pork muscle for four days at -5 degrees C, three days at -15 degrees C, or one day at -24 degrees C. These simple measures would help prevent the most frequent parasitosis of man's central nervous system.

Immunogenetic profile of multiple sclerosis in Mexicans

This is the first study on genetic markers in Mexican Mestizos with multiple sclerosis (MS). Patients were born in Mexico, had no family history of MS are middle-class, and have a high-level education. HLA class I, class II determinants, C2, C4, BF, GLO-1, ABO, and Rb red cell systems were analyzed and compared with results of 295 controls. Measles antibodies, glucose, IgG, total proteins, and cell count were measured in cerebrospinal fluid; anti-neuron, T-cell, and B-cell antibodies were determined in serum. MS in Mexican Mestizos was clinically similar to MS reported in high prevalence countries. DRw6, as previously found in Japanese patients, and its subtype, DRw13, were increased in patients in our study (pc = 0.0007, pc = 0.01, respectively), and the combination A3, B7, DR2, was also elevated (pc = 0.003). The polygenicity of the disease is emphasized by the excess of AB group carriers (pc = 0.01). IgG levels were high in patients with DR2 or DRw6 and 67% of the latter had anti-T cell antibodies. Severity of the disease was also related to the DR markers. It is suggested that at least two HLA-DR linked genes and the industrialized environment are important for the expression of MS in Mestizos.

ELISA in the diagnosis of neurocysticercosis

IgM antibodies against cysticercus antigens were measured by enzyme-linked immunosorbent assay (ELISA) in 133 serum and 126 cerebrospinal fluid (CSF) samples from patients with active neurocysticercosis (NCC), in 61 serum and 32 CSF samples from patients with inactive NCC, and in 556 serum and 449 CSF samples from patients with other neurological disorders. For diagnosis of active NCC the test showed 50% sensitivity with 70% specificity in serum and 87% sensitivity with 95% specificity in CSF. We concluded that the use of the ELISA with serum is not reliable for diagnosis of NCC and therefore cannot be used routinely for the detection of cases or epidemiological studies. Conversely, ELISA used with CSF is highly dependable for detecting all forms of active NCC. The possible explanations for the discrepancy between serum and CSF results are discussed.

Glial fibrillary acidic protein in brain tumors

Glial fibrillary acidic protein has been widely used in neurobiology and neuropathology as a specific marker for normal and abnormal astrocytes. Here, we report the immunostaining of 107 brain tumors and controls using an antiserum against glial fibrillary acidic protein. Selection of astroglia-derived tumors was easy and of high accuracy. Pattern of staining and usefulness of the method are described.

Glial polyp (glioma) of the uterine cervix, report of a case with demonstration of glial fibrillary acidic protein

A case of glial tissue in a polypoid structure of the uterine cervix is presented; the presence of glial fibrillary acidic protein was demonstrated by immunoperoxidase, confirming the astrocytic nature of the tissue. The main hypotheses to explain this unusual finding are discussed.

Praziquantel in the treatment of neurocysticercosis: long-term follow-up

Thirty-five patients with active neurocysticercosis were treated with praziquantel and followed for 1 year after therapy. CT and CSF analysis showed that 91% of patients with parenchymal cysts improved, and 47% of patients with chronic arachnoiditis had remission. A single treatment with praziquantel for 2 weeks, administered in a daily dose of 50 mg/kg of body weight, was highly effective in parenchymal cysticercosis but less effective in meningeal cysticercosis. The benefits were sustained for at least 1 year.

Neurocysticercosis: a new classification based on active and inactive forms. A study of 753 cases

Cysticercosis of the central nervous system, because of the combination of inflammatory response, topography of lesions, degree of parasitic infestation, and sequelae of previous infestations produces a most variable clinical picture. The symptomatology may range from a discrete neurological disturbance to the most dramatic brain disorder. Severity of the disease, prognosis, and medical or surgical decision for treatment largely depend on the individual amalgam of the above-referred factors. An improved classification of neurocysticercosis (NCC) that delineates active from inactive forms of the disease will eventually be important in the research of immunodiagnosis and in therapeutic trials. In this report, a classification is presented that separates active from nonactive forms of NCC and is based on our experience with 735 patients studied. Characteristics of each form of NCC, frequency of principal signs and symptoms, and findings in cerebrospinal fluid analysis are discussed.

Therapy of parenchymal brain cysticercosis with praziquantel

Twenty-six patients with cysticercosis of the brain parenchyma were treated with the antihelmintic agent praziquantel (50 mg per kilogram of body weight daily for 15 days). During treatment a strong inflammatory reaction occurred, as evidenced by increased protein and cells in the cerebrospinal fluid. This finding correlated with headache, exacerbation of neurologic symptoms, and edema and inflammation around cystic lesions. After three months of treatment all patients had improved clinically, and 13 (50 per cent) were asymptomatic. The total number of cysts on CT scans had decreased from 152 at the beginning of treatment to 51, and the mean diameter of cysts was reduced by 72 per cent. CT scans showed improvement in 25 of the 26 patients, with total remission of all cysts in nine. Seventeen control patients followed with CT studies for a mean of 9 +/- 2 months had no spontaneous remission of lesions, and in many cases the scans showed worsening during the observation period. Our results indicate that praziquantel is effective in cysticercosis of the brain parenchyma.