Diagnosis of neurocysticercosis among patients with seizures in northern coastal districts of Andhra Pradesh, India

Estimating the active and lifetime prevalence and incidence of epilepsy in Asian Countries: A systematic review and meta-analysis

OBJECTIVE

In the current era of the World Health Organization's Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031 (IGAP), precise and updated estimates of epilepsy burden are vital in formulating policies to improve the care of persons with epilepsy, especially in Asian countries with significant treatment gap. Hence, we aimed to consolidate the available data and quantify epilepsy prevalence and incidence estimates in Asian countries.

METHODS

We systematically searched PubMed, Embase, Ovid, and Scopus databases from inception until March 2023 for studies reporting epilepsy prevalence and incidence in Asian countries. We applied random effects meta-analysis to generate the pooled prevalence and incidence using the Meta package in R. Additionally, we performed a subgroup meta-analysis to explore the potential sources of heterogeneity. A meta-regression analysis was conducted to examine the trend of epilepsy over time.

RESULTS

A total of 99 studies with 100,654,124 participants were included in the meta-analysis. The pooled prevalence was 5.6 per 1000 (95 % confidence interval (CI) 4.4-6.8) for active epilepsy and 6.7 per 1000 (95 % CI 5.7-7.9) for lifetime epilepsy. The pooled incidence rate of epilepsy was 52.5 per 100,000 person-years (95 % CI 42.7-79.4). The subgroup analysis revealed a higher prevalence of active epilepsy (6.7/1000) and lifetime epilepsy (8.6/1000) in West Asia than in other regions. The funnel plot and Egger's test (p-value =<0.0001) revealed publication bias for active epilepsy.

CONCLUSION

Our findings highlight a high prevalence of active and lifetime epilepsy in West Asia and emphasize the necessity of implementing and formulating specific strategies to tackle the epilepsy burden in this region. Furthermore, high-quality epidemiological studies incorporating economic burdens and comorbidities associated with epilepsy in Asia are still needed.

H, Krovvidi S, Chennuru S. Prevalence of taeniosis in pig farming community in Andhra Pradesh, India

Taeniosis is one of the neglected zoonoses in India. Facts on taeniosis, compared to cysticercosis are scanty in India. Hence, this study is aimed to determine the occurrence of taeniosis in human beings in Andhra Pradesh, India. A total of 1380 stool samples were collected from people associated with pig farming and or had the habit of pork eating in certain districts (n = 7) of Andhra Pradesh. Prevalence of human taeniosis was determined using microscopic examination of stool samples and proglottds. The overall prevalence of taeniosis was found to be 0.79%. Morphology of gravid segments revealed lower number of lateral branches indicating T. solium segments. Age and gender of human were not associated with the occurrence of taeniosis. The low prevalence of taeniosis in human indicates good hygiene and sanitation practices in humans, and awareness about the disease and its transmission. Further studies involving more sensitive techniques on stool and serum samples are warranted.

High prevalence of neurocysticercosis among patients with epilepsy in a tertiary care hospital of Assam, India

Background:

Neurocysticercosis (NCC) is a parasitic disease of the central nervous system, which is caused by the metacestode of the pork tapeworm, Taenia solium. The present unicentric, hospital-based, cross-sectional study was undertaken to assess the contribution of NCC as a cause of active epilepsy among patients attending a tertiary health care center in Assam, India.

Materials and Methods:

Over a period of 2 years, 152 active epilepsy patients were investigated based on clinical, epidemiological, neuroimaging (contrast-enhanced computerized tomography), and immunological techniques to establish the diagnosis of NCC. A precoded questionnaire was administered to patients and/or guardians to collect detailed medical history.

Results:

Ninety-three cases (61.2%) fulfilled either definitive or probable diagnostic criteria for NCC. Anti-cysticercus immunoglobulin G antibodies were detected by ELISA and enzyme electro-immune transfer blot in 69 (45.4%) active epilepsy patients. Seroprevalence was higher in males, 46.6% (54/116); than in females, 41.7% (15/36), and increased significantly with age; peaking in the 20–39 years age group (36/76; χ² = 5.64; P = 0.02). Among the seropositive cases, 54 (78.3%) were diagnosed with NCC. A significantly higher number of seropositive individuals were diagnosed with NCC in the 20–39 years age group as compared to the 40 years and above age group (χ² = 6.28; P = 0.01). The association between seropositivity for NCC, and the number of lesions in the brain was statistically significant (χ² = −8.33; P = 0.003).

Conclusions:

This study indicates that NCC is a major cause of active epilepsy in Assam. A high prevalence of pediatric NCC is also a major concern.

Prevalence and risk factors for neurocysticercosis in children with a first-onset seizure in rural North India

BACKGROUND

Neurocysticercosis (NCC) is a parasitic infection acquired by consuming food and water contaminated by the faeces of a Taenia solium tapeworm carrier. It is an important cause of acquired seizures and also the common identifiable cause of new-onset seizures in children.

METHODS

A hospital-based prospective cross-sectional study of NCC was undertaken in a medical college in north-west India. All patients aged 1-15 years admitted to the paediatric emergency room with a first-onset seizure were selected.NCC was diagnosed and staged on the basis of MRI findings. A structured, pretested schedule was administered to each patient's parent for analysis of risk factors for NCC.

RESULTS

Of 79 patients with first-onset seizure, 43 (54.4% were diagnosed with NCC based on MRI findings. The association of NCC with age and pig-rearing near the patients' homes was statistically significant (p = 0.01 and 0.02, respectively). The association between NCC and other risk factors such as gender, religion, father's occupation, parents' literacy, source and storage of drinking water, the washing and peeling of fruit and vegetables and distance of refuse disposal from residential areas was not statistically significant. Although open defaecation is an important risk factor for transmission of NCC, there was no significant association with NCC.

CONCLUSION

In India, NCC is a common cause of first-onset seizure. The major risk factors are poor environmental sanitation and poor food and drinking water hygiene. NCC can be controlled and prevented by generating awareness of hygienic consumption of food and water and the provision of good sanitation.

Epidemiology of neurocysticercosis and epilepsy, is everything described?

In recent years clinical and epidemiological research on cysticercosis has gained significant interest in some countries, especially in Latin American countries and some countries in Asia and Africa. For many years it has been proposed that the higher prevalence of epilepsy seen in some regions such as Latin-America could be explained by parasitic infections, particularly neurocysticercosis (NCC). In this review we discussed selected epidemiological topics of the association of NCC and epilepsy, such as global distribution around the world, identification of NCC in developed countries, drug resistant epilepsy and NCC. Finally this review presents a critical review of biases of the published literature in NCC. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy".

Neurocysticercosis: A case study of a Mongolian traveler who visited China and India with an updated review in Asia

BACKGROUND

Neurocysticercosis (NCC) of Taenia solium has never been reported in Mongolia. A Mongolian traveler who visited China and India presented with epileptic seizures after his return to Mongolia. Magnetic resonance imaging showed multiple ring enhancing lesions with edema surrounding several lesions in his brain that were initially diagnosed to be viral encephalitis or NCC.

METHODS

Serology for cysticercosis using diagnostic antigens partially purified by cation-exchange chromatography and chimeric recombinant antigens and DNA analysis of a proglottid found in the patient's stool were applied for differential diagnosis.

RESULTS

Serology showed strong positivity for NCC, and mitochondrial cox1 gene analysis revealed Indian but not Chinese haplotype of T. solium.

CONCLUSION

This NCC case was considered to be caused by eggs released from adult tapeworm(s) established after eating uncooked or undercooked pork contaminated with cysticerci during his stay in India. This is a case report of taeniasis and secondary NCC associated with travel to India with an updated review of NCC in Asia. Molecular tracking of the specimen is highly informative as a way to identify where the infection was acquired.