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De la Cruz W, Sánchez-Boluarte SS, Chacón DE, Herrera M, Núñez del Prado L, Vásquez CM, Delgado JC. Postsurgical Outcomes of Mesial Temporal Lobe Epilepsy due to Hippocampal Sclerosis Associated with Calcified Neurocysticercosis. Am J Trop Med Hyg 2024; 110:700-705. [PMID: 38442416 PMCID: PMC10993823 DOI: 10.4269/ajtmh.23-0506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/28/2023] [Indexed: 03/07/2024] Open
Abstract
The aim of this study was to analyze postsurgical outcomes for individuals with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) who underwent anterior temporal lobectomy, based on the presence of calcified neurocysticercosis (cNCC). A retrospective cross-sectional study was conducted on 89 patients with MTLE-HS who underwent anterior temporal lobectomy between January 2012 and December 2020 at a basic epilepsy surgery center located in Lima, Peru. We collected sociodemographic, clinical, and diagnostic information. The postsurgical results were analyzed using bivariate analysis according to the Engel classification. We included 89 individuals with a median age of 28 years (interquartile range [IQR]: 24-37), and more than half (55.1%) were male. Seventeen (19.1%) were diagnosed with cNCC. A greater number of patients with cNCC had lived in rural areas of Peru during their early life compared with those without cNCC (12 [70.6%] versus 26 [36.1%]; P = 0.010). Patients with cNCC exhibited a greater median frequency of focal to bilateral tonic-clonic seizures per month (1 [IQR: 0-2] versus 0 [0-0.5]; P = 0.009). Conversely, a lower proportion of patients with cNCC reported a history of an initial precipitating injury in comparison to the group without cNCC (4 [23.5%] versus 42 [58.3%]; P = 0.014). At the 1-year follow-up, most patients (82.4%) with cNCC were categorized as Engel IA. Similarly, at the 2-year follow-up, nine (75.0%) were classified as Engel IA. Our findings suggest that most patients diagnosed with cNCC exhibit favorable postsurgical outcomes, comparable to those without cNCC. Additionally, it can be postulated that cNCC may play a role as an initial precipitating injury.
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Affiliation(s)
- Walter De la Cruz
- Epilepsy Department, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Sofía S. Sánchez-Boluarte
- Epilepsy Department, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- School of Medicine, Universidad Cesar Vallejo, Trujillo, Peru
| | - Denisse E. Chacón
- Epilepsy Department, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Manuel Herrera
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Carlos M. Vásquez
- Neurosurgery Department, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - José C. Delgado
- Epilepsy Department, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
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Smith J, Anand D, Peteru S, Lynch H, Kaur J. Suicidal Ideation in the Setting of Neurocysticercosis. Cureus 2024; 16:e53934. [PMID: 38469027 PMCID: PMC10925490 DOI: 10.7759/cureus.53934] [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] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
Neurocysticercosis (NCC) is considered a significant health concern in developing countries in parts of Asia, Africa, and Central and South America. However, with the increased immigration, it is now becoming increasingly prevalent in the United States. NCC has psychiatric implications often neglected and not recognized in the initial diagnostic workup of patients from developing countries suffering from seizures and psychiatric illnesses, such as depression. This case report aims to signify the presentation of NCC and illustrate the importance of the psychiatric manifestations of NCC in patients. We discuss the case of a 32-year-old female patient from a rural town in Central America who immigrated to New York and presented with uncontrolled seizures and symptomatic depression with suicidal ideations.
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Affiliation(s)
- Jake Smith
- Psychiatry, Jamaica Hospital Medical Center, New York City, USA
| | - Diana Anand
- Psychiatry, Jamaica Hospital Medical Center, New York City, USA
| | - Sachidanand Peteru
- Psychiatry, Jamaica Hospital Medical Center, New York City, USA
- Consultation-Liaison Psychiatry, Flushing Hospital Medical Center, New York City, USA
| | - Hannah Lynch
- Psychiatry, New York Institute of Technology College of Osteopathic Medicine, New York City, USA
| | - Jashandeep Kaur
- Psychiatry, New York Institute of Technology College of Osteopathic Medicine, New York City, USA
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3
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Castillo G, Fustamante L, Delgado-Kamiche AD, Camen-Orozco RP, Clark T, Bernal E, Morales-Alvarez J, Ferrufino M, Mamani-Palomino J, Bustos JA, Garcia HH, Gavidia CM, Gilman RH, Verastegui M. Understanding the pathogenic mechanisms and therapeutic effects in neurocysticercosis. Brain Pathol 2024:e13237. [PMID: 38212958 DOI: 10.1111/bpa.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/01/2024] [Indexed: 01/13/2024] Open
Abstract
Despite being a leading cause of acquired seizures in endemic regions, the pathological mechanisms of neurocysticercosis are still poorly understood. This study aims to investigate the impact of anthelmintic treatment on neuropathological features in a rat model of neurocysticercosis. Rats were intracranially infected with Taenia solium oncospheres and treated with albendazole + praziquantel (ABZ), oxfendazole + praziquantel (OXF), or untreated placebo (UT) for 7 days. Following the last dose of treatment, brain tissues were evaluated at 24 h and 2 months. We performed neuropathological assessment for cyst damage, perilesional brain inflammation, presence of axonal spheroids, and spongy changes. Both treatments showed comparable efficacy in cyst damage and inflammation. The presence of spongy change correlated with spheroids counts and were not affected by anthelmintic treatment. Compared to white matter, gray matter showed greater spongy change (91.7% vs. 21.4%, p < 0.0001), higher spheroids count (45.2 vs. 0.2, p = 0.0001), and increased inflammation (72.0% vs. 21.4%, p = 0.003). In this rat model, anthelmintic treatment destroyed brain parasitic cysts at the cost of local inflammation similar to what is described in human neurocysticercosis. Axonal spheroids and spongy changes as markers of damage were topographically correlated, and not affected by anthelmintic treatment.
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Affiliation(s)
- Gino Castillo
- Infectious Diseases Laboratory Research-LID, Facultad de Ciencia e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lizbeth Fustamante
- Infectious Diseases Laboratory Research-LID, Facultad de Ciencia e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ana D Delgado-Kamiche
- Infectious Diseases Laboratory Research-LID, Facultad de Ciencia e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Rogger P Camen-Orozco
- Infectious Diseases Laboratory Research-LID, Facultad de Ciencia e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Taryn Clark
- The Department of International Health, Bloomberg School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Emergency Medicine, SUNY Downstate Medical Center, Kings County Hospital Medical Center, Brooklyn, New York, New York, United States
| | - Edson Bernal
- Infectious Diseases Laboratory Research-LID, Facultad de Ciencia e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jemima Morales-Alvarez
- Infectious Diseases Laboratory Research-LID, Facultad de Ciencia e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Ferrufino
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Javier Mamani-Palomino
- Facultad de Medicina Veterinaria y Salud animal, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Javier A Bustos
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hector H Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Cesar M Gavidia
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Robert H Gilman
- The Department of International Health, Bloomberg School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Manuela Verastegui
- Infectious Diseases Laboratory Research-LID, Facultad de Ciencia e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
- Asociación Benéfica Prisma, Lima, Peru
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4
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Bustos JA, Arroyo G, Del Brutto OH, Gonzales I, Saavedra H, Guzman C, Sanchez-Boluarte SS, Thakur KT, Coyle C, O’Neal SE, Garcia HH. Calcified Neurocysticercosis: Demographic, Clinical, and Radiological Characteristics of a Large Hospital-Based Patient Cohort. Pathogens 2023; 13:26. [PMID: 38251334 PMCID: PMC10820744 DOI: 10.3390/pathogens13010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Neurocysticercosis (NCC), the infection of the central nervous system caused by Taenia solium larvae (cysticerci), is a major cause of acquired epilepsy worldwide. Calcification in NCC is the most common neuroimaging finding among individuals with epilepsy in T. solium-endemic areas. We describe the demographic, clinical, and radiological profiles of a large hospital cohort of patients with calcified NCC in Peru (during the period 2012-2022) and compared profiles between patients with and without a previous known diagnosis of viable infection. A total of 524 patients were enrolled (mean age at enrollment: 40.2 ± 15.2 years, mean age at symptom onset: 29.1 ± 16.1 years, 56.3% women). Of those, 415 patients (79.2%) had previous seizures (median time with seizures: 5 years, interquartile range (IQR): 2-13 years; median number of seizures: 7 (IQR: 3-32)), of which 333 (80.2%) had predominantly focal to bilateral tonic-clonic seizures; and 358 (68.3%) used antiseizure medication). Patients had a median number of three calcifications (IQR: 1-7), mostly located in the frontal lobes (79%). In 282 patients (53.8%) there was a previous diagnosis of viable infection, while 242 only had evidence of calcified NCC since their initial neuroimaging. Most patients previously diagnosed with viable infection were male, had previous seizures, had seizures for a longer time, had more calcifications, and had a history of taeniasis more frequently than patients without previously diagnosed viable infection (all p < 0.05). Patients with calcified NCC were heterogeneous regarding burden of infection and clinical manifestations, and individuals who were diagnosed after parasites calcified presented with milder disease manifestations.
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Affiliation(s)
- Javier A. Bustos
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (C.G.); (S.S.S.-B.); (H.H.G.)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
| | - Gianfranco Arroyo
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (C.G.); (S.S.S.-B.); (H.H.G.)
- Direccion de Investigacion, Desarrollo e Innovacion, Universidad Cientifica del Sur, Lima 15067, Peru
| | - Oscar H. Del Brutto
- School of Medicine and Research Center, Universidad Espiritu Santo-Ecuador, Samborondon 092301, Ecuador;
| | - Isidro Gonzales
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
| | - Herbert Saavedra
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
| | - Carolina Guzman
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (C.G.); (S.S.S.-B.); (H.H.G.)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
| | - Sofia S. Sanchez-Boluarte
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (C.G.); (S.S.S.-B.); (H.H.G.)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
| | - Kiran T. Thakur
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY 10032, USA;
| | - Christina Coyle
- Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Seth E. O’Neal
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR 97207, USA
| | - Hector H. Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (C.G.); (S.S.S.-B.); (H.H.G.)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
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Allen SE, Moyano LM, Wardle MT, Guzman C, Sanchez-Boluarte SS, Bonnet G, Bustos JA, O’Neal S, Garcia HH. Clinical Characteristics of Neurocysticercosis in a Peruvian Population-Based Epilepsy Cohort: A Descriptive Cross-Sectional Study of Baseline Clinical Intake. Pathogens 2023; 12:1313. [PMID: 38003778 PMCID: PMC10675766 DOI: 10.3390/pathogens12111313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: This study presents the baseline characteristics of a community-level population of people with epilepsy (n = 1975) living in an area endemic for Taenia solium, the pathogen responsible for neurocysticercosis (NCC). (2) Methods: Participants were sequentially enrolled in a clinical cohort from 2007 to 2020 in Tumbes, Peru. All participants provided demographic and clinical history and received clinical evaluations. Diagnostics, including neuroimaging, cysticercosis serologies, and EEG, were obtained where possible. The data presented are from the cross-sectional baseline assessment of cohort participants. (3) Results: Approximately 38% of participants met the criteria for NCC. Those with NCC were more likely to have adult-onset epilepsy, as well as a longer duration of epilepsy, as compared to their counterparts without NCC. Overall, the data indicate a large treatment gap, with only approximately a quarter of the baseline population with prescriptions for anti-seizure medications. (4) Conclusions: These data reveal a high proportion of NCC among people living with epilepsy in these communities, with limited health care resources. At baseline, 74% of the population were not receiving anti-seizure treatments. Further analyses of these data will clarify the natural history of the disease for this population.
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Affiliation(s)
- Samantha E. Allen
- Department of Neurology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Luz M. Moyano
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes 24000, Peru; (L.M.M.); (J.A.B.); (S.O.); (H.H.G.)
| | - Melissa T. Wardle
- Department of Epidemiology, Oregon Health and Science—Portland State University School of Public Health, Portland, OR 97236, USA;
| | - Carolina Guzman
- Instituto Nacional de Ciencias Neurologicas, Lima 02002, Peru; (C.G.); (S.S.S.-B.)
| | | | - Gabrielle Bonnet
- Centre for the Mathematical Modeling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK;
| | - Javier A. Bustos
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes 24000, Peru; (L.M.M.); (J.A.B.); (S.O.); (H.H.G.)
- Instituto Nacional de Ciencias Neurologicas, Lima 02002, Peru; (C.G.); (S.S.S.-B.)
- Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima 02002, Peru
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21224, USA
| | - Seth O’Neal
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes 24000, Peru; (L.M.M.); (J.A.B.); (S.O.); (H.H.G.)
- Department of Infectious Diseases, Oregon Health & Science University, Portland, OR 97236, USA
| | - Hector H. Garcia
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes 24000, Peru; (L.M.M.); (J.A.B.); (S.O.); (H.H.G.)
- Instituto Nacional de Ciencias Neurologicas, Lima 02002, Peru; (C.G.); (S.S.S.-B.)
- Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima 02002, Peru
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21224, USA
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6
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Murthy JMK. Epilepsy Due to Solitary Calcified Cysticercus Granuloma. Pathogens 2023; 12:1037. [PMID: 37623997 PMCID: PMC10459524 DOI: 10.3390/pathogens12081037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
The calcified stage of the neurocysticercosis (NCC) is the common cause of acquired epilepsy in low and middle income countries in people aged > 20 years. Approximately 30% of adult onset seizures and epilepsy are attributable to NCC. In India and some of the Latin American countries, epilepsy due to solitary calcified NCC is the common adult onset epilepsy. The current evidence suggests that the calcified cysticercus granuloma is probably the epileptogenic focus. The mechanisms involved in the epileptogenic process are not well understood; Focal-onset seizures with or without impaired awareness are the common seizure type. Focal-onset seizure can evolve to bilateral tonic-clonic seizure. Seizure outcome with anti-seizure medication, most often with monotherapy, is very good. The seizure disorders associated with various stages of NCC can be preventable.
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Affiliation(s)
- Jagarlapudi M K Murthy
- Department of Neurology, CARE Hospitals, Banjara Hills, Hyderabad 500034, Telengana, India
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Stelzle D, Makasi C, Welte TM, Ruether C, Schmidt V, Gabriel S, Bottieau E, Fleury A, Ngowi BJ, Winkler AS. Report of three patients with extensive neurocysticercosis in rural southern Tanzania: neurological, serological and neuroradiological findings. J Med Case Rep 2023; 17:311. [PMID: 37408061 DOI: 10.1186/s13256-023-03974-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/05/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Neurocysticercosis (NCC) is common in eastern Africa, but disease presentation varies considerably. Most patients have single or few NCC-typical lesions in their brain but some present with a large number of lesions. We present three patients with positive antibody-based serology for Taenia solium cysticercosis screened at the Vwawa district hospital, Mbozi district, southern Tanzania, in whom extensive NCC was confirmed by neuroimaging. CASE PRESENTATIONS Patient 1 was a 55-year-old female from the tribe Malila smallholder farmer who has had four generalized tonic-clonic epileptic seizures over a period of 11 years and one episode of transient left hemiparesis one year before seizure onset. The patient also reported monthly to weekly episodes of severe, progressive, unilateral headache. The computed tomography (CT) scan of the brain showed 25 NCC lesions of which 15 were in the vesicular stage. Patient 2 was a 30-year-old male from tribe Nyha mechanic who reported monthly episodes of moderate to severe, progressive, bilateral headache, but no epileptic seizures. The CT scan showed 63 NCC lesions of which 50 were in the vesicular stage. Patient 3 was a 54-year-old female from the tribe Malila smallholder farmer who suffered from frequent generalized tonic-clonic epileptic seizures with potential signs of focal seizure onset. She also reported weekly to daily episodes of severe, progressive, unilateral headache. The CT scan showed 29 NCC lesions of which 28 were in the vesicular stage. CONCLUSIONS Clinical presentation of NCC with multiple brain lesions varies considerably ranging from few epileptic seizures and severe headache to severe epilepsy with frequent epileptic seizures. Individuals with neurological signs/symptoms that may be due to NCC, based for example on epidemiological criteria or serological evidence of cysticercosis, are recommended to undergo neuroimaging before anthelminthic treatment is considered.
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Affiliation(s)
- D Stelzle
- Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany.
| | - C Makasi
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - T M Welte
- Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - C Ruether
- Department of Neuroradiology, RoMed Clinic Rosenheim, Rosenheim, Germany
| | - V Schmidt
- Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - S Gabriel
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - E Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - A Fleury
- Departamento de Medicina Genómica y Toxicología ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México/Instituto Nacional de Neurología y Neurocirugía, Ciudad de Mexico, Mexico
| | - B J Ngowi
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
- University of Dar Es Salaam, Mbeya College of Health and Allies Sciences, Mbeya, Tanzania
| | - A S Winkler
- Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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8
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Hagen EH, Blackwell AD, Lightner AD, Sullivan RJ. Homo medicus: The transition to meat eating increased pathogen pressure and the use of pharmacological plants in Homo. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 180:589-617. [PMID: 36815505 DOI: 10.1002/ajpa.24718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
The human lineage transitioned to a more carnivorous niche 2.6 mya and evolved a large body size and slower life history, which likely increased zoonotic pathogen pressure. Evidence for this increase includes increased zoonotic infections in modern hunter-gatherers and bushmeat hunters, exceptionally low stomach pH compared to other primates, and divergence in immune-related genes. These all point to change, and probably intensification, in the infectious disease environment of Homo compared to earlier hominins and other apes. At the same time, the brain, an organ in which immune responses are constrained, began to triple in size. We propose that the combination of increased zoonotic pathogen pressure and the challenges of defending a large brain and body from pathogens in a long-lived mammal, selected for intensification of the plant-based self-medication strategies already in place in apes and other primates. In support, there is evidence of medicinal plant use by hominins in the middle Paleolithic, and all cultures today have sophisticated, plant-based medical systems, add spices to food, and regularly consume psychoactive plant substances that are harmful to helminths and other pathogens. We propose that the computational challenges of discovering effective plant-based treatments, the consequent ability to consume more energy-rich animal foods, and the reduced reliance on energetically-costly immune responses helped select for increased cognitive abilities and unique exchange relationships in Homo. In the story of human evolution, which has long emphasized hunting skills, medical skills had an equal role to play.
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Affiliation(s)
- Edward H Hagen
- Department of Anthropology, Washington State University, Pullman, Washington, USA
| | - Aaron D Blackwell
- Department of Anthropology, Washington State University, Pullman, Washington, USA
| | - Aaron D Lightner
- Department of Anthropology, Washington State University, Pullman, Washington, USA
- Department of the Study of Religion, Aarhus University, Aarhus, Denmark
| | - Roger J Sullivan
- Department of Anthropology, California State University, Sacramento, California, USA
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Haddad N, Shaheen Y, Abunaib M, Melikyan G, El Sotouhy A, Wahbeh F, Nauman A, Al-Maadid F, Soliman M, Mesraoua B, Elkhider H, Mahfoud Z. Neurocysticercosis in non-endemic regions: The experience of Qatar. Front Neurol 2023; 14:1173909. [PMID: 37153684 PMCID: PMC10156967 DOI: 10.3389/fneur.2023.1173909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
Objective To describe the occurrence and features of Neurocystircercosis (NCC) in Qatar. Background Qatar has a mixed population of natives and expats. NCC is not endemic to the region, but clinical practice suggests its occurrence in large numbers. Design/ methods A database was created to summarize information retrospectively collected on patients with NCC seen through the national health system (HMC) between 2013 and 2018. We identified demographic and disease related variables (clinical manifestations, investigative findings, treatment and outcome) for all patients. Results Out of 420 identified NCC patients, 393 (93.6%) were men, and 98.3% were immigrants from NCC endemic countries such as Nepal (63.8%) and India (29.5%). Eighty percent of patients presented with seizures, with the majority (69%) experiencing generalized tonic-clonic seizures. Five percent presented with status epilepticus. Headaches, the second most common complaint, were reported in 18% of subjects. On imaging, 50% had a single lesion while 63% included pathology at the calcified stage. The lesions were parenchymal in 99.5% of cases, predominantly in the frontal lobe (59%). Thirteen percent were diagnosed incidentally on imaging, mainly in the form of isolated calcified non enhancing lesions. Albendazole was received by 55% of patients, and phenytoin was the most prescribed anti-seizure drug (57%). When long term follow up was available, 70% of the patients presenting with seizures were completely seizure free. Conclusion NCC is prevalent in Qatar, mainly within the large Southeast Asian immigrant population. NCC is currently a significant contributor to the epilepsy burden in Qatar, often with a good outcome regarding seizure control. NCC with intraparenchymal single lesion shares a large proportion of our cohort.
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Affiliation(s)
- Naim Haddad
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
- *Correspondence: Naim Haddad,
| | - Yanal Shaheen
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Mohammed Abunaib
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Gayane Melikyan
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed El Sotouhy
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Farah Wahbeh
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Areej Nauman
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Fatima Al-Maadid
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Mohamed Soliman
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Boulenouar Mesraoua
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Elkhider
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad Mahfoud
- Department of Population Health Sciences, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
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10
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Human Neurocysticercosis: An Overview. Pathogens 2022; 11:pathogens11101212. [PMID: 36297269 PMCID: PMC9607454 DOI: 10.3390/pathogens11101212] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/20/2022] Open
Abstract
Human cysticercosis is caused by ingestion of T. solium eggs from taenia carriers. Neurocysticercosis (NCC), defined as the infection of the CNS and the meninges by the larval stage of Taenia solium, is the most common helminthic infection of the CNS worldwide. Parasites may lodge in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that account for the pleomorphism of this disease. Seizures/epilepsy are the most common clinical manifestation, but other patients present with headache, focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of NCC is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. However, neuroimaging studies are fundamental for diagnosis because immunological test and clinical manifestations only provide circumstantial evidence of NCC. The introduction of cysticidal drugs changed the prognosis of most NCC patients. These drugs have been shown to reduce the burden of infection and to improve the clinical course of the disease in many patients. Efforts should be directed to eradicate the disease through the implementation of control programs against all the steps in the life cycle of T. solium, including carriers of the adult tapeworm, infected pigs, and eggs in the environment.
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11
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Neurocysticercosis in the Tropics (and Beyond). CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Bonnet G, Pizzitutti F, Gonzales-Gustavson EA, Gabriël S, Pan WK, Garcia HH, Bustos JA, Vilchez P, O’Neal SE. CystiHuman: A model of human neurocysticercosis. PLoS Comput Biol 2022; 18:e1010118. [PMID: 35587497 PMCID: PMC9159625 DOI: 10.1371/journal.pcbi.1010118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 06/01/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Taenia solium tapeworm is responsible for cysticercosis, a neglected tropical disease presenting as larvae in the body of a host following taenia egg ingestion. Neurocysticercosis (NCC), the name of the disease when it affects the human central nervous system, is a major cause of epilepsy in developing countries, and can also cause intracranial hypertension, hydrocephalus and death. Simulation models can help identify the most cost-effective interventions before their implementation. Modelling NCC should enable the comparison of a broad range of interventions, from treatment of human taeniasis (presence of an adult taenia worm in the human intestine) to NCC mitigation. It also allows a focus on the actual impact of the disease, rather than using proxies as is the case for other models. METHODS This agent-based model is the first model that simulates human NCC and associated pathologies. It uses the output of another model, CystiAgent, which simulates the evolution of pig cysticercosis and human taeniasis, adding human and cyst agents, including a model of cyst location and stage, human symptoms, and treatment. CystiHuman also accounts for delays in the appearance of NCC-related symptoms. It comprises three modules detailing cyst development, seizure probability and timing, and intracranial hypertension/hydrocephalus, respectively. It has been implemented in Java MASON and calibrated in three endemic villages in Peru, then applied to another village (Rica Playa) to compare simulation results with field data in that village. RESULTS AND DISCUSSION Despite limitations in available field data, parameter values found through calibration are plausible and simulated outcomes in Rica Playa are close to actual values for NCC prevalence and the way it increases with age and cases with single lesions. Initial simulations further suggest that short-term interventions followed by a rapid increase in taeniasis prevalence back to original levels may have limited impacts on NCC prevalence.
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Affiliation(s)
- Gabrielle Bonnet
- Independent Consultant for the School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Francesco Pizzitutti
- Independent Consultant for the School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
| | | | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Ghent University, Gent, Belgium
| | - William K. Pan
- Nicholas School of Environment and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Hector H. Garcia
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru
| | - Javier A. Bustos
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Percy Vilchez
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Seth E. O’Neal
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
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Rahantamalala A, Rakotoarison RL, Rakotomalala E, Rakotondrazaka M, Kiernan J, Castle PM, Hakami L, Choi K, Rafalimanantsoa AS, Harimanana A, Wright P, Grandjean Lapierre S, Schoenhals M, Small PM, Marcos LA, Vigan-Womas I. Prevalence and factors associated with human Taenia solium taeniosis and cysticercosis in twelve remote villages of Ranomafana rainforest, Madagascar. PLoS Negl Trop Dis 2022; 16:e0010265. [PMID: 35404983 PMCID: PMC9064101 DOI: 10.1371/journal.pntd.0010265] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/03/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Infections with the tapeworm Taenia solium (taeniosis and cysticercosis) are Neglected Tropical Diseases (NTD) highly endemic in Madagascar. These infections are however underdiagnosed, underreported and their burden at the community level remains unknown especially in rural remote settings. This study aims at assessing the prevalence of T. solium infections and associated risk factors in twelve remote villages surrounding Ranomafana National Park (RNP), Ifanadiana District, Madagascar. Methodology A community based cross-sectional survey was conducted in June 2016. Stool and serum samples were collected from participants. Tapeworm carriers were identified by stool examination. Taenia species and T. solium genotypes were characterised by PCR and sequencing of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. Detection of specific anti-cysticercal antibodies (IgG) or circulating cysticercal antigens was performed by ELISA or EITB/Western blot assays. Principal findings Of the 459 participants with paired stool and blood samples included ten participants from seven distinct villages harbored Taenia spp. eggs in their stools samples DNA sequencing of the cox1 gene revealed a majority of T. solium Asian genotype (9/10) carriage. The overall seroprevalences of anti-cysticercal IgGs detected by ELISA and EITB were quite similar (27.5% and 29.8% respectively). A prevalence rate of 12.4% of circulating cysticercal antigens was observed reflecting cysticercosis with viable cysts. Open defecation (Odds Ratio, OR = 1.5, 95% CI: 1.0–2.3) and promiscuity with households of more than 4 people (OR = 1.9, 95% CI: 1.1–3.1) seem to be the main risk factors associated with anticysticercal antibodies detection. Being over 15 years of age would be a risk factor associated with an active cysticercosis (OR = 1.6, 95% CI: 1.0–2.7). Females (OR = 0.5, 95% CI: 0.3–0.9) and use of river as house water source (OR = 0.3, 95% CI: 0.1–1.5) were less likely to have cysticercosis with viable cysts. Conclusions/Significance This study indicates a high exposure of the investigated population to T. solium infections with a high prevalence of cysticercosis with viable cysts. These data can be useful to strengthen public health interventions in these remote settings. Taenia solium infections in humans (taeniosis and neurocysticercosis) and in pigs (cysticercosis) are endemic in Madagascar presenting a significant public health burden. Neurocysticercosis with localization of the parasite in the Central Nervous System is the most severe and frequent form of parasitic brain diseases in humans and responsible of thousands of worldwide deaths per year. Madagascar is a T. solium endemic country where poor sanitation, free roaming pigs and outdoor defecation are common, and maintain the parasite transmission cycle. Little information is available regarding taeniosis/cysticercosis epidemiology in Madagascar. We carried out a community-based study to investigate the prevalence of human taeniosis/cysticercosis and associated risk factors in 12 rural remote villages of Ranomafana and Kelilalina townships (Ifanadiana district, Madagascar). Our results reveal that in 7/12 villages investigated, a high number of participants had teaniosis. Moreover, a high number of active cysticercosis cases were detected. Open defecation and promiscuity were seemed to be the main risk factors associated to T. solium infections. The results of this study will be useful to guide interventions in these remote settings surrounding the Ranomafana National Park.
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Affiliation(s)
- Anjanirina Rahantamalala
- Institut Pasteur de Madagascar, Immunology of Infectious Diseases Unit, Antananarivo, Madagascar
- * E-mail:
| | | | - Emma Rakotomalala
- Institut Pasteur de Madagascar, Immunology of Infectious Diseases Unit, Antananarivo, Madagascar
| | | | - Jaydon Kiernan
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Paul M. Castle
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Lee Hakami
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Koeun Choi
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | | | - Aina Harimanana
- Institut Pasteur de Madagascar, Epidemiology and Clinical Research Unit, Antananarivo, Madagascar
| | - Patricia Wright
- Centre ValBio, Ranomafana, Ifanadiana, Madagascar
- Department of Anthropology, Stony Brook University, Stony Brook, New York, United States of America
| | - Simon Grandjean Lapierre
- Global Health Institute, Stony Brook University, Stony Brook, New York, United States of America
| | - Matthieu Schoenhals
- Institut Pasteur de Madagascar, Immunology of Infectious Diseases Unit, Antananarivo, Madagascar
| | - Peter M. Small
- Centre ValBio, Ranomafana, Ifanadiana, Madagascar
- Global Health Institute, Stony Brook University, Stony Brook, New York, United States of America
| | - Luis A. Marcos
- Global Health Institute, Stony Brook University, Stony Brook, New York, United States of America
- Division of Infectious Diseases, Department of Medicine, Department of Microbiology and Molecular Genetics, Stony Brook University, Stony Brook, New York, United States of America
| | - Inès Vigan-Womas
- Institut Pasteur de Madagascar, Immunology of Infectious Diseases Unit, Antananarivo, Madagascar
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Del Brutto OH, Recalde BY, Mera RM. Incidence of Adult-Onset Epilepsy and the Contributory Role of Neurocysticercosis in a Five-Year, Population-Based, Prospective Study in Rural Ecuador. Am J Trop Med Hyg 2022; 106:208-214. [PMID: 34634771 PMCID: PMC8733542 DOI: 10.4269/ajtmh.21-0835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/22/2021] [Indexed: 01/03/2023] Open
Abstract
This prospective cohort study aimed to assess incidence and etiology of adult-onset epilepsy in previously seizure-free Atahualpa residents aged ≥ 20 years. Persons with adult-onset epilepsy occurring over 5 years were identified from annual door-to-door surveys and other overlapping sources. Those who emigrated or declined consent were excluded at the administrative censoring date of the last survey when these subjects were interviewed. Persons who died and those who developed incident epilepsy were censored at the time of these outcomes. Poisson regression models adjusted for demographics, education, alcohol intake, and the length of observation time, were used to estimate annual adult-onset epilepsy incidence rate ratio and cumulative incidence. Systematic neuroimaging screening was offered to participants to get insights on the etiology of epilepsy. Individuals enrolled in this cohort (N = 1,480) contributed to 6,811.6 years of follow-up. Seventeen developed incident adult-onset epilepsy, for an annual incident rate of 249.2 per 100,000 persons-year (95% CI: 130.7-367.7). Cumulative incidence was 1,245.9 per 100,000 persons (95% CI: 653.7-1,838.3) after a mean of 4.6 (SE: 0.06) years of follow-up. Six persons with incident epilepsy had neurocysticercosis (35%). Individuals with neurocysticercosis were six times more likely to develop adult-onset epilepsy than those without this disease (IRR: 6.01; 95% CI: 2.16-16.7), after adjusting for relevant covariates. The attributable fraction of incident adult-onset epilepsy due to neurocysticercosis was 30.9% (95% CI: 25.6-46.2%). This rural Ecuadorian population has a high incidence of adult-onset epilepsy, with neurocysticercosis being an important contributory cause.
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Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo—Ecuador, Samborondón, Ecuador;,Address correspondence to Oscar H. Del Brutto, Urbanización Toscana, Apt 3H, Km 4.5 vía Puntilla-Samborondón, 092301, Samborondón—Ecuador. E-mail:
| | | | - Robertino M. Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, California
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Burden of epilepsy in Latin America and The Caribbean: a trend analysis of the Global Burden of Disease Study 1990 - 2019. LANCET REGIONAL HEALTH. AMERICAS 2021; 8:100140. [PMID: 36778734 PMCID: PMC9904123 DOI: 10.1016/j.lana.2021.100140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background The epilepsy prevalence in Latin America and the Caribbean (LAC) had remained high over the last 20 years. Data on the burden of epilepsy are needed for healthcare planning and resource allocation. However, no systematic analysis had been performed for epilepsy burden in LAC. Methods We extracted data of all LAC countries from the Global Burden of Disease (GBD) study from 1990 to 2019. Epilepsy burden was measured as prevalence, mortality, and disability-adjusted life-years (DALYs; defined by the sum of years of life lost [YLLs] for premature mortality and years lived with disability [YLDs]), by age, sex, year, and country. Absolute numbers, rates, and 95% uncertainty intervals were reported. We performed correlational analyses among burden metrics and Socio-demographic Index (SDI). Findings The burden of epilepsy decreased around 20% in LAC, led by YLLs reduction. In 2019, 6·3 million people were living with active epilepsy of all causes (95% UI 5·3 - 7·4), with 3·22 million (95% UI 2·21 - 4·03) and 3·11 million (95% UI 2·21 to 4·03) cases of epilepsy with identifiable aetiology and idiopathic epilepsy, respectively. The number of DALYs represented the 9·51% (1.37 million, 95% UI 0·99 -1·86) of the global epilepsy burden in 2019. The age-standardized burden was 175·9 per 100 000 population (95% UI 119·4 - 253·3), which tend to have a bimodal age distribution (higher in the youth and elderly) and was driven by high YLDs estimates. The burden was higher in men and older adults, primarily due to high YLLs and mortality. Alcohol use was associated with 17% of the reported DALYs. The SDI estimates significantly influenced this burden (countries with high SDI have less epilepsy burden and mortality, but not prevalence or disability). Interpretation The epilepsy burden has decreased in LAC over the past 30 years. Even though, LAC is still ranked as the third region with the highest global epilepsy burden. This reduction was higher in children, but burden and mortality increased for older adults. The epilepsy burden is disability predominant; however, the mortality-related estimates are still higher than in other regions. Alcohol consumption and countries' development are important determinants of this burden. There is an urgent need to improve access to epilepsy care in LAC, particularly for older adults. Strengthening primary care with online learning and telemedicine tools, and promoting risk factors modification should be prioritized in the region. Funding This research was self-funded by the authors.
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White AC. Calcifications and the Global Burden of Neurocysticercosis: Not Just Rocks in Your Head. Clin Infect Dis 2021; 73:e2604-e2606. [PMID: 32556094 DOI: 10.1093/cid/ciaa764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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17
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Kaur R, Arora N, Rawat SS, Keshri AK, Sharma SR, Mishra A, Singh G, Prasad A. Vaccine for a neglected tropical disease Taenia solium cysticercosis: fight for eradication against all odds. Expert Rev Vaccines 2021; 20:1447-1458. [PMID: 34379534 DOI: 10.1080/14760584.2021.1967750] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Taenia solium infection is among the 17 most neglected tropical diseases identified by World Health Organization and to be eradicated by 2030. This parasite infects the central nervous system (Neurocysticercosis [NCC]) and intestine [Taeniasis]). NCC is the most frequent cause of acquired epilepsy in endemic regions and Taeniasis is responsible for the widespread malnutrition and abdominal discomfort among children. Epilepsy caused by T. solium is preventable and the total elimination of NCC can be achieved by good hygiene, mass therapy, and most importantly vaccination of pigs or humans. Vaccine for pig is available but not widely in use and for humans it's still elusive. AREA COVERED Several vaccine candidates for porcine cysticercosis have been tried like TSOL18, SP3Vac, KETc7, TSOL45, etc. with good success in the limited field trial. This review highlights some seminal contributions for the anti-cestode vaccine, the associated challenges, current status, suggestive future directions, and the need of vaccine for human use. EXPERT OPINION Though several vaccines are available, none is being widely used due to lack of awareness, economic constraints, accessibility, etc. Hence, there is a need for a newer, economic, and reliable vaccine for humans or pigs use to reduce the disease burden.
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Affiliation(s)
- Rimanpreet Kaur
- School of Basic Sciences, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, India
| | - Naina Arora
- School of Basic Sciences, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, India
| | - Suraj S Rawat
- School of Basic Sciences, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, India
| | - Anand Kumar Keshri
- School of Basic Sciences, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, India
| | - Shubha Rani Sharma
- Department of Bio-Engineering, Birla Institute of Technology, Ranchi-Jharkhand, India
| | - Amit Mishra
- Cellular and Molecular Neurobiology Unit, Indian Institute of Technology Jodhpur, Rajasthan, India
| | - Gagandeep Singh
- Department of Neurology, Dayanad Medical College, Ludhiana, Punjab, India
| | - Amit Prasad
- School of Basic Sciences, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, India
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18
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Carpio A, Romo ML, Hauser WA, Kelvin EA. New understanding about the relationship among neurocysticercosis, seizures, and epilepsy. Seizure 2021; 90:123-129. [DOI: 10.1016/j.seizure.2021.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 02/08/2023] Open
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Abstract
PURPOSE OF REVIEW Neurocysticercosis is the most common helminthic infection of the central nervous system caused by the larval stage of the pork tapeworm, Taenia solium. Endemic regions include Latin American countries, sub-Saharan Africa, and large regions of Asia, including the Indian subcontinent and is a global health problem. Seizures are the most common manifestation and approximately 30% of adult-onset seizures in endemic regions are attributable to NCC. Calcifications because of neurocysticercosis is the most common finding on imaging in endemic regions and are important seizure foci contributing to the burden of epilepsy. RECENT FINDINGS After treatment with antiparasitics for multiple viable parenchymal disease, approximately 38% of cysts that resolved after 6 months of therapy will result in residual calcifications, which represents a significant burden of residual disease. Calcified disease has been referred to as 'inactive disease', but there is accumulating evidence to suggest that calcified granulomas are actually dynamic and substantially contribute to the development and maintenance of seizures. SUMMARY Calcified parenchymal neurocysticercosis contributes significantly to the development and maintenance of seizures in endemic regions. Understanding the pathogenesis of the role of calcified NCC in seizure development and risk factors for development of calcifications after treatment is critical to decreasing the burden of symptomatic disease in endemic regions.
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Lim W, Atere M, Nugent B, Tin S, Khalil A. Neurocysticercosis Presenting With a New-Onset Seizure: A Case Report. Cureus 2021; 13:e13897. [PMID: 33880253 PMCID: PMC8046168 DOI: 10.7759/cureus.13897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Neurocysticercosis (NCC) is a common infection that is found worldwide but is often neglected in the United States (US). This case report aims to illustrate the presentation of the disease, provide information on this globally prevalent pathogen, and shed light on the diagnostic workup and treatment of the infection. We discuss the case of a 31-year-old male patient of Central American origin presenting with a new-onset seizure. He had no significant past medical history and had never experienced similar events before. The diagnosis was made through neuroimaging, serum antibody testing, and biopsy of the brain lesion. This case highlights the importance of performing a good clinical history and a proper diagnostic workup that would help in the prompt recognization and treatment of this common worldwide illness that may not be endemic to the clinician’s geographical area.
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Affiliation(s)
- William Lim
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Muhammed Atere
- Medicine, Richmond University Medical Center, Staten Island, USA
| | - Bryan Nugent
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Swann Tin
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Ambreen Khalil
- Internal Medicine/Infectious Disease, Richmond University Medical Center, Staten Island, USA
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21
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Alva-Díaz C, Navarro-Flores A, Rivera-Torrejon O, Huerta-Rosario A, Molina RA, Velásquez-Rimachi V, Morán-Mariños C, Farroñay C, Pacheco-Mendoza J, Metcalf T, Burneo JG, Pacheco-Barrios K. Prevalence and incidence of epilepsy in Latin America and the Caribbean: A systematic review and meta-analysis of population-based studies. Epilepsia 2021; 62:984-996. [PMID: 33651439 DOI: 10.1111/epi.16850] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study was undertaken to perform an updated systematic review and meta-analysis to estimate the pooled prevalence and incidence of epilepsy in Latin America and the Caribbean (LAC), describing trends over time, and exploring potential clinical and epidemiological factors explaining the heterogeneity in the region. METHODS Observational studies assessing the incidence or prevalence of epilepsy in LAC countries up to March 2020 were systematically reviewed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses and cumulative analyses were performed using random-effects models. We assessed between-study heterogeneity with sensitivity, subgroup, and meta-regression analyses. Moreover, the quality of the included studies and the certainty of evidence were evaluated using the GRADE (grading of recommendation, assessment, development, and evaluation) approach. RESULTS Overall, 40 studies (from 42 records) were included, 37 for prevalence analyses and six for incidence (312 387 inhabitants; 410 178 person-years). The lifetime prevalence was 14.09 per 1000 inhabitants (95% confidence interval [CI] = 11.72-16.67), for active epilepsy prevalence was 9.06 per 1000 individuals (95% CI = 6.94-11.44), and the incidence rate was 1.11 per 1000 person-years (95% CI = .65-1.70). These high estimates have been constant in the region since 1990. However, substantial statistical heterogeneity between studies and publication bias were found. The overall certainty of evidence was low. Methodological aspects (sample size) and countries' epidemiological characteristics such as access to sanitation services and child and adult mortality rates explained the high heterogeneity. Finally, the prevalence of epilepsy associated with neurocysticercosis (NCC) in the general population was high, and the proportion of NCC diagnosis among people living with epilepsy was 17.37%. SIGNIFICANCE The epilepsy prevalence and incidence in LAC are higher than worldwide estimates, being constant since 1990 and strongly influenced by NCC. We identified high between-study heterogeneity and significant methodological limitations (e.g., heterogeneous definitions, lack of longitudinal studies). The region needs upgraded research using standardized definitions and diagnostic methods, and urgent action against preventable causes.
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Affiliation(s)
- Carlos Alva-Díaz
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru
| | - Alba Navarro-Flores
- Clinical and Health Efficacy Network, REDECS, Lima, Peru.,School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Oscar Rivera-Torrejon
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru
| | - Andrely Huerta-Rosario
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru.,School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Roberto A Molina
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru.,School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Victor Velásquez-Rimachi
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru
| | - Cristian Morán-Mariños
- Clinical and Health Efficacy Network, REDECS, Lima, Peru.,San Ignacio de Loyola University, Lima, Peru
| | | | | | - Tatiana Metcalf
- Neurology Department, Department of Medicine and Office for Teaching Support and Research, Daniel Alcides Carrion Hospital, Callao, Peru
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine, Western University, London, Canada
| | - Kevin Pacheco-Barrios
- Research Unit for the Generation and Synthesis of Evidence in Health, San Ignacio de Loyola University, Lima, Peru.,SYNAPSIS Mental Health and Neurology, Lima, Peru.,Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
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22
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Del Brutto OH, Wu S, Mera RM, Costa AF, Recalde BY, Issa NP. Cognitive decline among individuals with history of mild symptomatic SARS-CoV-2 infection: A longitudinal prospective study nested to a population cohort. Eur J Neurol 2021; 28:3245-3253. [PMID: 33576150 PMCID: PMC8014083 DOI: 10.1111/ene.14775] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Neurological complications of SARS-CoV-2 infection are noticed among critically ill patients soon after disease onset. Information on delayed neurological sequelae of SARS-CoV-2 infection is nil. Following a longitudinal study design, the occurrence of cognitive decline among individuals with a history of mild symptomatic SARS-CoV-2 infection was assessed. METHODS Stroke- and seizure-free Atahualpa residents aged ≥40 years, who had pre-pandemic cognitive assessments as well as normal brain magnetic resonance imaging and electroencephalogram recordings, underwent repeated evaluations 6 months after a SARS-CoV-2 outbreak infection in Atahualpa. Patients requiring oxygen therapy, hospitalization, and those who had initial neurological manifestations were excluded. Cognitive decline was defined as a reduction in the Montreal Cognitive Assessment (MoCA) score between the post-pandemic and pre-pandemic assessments that was ≥4 points greater than the reduction observed between two pre-pandemic MoCAs. The relationship between SARS-CoV-2 infection and cognitive decline was assessed by fitting logistic mixed models for longitudinal data as well as exposure-effect models. RESULTS Of 93 included individuals (mean age 62.6 ± 11 years), 52 (56%) had a history of mild symptomatic SARS-CoV-2 infection. Post-pandemic MoCA decay was worse in seropositive individuals. Cognitive decline was recognized in 11/52 (21%) seropositive and 1/41 (2%) seronegative individuals. In multivariate analyses, the odds for developing cognitive decline were 18.1 times higher among SARS-CoV-2 seropositive individuals (95% confidence interval 1.75-188; p = 0.015). Exposure-effect models confirmed this association (β = 0.24; 95% confidence interval 0.07-0.41; p = 0.006). CONCLUSIONS This study provides evidence of cognitive decline among individuals with mild symptomatic SARS-CoV-2 infection. The pathogenesis of this complication remains unknown.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Samborondón, Ecuador
| | - Shasha Wu
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc, Foster City, CA, USA
| | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Cordoba, Spain
| | | | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, IL, USA
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23
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El-Kady AM, Allemailem KS, Almatroudi A, Abler B, Elsayed M. Psychiatric Disorders of Neurocysticercosis: Narrative Review. Neuropsychiatr Dis Treat 2021; 17:1599-1610. [PMID: 34079258 PMCID: PMC8164720 DOI: 10.2147/ndt.s306585] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/22/2021] [Indexed: 12/29/2022] Open
Abstract
Neurocysticercosis, the most common type of neuroparasitosis, is a condition in which the central nervous system (CNS) is infested with the pork tapeworm Taenia solium cysticercosis' larvae. Neurocysticercosis is the most widespread parasitic CNS disease worldwide, affecting more than 50 million individuals. As neurocysticercosis is prevalent in developing countries, the growing number of migrants and travelers increases prevalence in developed countries. Possible neuropsychiatric manifestations are depression, cognitive dysfunction, dementia, and visual hallucinations. Depending on the cysts' location in the CNS, focal neurology or psychiatric symptoms manifest. The diagnosis of neurocysticercosis is based on neuroimaging and serology. The correlation between specific symptoms and the cyst's location might help better understand psychiatric disorders' pathophysiology. Nonetheless, the exact prevalence of neurocysticercosis is seldom reported in patients with psychiatric disorders, which may be due to the lack of imaging availability in developing countries with a high prevalence.
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Affiliation(s)
- Asmaa M El-Kady
- Department of Medical Parasitology, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Khaled S Allemailem
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Birgit Abler
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, 89075, Germany
| | - Mohamed Elsayed
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, 89075, Germany
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24
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Mukuku O, Sánchez SS, Bugeme M, Garcia HH. Case Report: Three Cases of Neurocysticercosis in Central Africa. Am J Trop Med Hyg 2020; 103:1955-1957. [PMID: 32901607 DOI: 10.4269/ajtmh.19-0759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Neurocysticercosis (NCC) is an infection prevalent in developing countries; however, it is neglected in the Democratic Republic of the Congo (DRC) and in sub-Saharan Africa. Here, we present three different cases seen in a consulting room in Lubumbashi. These cases are evidence that NCC is more common than it was previously thought in sub-Saharan Africa. Neurocysticercosis is a pathology-neglected and ignored infection, not only by the population but also by health professionals and health authorities in the DRC, and because of that, it is important to increase the research about NCC in the DRC to assess the prevalence and risk factors for NCC to assess the severity of the phenomenon and to help designing appropriate prevention and control measures.
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Affiliation(s)
- Olivier Mukuku
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Sofía S Sánchez
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Marcellin Bugeme
- University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Hector H Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru.,Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
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25
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Marcellin B, Adjratou Djeynabou S, Olivier M, Athanase M, Oscar Numbi L, Kamadore T. Epilepsy due to Neurocysticercosis: Analysis of a Hospital Cohort. JOURNAL OF NEUROSCIENCE AND NEUROLOGICAL DISORDERS 2020. [DOI: 10.29328/journal.jnnd.1001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction: Neurocysticercosis (NCC) is a common helminthic infection of the nervous system that occurs when humans become intermediate hosts in the life cycle of the pig tapeworm (Taenia solium) after ingesting its eggs. The objective of this study was to analyze socio-demographic, clinical and paraclinical features of patients with NCC in Lubumbashi, DRC. Methods: This is a cross-sectional study conducted over a period of 2 years within the Neuropsychiatric Center of Lubumbashi. Socio-demographic, clinical, paraclinical and therapeutic features were studied. Results: A total of 18 patients with NCC were listed. Epilepsy was found in 72.2% (13/18) of the cases. The mean age of the patients was 30.2 ± 13.5 years; males accounted for 61.2% of the cases. 84.6% were consumers of pork. Generalized epilepsy was found in 84.6% of the cases and hypereosinophilia in 38% of the cases. On the neuroimaging, the parietal location of lesions represented 92.3%; calcifications were the type of lesion in 53.8% of the cases and 69.2% of the cases presented lesions in the 4th evolutionary stage. Electroencephalogram was normal in 84.4% of the cases. Phenobarbital was the antiepileptic drug used in 69.3%; albendazole and prednisone were used in 53.9% of the cases. Conclusion: This study shows that NCC is one of the causes of epilepsy in Lubumbashi. Generalized tonic-clonic seizures are the most common form of presentation and calcified parenchymal lesions are the most common radiological feature of NCC. So, any patient with acute onset of afebrile seizure should be screened for NCC provided other common causes been ruled out.
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26
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Garcia HH, Gonzalez AE, Gilman RH. Taenia solium Cysticercosis and Its Impact in Neurological Disease. Clin Microbiol Rev 2020; 33:e00085-19. [PMID: 32461308 PMCID: PMC7254859 DOI: 10.1128/cmr.00085-19] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Taenia solium neurocysticercosis (NCC) is endemic in most of the world and contributes significantly to the burden of epilepsy and other neurological morbidity. Also present in developed countries because of immigration and travel, NCC is one of few diseases targeted for eradication. This paper reviews all aspects of its life cycle (taeniasis, porcine cysticercosis, human cysticercosis), with a focus on recent advances in its diagnosis, management, and control. Diagnosis of taeniasis is limited by poor availability of immunological or molecular assays. Diagnosis of NCC rests on neuroimaging findings, supported by serological assays. The treatment of NCC should be approached in the context of the particular type of infection (intra- or extraparenchymal; number, location, and stage of lesions) and has evolved toward combined symptomatic and antiparasitic management, with particular attention to modulating inflammation. Research on NCC and particularly the use of recently available genome data and animal models of infection should help to elucidate mechanisms of brain inflammation, damage, and epileptogenesis.
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Affiliation(s)
- Hector H Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Armando E Gonzalez
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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27
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Herrick JA, Bustos JA, Clapham P, Garcia HH, Loeb JA, For The Cysticercosis Working Group In Peru. Unique Characteristics of Epilepsy Development in Neurocysticercosis. Am J Trop Med Hyg 2020; 103:639-645. [PMID: 32431269 PMCID: PMC7410468 DOI: 10.4269/ajtmh.19-0485] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The parasitic helminth infection neurocysticercosis (NCC) is the most common cause of adult-acquired epilepsy in the world. Despite the serious consequences of epilepsy due to this infection, an in-depth review of the distinct characteristics of epilepsy due to neurocysticercosis has never been conducted. In this review, we evaluate the relationship between NCC and epilepsy and the unique characteristics of epilepsy caused by NCC. We also discuss recent advances in our understanding of NCC-related epilepsy, including the importance of anti-inflammatory therapies, the association between NCC and temporal lobe epilepsy, and the recent discovery of biomarkers of severe epilepsy development in individuals with NCC and seizures.
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Affiliation(s)
- Jesica A Herrick
- Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Javier A Bustos
- Center for Global Health, Instituto Nacional de Ciencias Neurológicas, Universidad Peruana Cayetano Heredia, and Cysticercosis Unit, Lima, Perú
| | - Philip Clapham
- Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Hector H Garcia
- Center for Global Health, Instituto Nacional de Ciencias Neurológicas, Universidad Peruana Cayetano Heredia, and Cysticercosis Unit, Lima, Perú
| | - Jeffrey A Loeb
- Department of Neurology and Rehabilitation Medicine, University of Illinois at Chicago, Chicago, Illinois
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28
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White AC, Fleury A. Optimal Treatment for Subarachnoid Neurocysticercosis: Closer, but Not There yet. Am J Trop Med Hyg 2020; 102:1-2. [PMID: 31674300 PMCID: PMC6947791 DOI: 10.4269/ajtmh.19-0754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- A Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Agnes Fleury
- Instituto de Investigaciones Biomédicas-UNAM/Instituto Nacional de Neurología y Neurocirugía/Facultad de Medicina-UNAM, Ciudad de México, Mexico
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29
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Modak A, Suthar R, Sharawat IK, Sankhyan N, Sahu JK, Malhi P, Khandelwal N. An Ambispective Cohort Study to Assess Seizure Recurrences in Children with Calcified Parenchymal Neurocysticercosis. Am J Trop Med Hyg 2020; 101:812-820. [PMID: 31452498 DOI: 10.4269/ajtmh.19-0278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Calcified neurocysticercosis (NCC), previously thought to be a dead end, is an important risk factor for seizure recurrences. We studied the pattern of seizure recurrences and associated radiological findings in children with calcified NCC. In this ambispective cohort study, we enrolled children (age 1-15 years) with calcified NCC attending the pediatric NCC clinic between January 2017 and December 2017. Retrospective data were collected from the hospital records, and all enrolled children were prospectively followed up till June 2018. The study group divided into two groups: 1) children first presenting with calcified granuloma and 2) children presented with ring-enhancing lesion (REL) and transformed into the calcified lesion during follow-up imaging. During the study period (January 2017-December 2017), 520 children with NCC were screened and 128 with calcified NCC were enrolled. The mean age was 10.8 ± 3.2 years, and 63% were boys. Among 128 children, 40 (31%) had calcified granuloma and 88 (69%) had REL transformed to calcified granuloma. Sixty-one (49%) children had seizure recurrence: 22 (58%) within calcified granuloma group and 39 (45%) within REL transformed to calcified granuloma group (P = 0.18). Seizure recurrence was associated with the presence of perilesional edema (PE) in 35 (57.4%) children on computed tomography scan. The median interval between two seizure recurrences was 30 (17-56) months, and the median antiepileptic drug-free interval was 17 (12-22) months. The total duration of continued seizures was 42 (26-58) months, slightly longer in children with REL transformed to calcified granuloma group (42, 95% CI: 18-66 months) in comparison to calcified granuloma group (35, 95% CI: 10-60 months, P = 0.32). To conclude, children with calcified NCC have seizure recurrences over a prolonged period. Seizure recurrences are intermittent and may be interspersed with a prolonged period of quiescence in between. The presence of PE and contrast enhancement around the lesion during seizure recurrence suggests lesion reactivation.
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Affiliation(s)
- Abhijit Modak
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Indar Kumar Sharawat
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Jitendra Kumar Sahu
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Prahbhjot Malhi
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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30
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Del Brutto OH. Twenty-five years of evolution of standard diagnostic criteria for neurocysticercosis. How have they impacted diagnosis and patient outcomes? Expert Rev Neurother 2019; 20:147-155. [DOI: 10.1080/14737175.2020.1707667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo – Ecuador, Samborondón, Ecuador
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31
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Prevalence, clinical characteristics, and seizure outcomes of epilepsy due to calcific clinical stage of neurocysticercosis: Study in a rural community in south India. Epilepsy Behav 2019; 98:168-172. [PMID: 31376678 DOI: 10.1016/j.yebeh.2019.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/17/2019] [Accepted: 07/05/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this research was to study the prevalence, clinical characteristics, and seizure remission rates of epilepsy due to calcific stage of neurocysticercosis (cNCC) in a rural community in south India. MATERIAL AND METHODS Comprehensive Rural Epilepsy Study South India (CRESSI) is a prospective longitudinal study of epilepsy care in a rural community in south India. As part of this study, prevalence of epilepsy was studied in a population of 74,086 in 22 villages. The prevalence study identified 451 people with epilepsy including 62 (13.7%) with epilepsy due to cNCC. Diagnosis of cNCC was based on computed tomography (CT) findings. The clinical characteristics and seizure outcomes were studied in this cohort of 62 patients. The data collected included demographics, seizure type, antiepileptic drugs (AEDs), seizure remission rates, and predictors of long-term seizure remissions. RESULTS The crude prevalence of epilepsy due to cNCC in this rural community was 0.84 per 1000 (95% confidence interval [CI]: 0.65-1.07). This lesion accounted for 41% of the established etiology among 451 prevalence cases of epilepsy. Mean age at presentation was 28.87 ± 14.45 (range: 8-65 years) with equal gender distribution. The common location of the lesion was in the perirolandic region. Focal onset motor seizures were the common seizure type. Seizure remission (≥2 years) rate was 80.3%. The independent predictor of drug resistance was failure to respond to monotherapy (odds ratio: 63.9; 95% CI: 8.4-485.4; p < 0.0001). Focal impaired awareness behavioral arrest/automatisms with lesion located in the temporal lobe in all the three patients were drug-resistant. CONCLUSIONS In this rural community in south India, epilepsy due to cNCC was the commonest acquired epilepsy in people aged ≥20 years. Long-term seizure remission rates were high, and failure to respond to monotherapy was the predictor of drug resistance. Drug-resistant epilepsy was extremely rare with this lesion.
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Carpio A, Chang M, Zhang H, Romo ML, Jaramillo A, Hauser WA, Kelvin EA. Exploring the complex associations over time among albendazole treatment, cyst evolution, and seizure outcomes in neurocysticercosis. Epilepsia 2019; 60:1820-1828. [PMID: 31355931 DOI: 10.1111/epi.16302] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop a causal model for the occurrence of neurocysticercosis (NC)-related seizures and test hypotheses generated from the model. METHODS We used data from a randomized controlled trial comparing albendazole with placebo among patients newly diagnosed with NC. Based on our causal model, we explored the associations among albendazole treatment, NC cyst evolution, and seizure outcomes over 24 months of follow-up using generalized linear mixed effect models. RESULTS We included 153 participants, of whom 51% received albendazole. The association between seizure outcomes and treatment over time demonstrated lack of linearity and heterogeneity, requiring the inclusion of time-treatment interaction terms for valid modeling. Participants in the albendazole group had fewer seizures overall and of partial onset at all time points compared with the placebo group, but the difference increased over the first few months following treatment, then decreased over time. Generalized seizures exhibited a more complex association; those in the albendazole group had fewer seizures compared with those in the placebo group for the first few months after treatment, and then the association reversed and those in the placebo arm had fewer seizures. Adjusting for the number of NC cysts in each phase resulted in an attenuation of the strength of association between albendazole and seizure outcomes, consistent with mediation. Among participants in whom all cysts had disappeared (n = 21), none continued to have seizures. SIGNIFICANCE Albendazole treatment is associated with a possible reduction in focal seizures in the short term (3-6 months), perhaps by hastening the resolution of the cysts. However, the effect is not discernible over the long term, because most cysts either calcify or resolve completely, regardless of whether treated with albendazole. The stage of evolution of the cysticercus is an important consideration in the evaluation of albendazole effect on seizure outcome.
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Affiliation(s)
- Arturo Carpio
- School of Medicine, University of Cuenca, Cuenca, Ecuador.,G. H. Sergievsky Center, Columbia University, New York, New York
| | - Mindy Chang
- Institute for Implementation Science in Population Health, City University of New York, New York, New York
| | - Hongbin Zhang
- Institute for Implementation Science in Population Health, City University of New York, New York, New York.,Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York
| | - Matthew L Romo
- Li Ka Shing Faculty of Medicine, School of Public Health, University of Hong Kong, Hong Kong, China
| | | | - W Allen Hauser
- G. H. Sergievsky Center, Columbia University, New York, New York
| | - Elizabeth A Kelvin
- Institute for Implementation Science in Population Health, City University of New York, New York, New York.,Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York
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Del Brutto OH, Mera RM, Kiernan J, Castle P, Zambrano M, Sedler MJ. Supratentorial arachnoid cysts and seizures/epilepsy: A population study in community dwellers aged ≥20 years. Epilepsia 2019; 60:e83-e87. [PMID: 31329287 DOI: 10.1111/epi.16287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
Literature on the association between arachnoid cysts and seizures/epilepsy is inconsistent, and most series have been flawed due to recruitment bias. In this study, we aimed to assess the prevalence of supratentorial arachnoid cysts (SACs) in Atahualpa residents aged ≥20 years, and to estimate whether these lesions were associated with seizures/epilepsy. A total of 1157 individuals were included. Computed tomography revealed SACs in 25 individuals (2.2%). Most had middle cranial fossa SACs (n = 19). Recurrent nonprovoked seizures were diagnosed in 28 individuals and a single seizure in 4. Only 1 of 25 (4%) individuals with SACs had seizures/epilepsy as opposed to 31 of 1132 (2.7%) who did not have SACs (P = 0.508). A logistic regression model showed no association between SACs and seizures/epilepsy, after taking into account the effect of relevant confounders (odds ratio [OR] 1.71; 95% confidence interval [95% CI] 0.22-13.3; P = 0.607). This study provides evidence of lack of association between SACs and seizures/epilepsy.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, University Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA
| | - Jaydon Kiernan
- School of Medicine, Stony Brook University, New York, NY, USA
| | - Paul Castle
- School of Medicine, Stony Brook University, New York, NY, USA
| | | | - Mark J Sedler
- School of Medicine, Stony Brook University, New York, NY, USA
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35
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Del Brutto OH, Mera RM, Zambrano M, Costa AF, Román GC. The Association between Calcified Neurocysticercosis and Cognitive Performance: A Case-Control Study Nested to a Population-Based Cohort. Am J Trop Med Hyg 2019; 100:323-326. [PMID: 30734692 DOI: 10.4269/ajtmh.18-0611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Mechanisms implicated in the association between neurocysticercosis (NCC) and cognitive impairment remain unknown. Atahualpa residents aged ≥ 40 years with calcified NCC were identified as case patients and paired 1:1 to age- and gender-matched controls. The selection process generated 79 pairs. Cognitive performance was measured by the Montreal Cognitive Assessment (MoCA). A conditional logistic regression model revealed no differences in MoCA scores across case patients and controls, after adjusting for education, epilepsy, depression, and hippocampal atrophy. The single covariate remaining significant was hippocampal atrophy. When participants were stratified according to this covariate, linear models showed lower MoCA scores among case patients (but not controls) with hippocampal atrophy. In a fully adjusted linear regression model, age remained as the single covariate explaining cognitive impairment among NCC patients. This study demonstrates an association between hippocampal atrophy and poor cognitive performance among patients with calcified NCC, most likely attributable to the effect of age.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc., Foster City, California
| | | | - Aldo F Costa
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador
| | - Gustavo C Román
- Department of Neurology, Houston Methodist Hospital, Houston, Texas
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EEG Patterns in Patients With Calcified Neurocysticercosis With or Without Hippocampal Atrophy. J Clin Neurophysiol 2018; 35:332-338. [PMID: 29649013 DOI: 10.1097/wnp.0000000000000471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To assess whether hippocampal atrophy develops in conjunction with clinical or subclinical epileptiform or encephalopathic activity in subjects with neurocysticercosis (NCC). METHODS Using a population-based and nested case-control study design, scalp EEGs and brain MRIs were performed in Atahualpa residents aged ≥40 years, who have imaging-confirmed NCC (case patients), as well as in age- and sex-matched NCC-free control subjects. RESULTS Sixty-two case patients and 62 control subjects were included. Encephalopathic EEG patterns were more common in five NCC subjects with epilepsy than in those without a history of seizures. Epileptiform EEG activity was noted in one patient with NCC but in none of the control subjects. This subject's focal epileptiform discharges correlated with the location of calcified cysticerci in the brain parenchyma, and the hippocampus ipsilateral to the epileptiform discharges was more atrophic than the contralateral hippocampus. The degree of hippocampal atrophy in patients with NCC without a history of seizures was significantly greater than in control subjects (P < 0.01) and tended to be even greater in patients with NCC with a history of seizures. CONCLUSIONS Hippocampal atrophy may not be exclusively related to seizure activity in patients with NCC. Other mechanisms, such as recurrent bouts of inflammation around calcified cysticerci, might explain the association between NCC and hippocampal atrophy.
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Del Brutto OH, Issa NP. Focal Seizures with Corresponding Neuroimaging and Electroencephalographic Findings in a Patient with Scolex Remnants within a Calcified Cysticercus. Am J Trop Med Hyg 2018; 99:815-816. [PMID: 30292247 PMCID: PMC6159585 DOI: 10.4269/ajtmh.18-0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador
| | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, Illinois
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Recent Advances in the Diagnosis of Neurocysticercosis. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018. [DOI: 10.1007/s40506-018-0173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Del Brutto OH, Robles AM, Mera RM, Costa AF, Darsan E, Milla L, Montes J, Lama J, Del Brutto VJ, Zambrano M, Sedler MJ. Calcified Neurocysticercosis and Headache in an Endemic Village: A Case-Control Study Nested to a Population-Based Cohort. Am J Trop Med Hyg 2018; 99:729-734. [PMID: 29943721 DOI: 10.4269/ajtmh.18-0310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Headache in patients with calcified neurocysticercosis (NCC) is probably common but has been largely overlooked. We aimed to assess the presence, characteristics, and diagnosis of headache across patients with calcified NCC and their matched controls. In this case-control study nested to a population-based cohort, Atahualpa residents aged ≥ 20 years with calcified NCC were identified as case patients and paired 1:1 to age- and gender-matched randomly selected controls. A culturally adapted questionnaire was derived from the EUROLIGHT. Headache diagnosis was established according to the International Classification of Headache Disorders, 3rd edition. Conditional logistic regression models for matched paired data were fitted to assess the independent association between calcified NCC (as the exposure) and headache variables, after adjusting for education, alcohol intake, depression, and epilepsy. The selection process generated 106 case patients and their matched controls. Lifetime headache prevalence (odds ratio [OR]: 4.18; 95% Confidence Interval [CI]: 1.79-9.75; P = 0.001), current headaches (OR: 4.19; 95% CI: 1.92-9.16; P < 0.001), and intense headaches (OR: 9.47; 95% CI: 2.88-31.19; P < 0.001) were more frequent among cases than in controls. In addition, migraine (but not other forms of headache) was more frequent among subjects with calcified NCC (OR: 4.89; 95% CI: 2.36-11.39; P < 0.001). This study shows a robust epidemiological association between headache-particularly migraine-and calcified NCC.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador
| | - Ana M Robles
- Universidad Central del Este, San Pedro de Macorís, Dominican Republic
| | | | - Aldo F Costa
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador
| | | | - Lucía Milla
- School of Medicine, Stony Brook University, New York, New York
| | - Jessica Montes
- School of Medicine, Stony Brook University, New York, New York
| | - Julio Lama
- Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador
| | | | | | - Mark J Sedler
- School of Medicine, Stony Brook University, New York, New York
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Carpio A, Fleury A, Romo ML, Abraham R. Neurocysticercosis: the good, the bad, and the missing. Expert Rev Neurother 2018. [DOI: 10.1080/14737175.2018.1451328] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Arturo Carpio
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca, Ecuador
- G.H. Sergievsky Center, Columbia University, New York, NY, USA
| | - Agnès Fleury
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma, Ciudad de México, México
- Secretaría de Salud, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - Matthew L. Romo
- Department of Epidemiology & Biostatistics and Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Ronaldo Abraham
- Departamento de Medicina, Universidade de Taubaté, São Paulo, Brazil
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Del Brutto OH, O'Neal SE, Dorny P, García HH. Spontaneously Arrested Transmission of Cysticercosis in a Highly Endemic Village with a Very Low Migration Rate. Am J Trop Med Hyg 2017; 98:776-778. [PMID: 29260655 DOI: 10.4269/ajtmh.17-0723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Taenia solium cysticercosis is difficult to eliminate without interventions or societal development. Atahualpa is a rural Ecuadorian village with documented low migration rate, where domestic pig raising is common and human cysticercosis is endemic. To assess neurocysticercosis (NCC) prevalence, 1,273 villagers aged ≥ 20 years underwent neuroimaging studies, which showed calcified lesions in 121 (9.5%) individuals, but no active disease. Likewise, positive reactions, apparently nonspecific, were found in only 3/200 subjects by the use of a monoclonal antibody-based enzyme-linked immunosorbent assay to detect T. solium antigens in urine. Only 2/418 pigs reacted to three antibody bands on serum western blot and none to more than three bands. This is the first time that spontaneously arrested T. solium transmission is documented in a known endemic village. Understanding why active transmission stopped could provide insights on potential targets for control interventions. Atahualpa could provide an optimal scenario for longitudinal studies on the consequences of calcified NCC.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo, Ecuador, Guayaquil, Ecuador
| | - Seth E O'Neal
- Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú.,Portland State University, Portland, Oregon.,School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Pierre Dorny
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Héctor H García
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú.,Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú.,Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Perú
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Carpio A, Romo ML, Tellez-Zenteno JF. What proportion of cases of epilepsy are actually caused by neurocysticercosis? Epilepsia 2017; 58:2186-2187. [PMID: 29205324 DOI: 10.1111/epi.13936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Arturo Carpio
- School of Medicine, University of Cuenca, Cuenca, Ecuador.,G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A
| | - Matthew L Romo
- Department of Epidemiology and Biostatistics, Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York, U.S.A
| | - José F Tellez-Zenteno
- Division of Neurology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Del Brutto OH. Response: Neurocysticercosis and epilepsy. Epilepsia 2017; 58:2187. [PMID: 29205323 DOI: 10.1111/epi.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
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