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Marquez-Romero JM, Huerta-Franco MR, Soto-Cabrera E, Espinoza-López DA, Orrego H, Martínez-Jurado E, Zermeño-Pöhls F, Guerrero-Juárez V. A Clinical Prognostic Scoring System for Neurocysticercosis. J Neurosci Rural Pract 2021; 12:39-45. [PMID: 33531758 PMCID: PMC7846341 DOI: 10.1055/s-0040-1718845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectives
In patients with neurocysticercosis (NCC), an accurate risk prediction would allow a better therapeutic approach; however, there are currently no tools that can enhance the accuracy of risk prediction. We designed a prognostic scoring system to be used by neurologists and other physicians managing patients with NCC.
Materials and Methods
Using data from clinical records of patients from a third-level national reference center for neurological diseases, we assessed demographic, clinical, and tomographic variables among 293 patients diagnosed with NCC. Multivariable logistic regression analyses were used to develop a clinical prognostic scoring instrument. Patients with NCC were assessed for neurological impairment at 3 months after diagnosis.
Statistical Analysis
Score accuracy was assessed by receiver operating characteristic (ROC) curve analysis. The primary outcome was the presence of neurological impairment, resulting in disability according to self-report or caregiver reports; this outcome was assessed during follow-up visits at 3 ± 1 months after discharge.
Results
The most common symptoms at presentation were headache (67%) and seizure (63%). A six-item (total score from –4 to + 2) prognostic instrument was constructed on the basis of the presence of seizures/headache at presentation, a leukocyte count above 12x 109/dL, the presence of six to ten parasites, subarachnoid localization, and the use of anthelmintic drugs. Among 113 patients with negative scores, 79.6% developed neurological deficits. Among patients with scores of 1 to 2, 64.6% recovered completely, with an overall accuracy of prediction of 74.7% and area under the ROC curve = 0.722 (95% CI, 0.664–0.780,
p
< 0.0001).
Conclusions
The clinical prognostic scoring system for NCC described in this study is a new instrument for use in daily clinical practice. It is simple to administer, and it has a prognostic accuracy of 75%. Its use has the potential to improve the quality of care by guiding appropriate decision-making and early management of patients with NCC.
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Affiliation(s)
| | | | - Elizabeth Soto-Cabrera
- Department of Neurology. Instituto Nacional de Neurología y Neurocirugía "MVS," Mexico City, Mexico
| | | | - Héctor Orrego
- Department of Neurology. Instituto Nacional de Neurología y Neurocirugía "MVS," Mexico City, Mexico
| | | | - Fernando Zermeño-Pöhls
- Department of Neurology. Instituto Nacional de Neurología y Neurocirugía "MVS," Mexico City, Mexico
| | - Vicente Guerrero-Juárez
- Department of Neurology. Instituto Nacional de Neurología y Neurocirugía "MVS," Mexico City, Mexico
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Thapa K, Romo ML, Carpio A, Leslie D, Andrews H, Hauser WA, Kelvin EA. The effect of albendazole treatment on non-seizure outcomes in patients with symptomatic neurocysticercosis. Trans R Soc Trop Med Hyg 2019; 112:73-80. [PMID: 29579308 DOI: 10.1093/trstmh/try023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/19/2018] [Indexed: 11/12/2022] Open
Abstract
Background There is little information about the impact of anthelminthic treatment on clinical symptoms other than seizures in neurocysticercosis (NC). We investigated the effect of albendazole on non-seizure symptoms experienced by patients with NC. Methods Data are from a randomized controlled trial comparing albendazole plus prednisone with placebo plus prednisone for treatment of NC among 173 patients with active or transitional NC cysts and new-onset symptoms. We performed negative binomial regression to examine the number of follow-up visits when a symptom was reported, logistic regression to examine the probability of experiencing the symptom and Cox proportional hazards models to examine the time to first reporting the symptom. Results Eighty-five percent of patients reported at least one non-seizure symptom at baseline. Those treated with albendazole had significantly lower odds of memory loss and/or confusion during months 1-24 (odds ratio [OR] 0.42, p=0.037) and significantly increased odds of anxiety and/or depression during months 1-12 (OR 1.87, p=0.049). No treatment difference existed in experiencing symptoms in general or in experiencing headaches, limb weakness or gait disturbances, vomiting, nausea and/or stomach pain or visual disturbances over the follow-up period. Conclusions While the prevalence of non-seizure symptoms was high, albendazole treatment was associated with only two significant differences in the non-seizure symptoms over follow-up. Further research is needed to identify strategies to reduce the long-term symptom burden in patients with NC.
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Affiliation(s)
- Kriti Thapa
- Epidemiology & Biostatistics Program, School of Urban Public Health at Hunter College, City University of New York, 2180 Third Avenue, New York, NY 10035, USA.,CUNY Graduate School of Public Health and Health Policy, City University of New York, 55 West 125 th Street, New York, NY 10027, USA.,University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Matthew L Romo
- Epidemiology & Biostatistics Program, School of Urban Public Health at Hunter College, City University of New York, 2180 Third Avenue, New York, NY 10035, USA.,CUNY Graduate School of Public Health and Health Policy, City University of New York, 55 West 125 th Street, New York, NY 10027, USA.,CUNY Institute for Implementation Science in Population Health, City University of New York, 55 West 125 th Street, New York, New York 10027, USA
| | - Arturo Carpio
- School of Medicine, University of Cuenca, PO Box 0101-719, Cuenca, Ecuador.,Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, New York 10032, USA
| | - Denise Leslie
- MRI Diagnostics of Westchester, 503 Grasslands Road, Suite 100, Valhalla, New York 10595, USA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, New York 10032, USA
| | - W Allen Hauser
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, New York 10032, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Elizabeth A Kelvin
- Epidemiology & Biostatistics Program, School of Urban Public Health at Hunter College, City University of New York, 2180 Third Avenue, New York, NY 10035, USA.,CUNY Graduate School of Public Health and Health Policy, City University of New York, 55 West 125 th Street, New York, NY 10027, USA.,CUNY Institute for Implementation Science in Population Health, City University of New York, 55 West 125 th Street, New York, New York 10027, USA
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Ron-Garrido L, Coral-Almeida M, Gabriël S, Benitez-Ortiz W, Saegerman C, Dorny P, Berkvens D, Abatih EN. Distribution and Potential Indicators of Hospitalized Cases of Neurocysticercosis and Epilepsy in Ecuador from 1996 to 2008. PLoS Negl Trop Dis 2015; 9:e0004236. [PMID: 26580210 PMCID: PMC4651332 DOI: 10.1371/journal.pntd.0004236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/23/2015] [Indexed: 11/29/2022] Open
Abstract
Background Epilepsy is one of the most common signs of Neurocysticercosis (NCC). In this study, spatial and temporal variations in the incidence of hospitalized cases (IHC) of epilepsy and NCC in Ecuadorian municipalities were analyzed. Additionally, potential socio-economic and landscape indicators were evaluated in order to understand in part the macro-epidemiology of the Taenia solium taeniasis/cysticercosis complex. Methodology Data on the number of hospitalized epilepsy and NCC cases by municipality of residence were obtained from morbidity-hospital systems in Ecuador. SatScan software was used to determine whether variations in the IHC of epilepsy and NCC in space and time. In addition, several socio-economic and landscape variables at municipality level were used to study factors intervening in the macro-epidemiology of these diseases. Negative Binomial regression models through stepwise selection and Bayesian Model Averaging (BMA) were used to explain the variations in the IHC of epilepsy and NCC. Principal findings Different clusters were identified through space and time. Traditional endemic zones for NCC and epilepsy, recognized in other studies were confirmed in our study. However, for both disorders more recent clusters were identified. Among municipalities, an increasing tendency for IHC of epilepsy, and a decreasing tendency for the IHC of NCC were observed over time. In contrast, within municipalities a positive linear relationship between both disorders was found. An increase in the implementation of systems for eliminating excrements would help to reduce the IHC of epilepsy by 1.00% (IC95%; 0.2%–1.8%) and by 5.12% (IC95%; 3.63%-6.59%) for the IHC of NCC. The presence of pig production was related to IHC of NCC. Conclusion/Significance Both disorders were related to the lack of an efficient system for eliminating excrements. Given the appearance of recent epilepsy clusters, these locations should be studied in depth to discriminate epilepsies due to NCC from epilepsies due to other causes. Field studies are needed to evaluate the true prevalence of cysticercosis in humans and pigs in different zones of the country in order to better implement and manage prevention and/or control campaigns. T. solium neurocysticercosis is considered the most important parasitic disease of the central nervous system in humans; it is estimated to be responsible for at least one third of acquired epilepsies in developing countries. In Ecuador, the relationship between acquired epilepsy and neurocysticercosis remains unclear due to different factors such as, the lack of specialized health care personnel, appropriate diagnostic techniques and the fact that acquired epilepsy is characteristic of many other infectious and non-infectious diseases in the endemic zones of the country. In this study, spatio-temporal information and potential socio-economic indicators were studied for the number of hospitalized neurocysticercosis and epileptic cases in the country in order to locate and characterize important clusters in space and time. This study identified traditional endemic clusters in the highlands for both conditions as well as new clusters appearing in recent years in other zones not considered endemic. Also the incidence of hospitalized cases of epilepsy and neurocysticercosis were significantly higher in urban zones, probably due to a better access to health facilities. The presence of systems for excrement disposal was significantly associated with a reduction in the incident cases for both epilepsy and neurocysticercosis. More studies are needed to evaluate the true prevalence of neurocysticercosis associated epilepsy in humans and cysticercosis in pigs around the country in order to better implement and manage control campaigns.
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Affiliation(s)
- Lenin Ron-Garrido
- Universidad Central del Ecuador, Centro Internacional de Zoonosis (CIZ), Ciudadela Universitaria, Quito, Ecuador
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Research Unit of Epidemiology and Risk Analysis applied to the Veterinary Sciences (UREAR-ULg), Fundamental and Applied Research for Animal and Health (FARAH), Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Marco Coral-Almeida
- Universidad Central del Ecuador, Centro Internacional de Zoonosis (CIZ), Ciudadela Universitaria, Quito, Ecuador
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Universidad de las Américas, Escuela de Medicina Veterinaria y Zootecnia, Quito Ecuador
- Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium
- * E-mail:
| | - Sarah Gabriël
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Washington Benitez-Ortiz
- Universidad Central del Ecuador, Centro Internacional de Zoonosis (CIZ), Ciudadela Universitaria, Quito, Ecuador
| | - Claude Saegerman
- Research Unit of Epidemiology and Risk Analysis applied to the Veterinary Sciences (UREAR-ULg), Fundamental and Applied Research for Animal and Health (FARAH), Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Dirk Berkvens
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emmanuel Nji Abatih
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Romo ML, Wyka K, Carpio A, Leslie D, Andrews H, Bagiella E, Hauser WA, Kelvin EA. The effect of albendazole treatment on seizure outcomes in patients with symptomatic neurocysticercosis. Trans R Soc Trop Med Hyg 2015; 109:738-46. [PMID: 26433183 DOI: 10.1093/trstmh/trv078] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/24/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Randomized controlled trials have found an inconsistent effect of anthelmintic treatment on long-term seizure outcomes in neurocysticercosis. The objective of this study was to further explore the effect of albendazole treatment on long-term seizure outcomes and to determine if there is evidence for a differential effect by seizure type. METHODS In this trial, 178 patients with active or transitional neurocysticercosis cysts and new-onset symptoms were randomized to 8 days of treatment with albendazole (n=88) or placebo (n=90), both with prednisone, and followed for 24 months. We used negative binomial regression and logistic regression models to determine the effect of albendazole on the number of seizures and probability of recurrent or new-onset seizures, respectively, over follow-up. RESULTS Treatment with albendazole was associated with a reduction in the number of seizures during 24 months of follow-up, but this was only significant for generalized seizures during months 1-12 (unadjusted rate ratio [RR] 0.19; 95% CI: 0.04-0.91) and months 1-24 (unadjusted RR 0.06; 95% CI: 0.01-0.57). We did not detect a significant effect of albendazole on reducing the number of focal seizures or on the probability of having a seizure, regardless of seizure type or time period. CONCLUSIONS Albendazole treatment may be associated with some symptomatic improvement; however, this association seems to be specific to generalized seizures. Future research is needed to identify strategies to better reduce long-term seizure burden in patients with neurocysticercosis.
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Affiliation(s)
- Matthew L Romo
- Epidemiology & Biostatistics Program, School of Urban Public Health at Hunter College, City University of New York, 2180 Third Avenue, New York, New York 10035, USA CUNY School of Public Health, 2180 Third Avenue, New York, New York 10035, USA
| | - Katarzyna Wyka
- Epidemiology & Biostatistics Program, School of Urban Public Health at Hunter College, City University of New York, 2180 Third Avenue, New York, New York 10035, USA CUNY School of Public Health, 2180 Third Avenue, New York, New York 10035, USA Doctor of Public Health Program, The Graduate Center, City University of New York, 365 5th Avenue, New York, New York 10016, USA
| | - Arturo Carpio
- Facultad de Ciencias Médicas, Universidad de Cuenca, Av. 12 de Abril s/n, Cuenca, Ecuador Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, New York 10032, USA
| | - Denise Leslie
- MRI Diagnostics of Westchester, 503 Grasslands Road, Suite 100, Valhalla, New York 10595, USA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, New York 10032, USA
| | - Emilia Bagiella
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, New York 10032, USA
| | - W Allen Hauser
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, New York 10032, USA Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, New York 10032, USA
| | - Elizabeth A Kelvin
- Epidemiology & Biostatistics Program, School of Urban Public Health at Hunter College, City University of New York, 2180 Third Avenue, New York, New York 10035, USA CUNY School of Public Health, 2180 Third Avenue, New York, New York 10035, USA Doctor of Public Health Program, The Graduate Center, City University of New York, 365 5th Avenue, New York, New York 10016, USA
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Rasamoelina-Andriamanivo H, Porphyre V, Jambou R. Control of cysticercosis in Madagascar: beware of the pitfalls. Trends Parasitol 2013; 29:538-47. [PMID: 24145061 DOI: 10.1016/j.pt.2013.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 09/09/2013] [Accepted: 09/09/2013] [Indexed: 01/21/2023]
Abstract
Taenia solium cysticercosis is a zoonosis of public health importance in areas where the disease is endemic, with significant economic impacts on human health and the swine industry. Several gaps remain in the epidemiology of the parasite and the strategies of control in developing countries. We detail the key factors to consider in Madagascar in terms of the porcine husbandry system, Taenia transmission cycle, and diagnosis of cysticercosis in pigs, in order to better estimate the sanitary and economic impacts of this parasitic disease as well as to define an integrated control program.
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Affiliation(s)
- Harentsoaniaina Rasamoelina-Andriamanivo
- FOFIFA, Département de Recherches Zootechniques et Vétérinaires, Antananarivo, Madagascar; Département Vétérinaire, Faculté de Médecine, Antananarivo, Madagascar
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