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Neurocysticercosis in Children with Seizures: A Cross-Sectional Study. Int J Pediatr 2018; 2018:1030878. [PMID: 29951102 PMCID: PMC5987327 DOI: 10.1155/2018/1030878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/08/2017] [Accepted: 02/28/2018] [Indexed: 11/22/2022] Open
Abstract
Background Neurocysticercosis (NCC), a common cause of seizures in children from low and middle income countries (LMICs), if not diagnosed and treated early enough may lead to considerable morbidity and mortality. There is a lack of data on the prevalence of NCC and its clinical characteristics among those with seizure in South-Western Nepal. Aims and Objectives To study the prevalence and clinical characteristics of NCC in children with seizures. Material and Methods All children admitted to Universal College of Medical Sciences, a tertiary hospital in South-Western Nepal with seizures during 2014–16, were tested for NCC. NCC was diagnosed by neuroimaging [computerized tomography (CT) scan or magnetic resonance imaging (MRI)]. We used logistic regression to test the association between NCC with participants' characteristics and clinical symptoms. Results Among 4962 in-patient children, 168 (104 boys and 64 girls) had seizures (138 with generalized tonic clonic seizures (GTCS) and 30 with focal seizures). 43% of children with seizures had CT scan confirmed NCC. The prevalence of NCC in the oldest children (13–16 years) was significantly greater (57.1% versus 15.6%) compared to the youngest (0–4 years) one (p < 0.001). Among 72 children with NCC, the proportions of children with vesicular, calcified, and colloidal stages were 76% (n = 35), 18% (n = 13), and 6% (n = 2), respectively. Children with focal seizures had 13% more NCC compared to those with GTCS but the result was statistically not significant. The adjusted odds of having NCC among 5–8 years, 9–12 years, and 13–16 years children were 6.6 (1.78–24.60), 11.06 (2.74–44.60), and 14.47 (3.13–66.96), respectively, compared to 0–4-year-old children. Reoccurrence of seizures within the first 3 months of taking antiepileptic drug in those with NCC was approximately 3 times higher compared to those without NCC (11% versus 4%, p = 0.084). Conclusions This study shows that NCC contributes significantly to higher prevalence of seizures in children in South-Western region of Nepal.
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Sahu PS, Patro S, Jena PK, Swain SK, Das BK. Imaging and Serological-Evidence of Neurocysticercosis Among Patients with Seizures in Odisha, an Unexplored Eastern Coastal Province in India. J Clin Diagn Res 2015; 9:DC06-10. [PMID: 26155476 DOI: 10.7860/jcdr/2015/12609.5967] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/14/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Neurocysticercosis being a potential to human transmitted disease, is the major cause of seizures and a public health problem in tropical countries. Though India is known to be highly endemic, there are many provinces where reports are still unavailable thereby underestimating its actual burden. MATERIALS AND METHODS Anti-Cysticercus IgG antibodies in sera from cases presenting with seizures were screened by ELISA in a preliminary study in Odisha state which is a province in Eastern coastal India that was never explored before. Patients presenting with recent onset of seizures within age group 5 to 50 years, either local residents of Odisha or inhabitants from other parts of the country living for at least one year period in the study area were included. RESULTS The present study showed 43.75% cases with seizures to be confirmed neurocysticercosis (NCC) based on serology and brain imaging. However, statistically no association was established between anti-Cysticercus antibody detection and radio imaging characteristics (location, number of lesions, and stage). CONCLUSION This is the first study in Odisha presenting a series of cases with serological evidence of exposure to the parasite along with imaging characteristics which was consistent with NCC. It is recommended that NCC must be considered for a differential diagnosis in each active epilepsy case irrespective of prior prevalence information in all unexplored provinces in India and other endemic regions; also a compulsory reporting is warranted in order to aid in quantifying its actual burden.
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Affiliation(s)
- Priyadarshi Soumyaranjan Sahu
- Assistant Professor, Department of Immunology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India. Division of Pathology, School of Medicine, International Medical University , Kuala Lumpur, Malaysia
| | - Shubhransu Patro
- Associate Professor, Department of Internal Medicine, Kalinga Institute of Medical Sciences, KIIT University , Bhubaneswar, Odisha, India
| | - Payod Kumar Jena
- Consultant Neurologist, Department of Neurology, Kalinga Institute of Medical Sciences, KIIT University , Bhubaneswar, Odisha, India
| | - Santosh Kumar Swain
- Assistant Professor, Department of Internal Medicine, SCB Medical College and Hospital , Cuttack, Odisha, India
| | - Bidyut Kumar Das
- Professor, Department of Internal Medicine, SCB Medical College and Hospital , Cuttack, Odisha, India
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Sahu PS, Seepana J, Padela S, Sahu AK, Subbarayudu S, Barua A. Neurocysticercosis in children presenting with afebrile seizure: clinical profile, imaging and serodiagnosis. Rev Inst Med Trop Sao Paulo 2014; 56:253-8. [PMID: 24879004 PMCID: PMC4085870 DOI: 10.1590/s0036-46652014000300011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 10/04/2013] [Indexed: 11/22/2022] Open
Abstract
Neurocysticercosis (NCC) is one of the major causes of childhood seizures
in developing countries including India and Latin America. In this study neurological
pediatric cases presenting with afebrile seizures were screened for anti-Cysticercus
antibodies (IgG) in their sera in order to estimate the possible burden of
cysticercal etiology. The study included a total of 61 pediatric afebrile seizure
subjects (aged one to 15 years old); there was a male predominance. All the sera were
tested using a pre-evaluated commercially procured IgG-ELISA kit (UB-Magiwell
Cysticercosis Kit ™). Anti-Cysticercus antibody in serum was positive in 23 of 61 (37.7%)
cases. The majority of cases with a positive ELISA test presented with generalized
seizure (52.17%), followed by complex partial seizure (26.08%), and simple partial
seizure (21.73%). Headaches were the major complaint (73.91%). Other presentations
were vomiting (47.82%), pallor (34.78%), altered sensorium (26.08%), and muscle
weakness (13.04%). There was one hemiparesis case diagnosed to be NCC. In this study
one child without any significant findings on imaging was also found to be positive
by serology. There was a statistically significant association found between the
cases with multiple lesions on the brain and the ELISA-positivity (p
= 0.017). Overall positivity of the ELISA showed a potential cysticercal etiology.
Hence, neurocysticercosis should be suspected in every child presenting with afebrile
seizure especially with a radio-imaging supportive diagnosis in tropical developing
countries or areas endemic for taeniasis/cysticercosis.
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Affiliation(s)
| | - Jyotsna Seepana
- Department of Microbiology, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh-534005, India
| | - Sudarsini Padela
- Department of Paediatrics, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh-534005, India
| | - Abani Kanta Sahu
- Department of Paediatrics, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh-534005, India
| | - Swarna Subbarayudu
- Department of Microbiology, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh-534005, India
| | - Ankur Barua
- Division of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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Pediatric neurocysticercosis: usefulness of antibody response in cysticidal treatment follow-up. BIOMED RESEARCH INTERNATIONAL 2014; 2014:904046. [PMID: 25215297 PMCID: PMC4158118 DOI: 10.1155/2014/904046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/09/2014] [Accepted: 07/10/2014] [Indexed: 11/17/2022]
Abstract
Serum and urine samples were collected from 33 NCC patients before the albendazole treatment, 3-6 and 12 months PT. At 3 months PT, 24 (72.7%) patients had no detectable CT/MRI lesions and 9 (27.2%) patients had persistent lesions. Antibody response to crude soluble extract (CSE), excretory secretory (ES), and lower molecular mass (LMM) (10-30 KDa) antigenic fraction of T. solium cysticerci was detected in serum and urine samples by ELISA. Before the treatment, out of 33 NCC children, 14 (42.4%), 22 (66.6%), and 11 (33.3%) serum samples were found positive with the use of CSE, ES, and LMM antigen, respectively. At 3-6 months PT, positivity rate was 5 (15.1%), 2 (6%), and 4 (12.1%) and at 12 months PT, positivity rate was 5 (15.1%), 0, and 3 (9%) with the use of CSE, ES, and LMM antigen, respectively. There was no significant difference in the positivity with the use of three antigens in pretreatment and PT urine samples. The study suggests that the use of ES antigen to detect antibody in serum samples may serve better purpose to evaluate the therapeutic response in patients with NCC.
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Parija SC, Balamurungan N, Sahu PS, Subbaiah SP. Cysticercus antibodies and antigens in serum from blood donors from Pondicherry, India. Rev Inst Med Trop Sao Paulo 2005; 47:227-30. [PMID: 16138207 DOI: 10.1590/s0036-46652005000400010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of the present study was to screen the serum of blood donors, which are apparently healthy and residing in Pondicherry or its neighboring districts of Tamil Nadu State, for specific detection of Cysticercus antigens and antibodies. A total of 216 blood samples were collected from blood donors at the Central Blood Bank, JIPMER Hospital, Pondicherry, India during January and February 2004. Enzyme-linked immunosorbent assay (ELISA) was used to demonstrate anti-Cysticercus antibodies and the Co-agglutination (CoA) was used to detect antigen in sera. 14 (6.48 %) males were positive for either anti-Cysticercus antibodies or antigens. Of these eight sera were positive for anti-Cysticercus antibodies and six were positive for antigens. Results of the present study show that serum Cysticercus antigen detection may be a useful adjunct to antibody testing for seroprevalence studies of cysticercosis in the community. The present study is the first kind of study, carried out to determine both cysticercal antibodies as well as antigens in the serum samples collected from the healthy blood donors.
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Affiliation(s)
- Subhash Chandra Parija
- Department of Microbiology, Jawaharlal Institute of Postgraduate Education & Research, Pondicherry, India.
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Abstract
Prevalence studies from India suggest that epilepsy prevalence is similar to developed nations. Neurocysticercosis (NCC) predominates as an etiology. A large treatment gap is still a public health problem. Benign epilepsies and West syndrome appear to be underrepresented in studies on classification of seizures/syndromes. Febrile seizures prevalence in India is similar to other countries and appear to be as benign. Risk factors of intractable epilepsy (IE) in Indian studies include early age of onset, neurodevelopmental abnormalities and certain seizure types. Perinatal injuries underlie many IE. Many IE are not truly intractable and respond to simple therapeutic measures. The ketogenic diet and surgery are other methods now being used in Indian centers. Neurocysticercosis and neonatal hypoglycemic brain injury, two widely prevalent etiologies are reviewed in detail.
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Affiliation(s)
- Vrajesh Udani
- Grant Medical College & JJ Group of Hospitals, PD Hinduja National Hospital and Bf Wadia Hospital for Children, Mumbai, India.
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Parija M, Biswas R, Harish BN, Parija SC. Detection of specific cysticercus antigen in the urine for diagnosis of neurocysticercosis. Acta Trop 2004; 92:253-60. [PMID: 15533295 DOI: 10.1016/j.actatropica.2004.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2004] [Revised: 08/16/2004] [Accepted: 08/26/2004] [Indexed: 10/26/2022]
Abstract
Neurocysticercosis (NCC) is an important zoonotic infection, and a significant cause of morbidity and mortality in India. Immunodiagnosis plays an important role in the early, rapid, and specific diagnosis of the condition. The aim of the present study was to detect specific cysticercal antigen excreted in the urine for the diagnosis of NCC. The objective was to develop and evaluate staphylococcal Co-agglutination (Co-A) test for the detection of urinary cysticercal antigen. In the present study, urine samples were collected from 9 cases of clinically suspected NCC, 8 cases of CT/MRI proven cases of NCC, 11 of non-cysticercal CNS infection controls, and 25 healthy control subjects. Polyclonal antisera raised in rabbits against porcine complete cysticercus homogenate antigen, was used in the Co-A test to detect cysticercal antigen. The Co-A detected excreted cysticercal antigen in the urine of five of nine (55.5%) clinically diagnosed NCC and in five of eight (62.5%), CT/MRI proven cases of NCC. A false positive reaction was observed with 1 of 11 (9%) of control urine specimens from non-cysticercal CNS infection controls. No false positivity was demonstrated with 25 urine samples collected from healthy controls. Results of the present study shows that the Co-A test can be employed as a moderately sensitive and specific test for detection of urinary antigen in the diagnosis of NCC in poorly equipped laboratories.
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Affiliation(s)
- Madhuri Parija
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 60006, India.
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Abstract
The aim of the present study was to standardize and evaluate dot-Enzyme linked immunosorbent assay (Dot-ELISA), a simple and rapid test for the detection of cysticercus antibodies in the serum for the diagnosis of neurocysticercosis (NCC). The antigen used in the study was a complete homogenate of Cysticercus cellulosae cysts obtained from infected pigs and dotted on to nitrocellulose membrane. Test sera were collected from the patients of NCC, and control sera from patients with other diseases and healthy students and blood donors of the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Hospital, Pondicherry, during a study period from 2001 to 2003. Dot-ELISA detected antibodies in 14 of 25 (56%) in clinically suspected cases of NCC, 13 of 23 (56.5%) in CT/MRI proven cases of NCC and 2 of 25 (8%) each in non-cysticercal CNS infection controls and healthy controls. The test showed a sensitivity of 56.25%, specificity of 92%, positive predictive value of 87.09%, and negative predictive value of 70.76%. Results of the present study shows that the Dot-ELISA as a simple test can be used in the field or poorly equipped laboratories for diagnosis of NCC .
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Affiliation(s)
- Rakhi Biswas
- Department of Microbiology, Jawaharlal Institute of Postgraduate, Medical Education & Research, Pondicherry 605006, India
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Gogia S, Talukdar B, Choudhury V, Arora BS. Neurocysticercosis in children: clinical findings and response to albendazole therapy in a randomized, double-blind, placebo-controlled trial in newly diagnosed cases. Trans R Soc Trop Med Hyg 2003; 97:416-21. [PMID: 15259471 DOI: 10.1016/s0035-9203(03)90075-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The clinical findings of neurocysticercosis, diagnosed primarily on the basis of computed tomography (CT), and response to albendazole therapy in a randomized, double-blind, placebo-controlled trial were studied in 72 newly diagnosed children aged 1.5-12 years admitted to hospital in New Delhi, India, during March to July 2000. The lesions by initial CT were mostly single with perilesional oedema, and were located in the parietal lobes. The most common clinical finding was partial seizure (79.2%). The outcome of the albendazole trial was assessed through changes in CT lesions and status of seizure after 6 months of follow-up; about 55% of the lesions had disappeared and about 80% of the children were seizure-free. The frequency of healing of CT lesions in the albendazole-treated group and placebo group was 54.2% and 55.2%, respectively, and the frequency of a seizure-free state in the albendazole-treated group and placebo group was 87.5% and 77.5%, respectively; the differences were not statistically significant. Changes in lesions by CT and the recurrence of seizures after 6 months of follow-up were not related to the number of lesions by initial CT and albendazole was not beneficial in neurocysticercosis in children with ring-enhancing lesions in CT.
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Affiliation(s)
- Siddhartha Gogia
- Department of Paediatrics, Maulana Azad Medical College, New Delhi 110 002, India
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Talukdar B, Saxena A, Popli VK, Choudhury V. Neurocysticercosis in children: clinical characteristics and outcome. ANNALS OF TROPICAL PAEDIATRICS 2002; 22:333-9. [PMID: 12530283 DOI: 10.1179/027249302125001994] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A study was undertaken on 176 children with neurocysticercosis to determine the clinical behaviour and long-term outcome of cases. The children were followed up prospectively in the paediatric neurology clinic for 6 years. Diagnosis was based primarily on CT scans. All the CT lesions were parenchymal and mostly single (87%) with ring enhancement and peri-lesional oedema. Partial seizure was the predominant presenting seizure type. About 65% of cases had recurrences at varying intervals during treatment. Albendazole therapy given to some cases did not appear to have any beneficial effect on seizure control. Repeat CTs done at varying intervals after the first seizures showed disappearance of the lesions in about 50% of cases. The majority of lesions disappeared without the use of albendazole. Recurrence of seizures after withdrawal of anti-epileptic medication was observed in 19% of the cases. Parenchymal neurocysticercosis in children commonly presents with partial seizures and ring lesions on CT. The disease can be managed well by anti-epileptic medication alone and the prognosis is good.
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Affiliation(s)
- Bibek Talukdar
- Department of Paediatrics, Maulana Azad Medical College, New Delhi-110002, India.
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Albuquerque ESD, Galhardo I. Neurocisticercose no estado do Rio Grande do Norte: relato de oito casos. ARQUIVOS DE NEURO-PSIQUIATRIA 1995. [DOI: 10.1590/s0004-282x1995000300016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Os autores apresentam o estudo de oito pacientes com neurocisticercose encefálica no Estado do Rio Grande do Norte. Fazem comentários sobre a incidência da parasitose e referem as convulsões como o achado clínico mais freqüente, seguido pela cefaléia. O exame neurológico foi anormal em cinco dos oito pacientes. O diagnóstico foi baseado em achados da tomografia computadorizada em sete pacientes e do líquido cefalorraquidiano em três.
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