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Jyotsna M, Doomra R, Yadav SK. Isolated cysticercosis of breast mimicking a mass lesion: A case report. Int J Surg Case Rep 2023; 112:108956. [PMID: 37837663 PMCID: PMC10667779 DOI: 10.1016/j.ijscr.2023.108956] [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: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Cysticercosis is a zoonotic disease caused by the larval form of Taenia solium. Its occurrence as a breast lump is rarely observed and therefore presents significant diagnostic challenges, especially in non-endemic regions. CASE PRESENTATION A 25-year-old female patient presented with a lump in her left breast. The lesion was initially non-diagnostic on ultrasound and fine needle aspiration cytology. Excision biopsy of the cystic lesion was done, and histopathological examination confirmed it to be cysticercosis. Post surgery patient was given Albendazole, and she was asymptomatic during the 3 month follow up. CLINICAL DISCUSSION This case highlights the disease's ability to present in atypical forms, such as a breast lump, and the importance of considering cysticercosis in differential diagnosis, especially in endemic regions. Ultrasonography remains the preferred initial diagnostic modality, and the role of FNAC and histopathology is crucial for confirmation. The case also emphasizes the need for heightened clinical suspicion, even when traditional risk factors like pork consumption are absent. CONCLUSION This case emphasizes the importance of considering cysticercosis as a differential diagnosis for breast lumps, even with atypical presentation or in a non-endemic region. It highlights the need for greater awareness of this disease, stringent public health measures, and improved personal hygiene to combat its spread.
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Affiliation(s)
- Mili Jyotsna
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Rhythm Doomra
- All India Institute of Medical Sciences, Bhopal, India
| | - Shakti Kumar Yadav
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, India.
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Satyaprakash K, Khan WA, Zade NN, Chaudhari SP, Shinde SV, Kurkure NV, Shembalkar PK. Serological and molecular detection of neurocysticercosis among epileptic patients in Nagpur, Maharashtra state (India). Helminthologia 2023; 60:208-220. [PMID: 38152476 PMCID: PMC10750244 DOI: 10.2478/helm-2023-0023] [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] [Received: 03/10/2021] [Accepted: 07/07/2023] [Indexed: 12/29/2023] Open
Abstract
Neurocysticercosis (NCC), one of the most important neuroparasitic diseases in humans, is caused by Cysticercus cellulosae, the metacestode stage of digenetic zoonotic cestode Taenia solium. The present study aims at the detection of anti-cysticercus antibodies in the sera of epileptic patients (n=26) visiting a tertiary care hospital in Nagpur, Maharashtra state, India, by an in-house developed indirect IgG-ELISA and enzyme-linked immunoelectro transfer blot (EITB) assay using different antigens (namely, Whole Cyst Antigen (WCA), Cystic Fluid Antigen (CFA), Scolex Antigen (SA), Excretory-Secretory Antigen (ESA) and Membrane-Body Antigen (MBA)) prepared from T. solium metacestodes to find out the status of NCC. An attempt has also been made for molecular detection of NCC from blood samples of those patients by Polymerase Chain Reaction (PCR) assay targeted at large subunit rRNA gene of T. solium. The IgG ELISA level of anti-cysticercus antibodies against WCA, CFA, SA, ESA and MBA antigens were as follows: 19.23 %, 23.07 %, 38.46 %, 30.76 % and 15.38 %. The seroreactivity to CFA, SA and ESA was found in equal proportions in patients with ring-enhancing lesions. In the EITB assay, the lower and medium molecular weight protein bands of SA and ESA were immunodominant compared to the higher WCA and CFA peptides. PCR positivity could be observed in 34.6 % (9/26) of the patients under study. It is the first report of detecting NCC among epileptic patients of the Nagpur region of Maharashtra state in India using serological and molecular tools.
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Affiliation(s)
- K. Satyaprakash
- Department of Veterinary Public Health & Epidemiology, Nagpur Veterinary College, Nagpur, Maharashtra, India-440006
- Department of Veterinary Public Health & Epidemiology, Faculty of Veterinary and Animal Sciences, Banaras Hindu University, Barkachha, Mirzapur, Uttar Pradesh, India-231001
| | - W. A. Khan
- Department of Veterinary Public Health & Epidemiology, Nagpur Veterinary College, Nagpur, Maharashtra, India-440006
| | - N. N. Zade
- Department of Veterinary Public Health & Epidemiology, Nagpur Veterinary College, Nagpur, Maharashtra, India-440006
| | - S. P. Chaudhari
- Department of Veterinary Public Health & Epidemiology, Nagpur Veterinary College, Nagpur, Maharashtra, India-440006
| | - S. V. Shinde
- Department of Veterinary Public Health & Epidemiology, Nagpur Veterinary College, Nagpur, Maharashtra, India-440006
| | - N. V. Kurkure
- Department of Veterinary Pathology, Nagpur Veterinary College, Nagpur, Maharashtra, India-440006
| | - P. K. Shembalkar
- Get Well Hospital and Research Institute, Nagpur, Maharashtra, India-440012
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Koffi KE, Soumahoro MK, N'Dri KB, Nowakowski M, Guédé CM, Boka OM, Melki J, Touré OA, Djaman J, Bellalou J, N'Goran KE, Jambou R. Seroprevalence of porcine cysticercosis in traditional farms in South-Eastern Côte d'Ivoire. Parasite Epidemiol Control 2023; 22:e00311. [PMID: 37361928 PMCID: PMC10285562 DOI: 10.1016/j.parepi.2023.e00311] [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] [Received: 03/19/2022] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023] Open
Abstract
Background Porcine cysticercosis is an endemic parasitic zoonosis in many developing countries. The objective of this study was to estimate the seroprevalence of porcine cysticercosis in traditional pig farms in the departments of Dabou, Aboisso and Agboville. Methods Blood samples were taken from pigs and analyzed by ELISA (IgG) and western blot. Data on farming practices and pig characteristics were collected. Multivariate logistic regression models were constructed to identify risk factors. Results A total of 668 pigs were sampled from 116 farms and 639 samples were analyzed. The seroprevalence of cysticercosis was estimated at 13.2%. Overweight [OR = 2.6; 95%CI (1.3-4.9)] and fat pigs [OR = 2.3; 95%CI (1.0-4.8)] were twice as likely to be seropositive for cysticercosis. This risk was increased in farms using well water for drinking [OR = 2.5; 95%CI (1.0-6.3)] as well as those reporting veterinary care of the animals (OR = 2.9; 95%CI (1.2-7.3)). Conclusions This study demonstrated the circulation of Taenia solium in pig farms in southern Côte d'Ivoire.
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Affiliation(s)
- Kouassi Eugene Koffi
- Institut Pasteur de Côte d'Ivoire, B.P. 490, Abidjan 01, Côte d'Ivoire
- Laboratoire de Biologie et Sante Félix Houphouët Boigny, Abidjan; 01 BP V34 Abidjan, Côte d'Ivoire
| | | | | | | | | | - O. Marcel Boka
- Université Alassane Ouattara, Ministère de l'Enseignement Supérieur et de la Recherche Scientifique, B.P. V18, Bouaké 01, Côte D'ivoire
| | - Jihen Melki
- Institut Pasteur de Côte d'Ivoire, B.P. 490, Abidjan 01, Côte d'Ivoire
| | | | - Joseph Djaman
- Institut Pasteur de Côte d'Ivoire, B.P. 490, Abidjan 01, Côte d'Ivoire
| | - Jacques Bellalou
- Institut Pasteur de Paris, 25–28 Rue du Dr Roux, 75015 Paris, France
| | - K. Eliezer N'Goran
- Laboratoire de Biologie et Sante Félix Houphouët Boigny, Abidjan; 01 BP V34 Abidjan, Côte d'Ivoire
| | - Ronan Jambou
- Institut Pasteur de Côte d'Ivoire, B.P. 490, Abidjan 01, Côte d'Ivoire
- Institut Pasteur de Paris, 25–28 Rue du Dr Roux, 75015 Paris, France
- CERMES, Niamey BP10887 Niamey, Niger
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Steyn TJS, Awala AN, de Lange A, Raimondo JV. What Causes Seizures in Neurocysticercosis? Epilepsy Curr 2022; 23:105-112. [PMID: 37122403 PMCID: PMC10131564 DOI: 10.1177/15357597221137418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Neurocysticercosis (NCC) is the most prevalent parasitic infection of the central nervous system. It is caused by the presence of larvae of the cestode Taenia solium in the brain. The most common symptom of NCC is seizures, and it is widely considered the world’s leading cause of preventable epilepsy. Despite the prevalence and impact of NCC, a thorough, mechanistic understanding of seizure generation is still lacking. In this review, we address the question “What causes seizures in NCC?” by summarizing and discussing the major theories that seek to explain the seizurogenic and epileptogenic processes in this disorder. In addition, we highlight the potential for recent advances in disease modeling to help accelerate progress in this area.
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Affiliation(s)
- Teresa Julieta Simões Steyn
- Division of Cell Biology, Department of Human Biology, Neuroscience Institute and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Western Cape, South Africa
| | - Amalia Naita Awala
- Division of Cell Biology, Department of Human Biology, Neuroscience Institute and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Western Cape, South Africa
| | - Anja de Lange
- Division of Cell Biology, Department of Human Biology, Neuroscience Institute and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Western Cape, South Africa
| | - Joseph Valentino Raimondo
- Division of Cell Biology, Department of Human Biology, Neuroscience Institute and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Western Cape, South Africa
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Rubio C, Rodríguez-Quintero P, Fleury A, Suástegui-Román RA, Bowles B, González-Garibay G, Pacheco-Aispuro G, Lee Á. Neurocysticercosis research in Mexico: A bibliometric analysis of the Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.975165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Neurocysticercosis (NCC) is the most common neglected parasitic disease of the central nervous system and leads to many economic and health issues in endemic and non-endemic countries. A bibliometric analysis would shed light on the evolution and development of research in this field, and this is the first study on NCC research. Our institution in Mexico City, the Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez (INNN), has set some milestones in the management of neurocysticercosis and has a decade-long experience and such an analysis in an endemic country like Mexico will be beneficial. We tracked the scientific output in Scopus, from its foundation to March 2021. The studied variables were article type, number of citations, area (clinical/experimental), chronological profile, and preferred journals. In the period from 1964 to 2021, from a total of 3,166 articles from the institution, 232 papers are related to neurocysticercosis with a total of 7,155 citations. The trending topics in the clinical area are pharmacology and pathology in the experimental papers. The number of articles has steadily increased, but NCC is currently a neglected topic that needs further research to better address the disease burden and allow its eradication.
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Hills KE, Kostarelos K, Wykes RC. Converging Mechanisms of Epileptogenesis and Their Insight in Glioblastoma. Front Mol Neurosci 2022; 15:903115. [PMID: 35832394 PMCID: PMC9271928 DOI: 10.3389/fnmol.2022.903115] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/25/2022] [Indexed: 12/15/2022] Open
Abstract
Glioblastoma (GBM) is the most common and advanced form of primary malignant tumor occurring in the adult central nervous system, and it is frequently associated with epilepsy, a debilitating comorbidity. Seizures are observed both pre- and post-surgical resection, indicating that several pathophysiological mechanisms are shared but also prompting questions about how the process of epileptogenesis evolves throughout GBM progression. Molecular mutations commonly seen in primary GBM, i.e., in PTEN and p53, and their associated downstream effects are known to influence seizure likelihood. Similarly, various intratumoral mechanisms, such as GBM-induced blood-brain barrier breakdown and glioma-immune cell interactions within the tumor microenvironment are also cited as contributing to network hyperexcitability. Substantial alterations to peri-tumoral glutamate and chloride transporter expressions, as well as widespread dysregulation of GABAergic signaling are known to confer increased epileptogenicity and excitotoxicity. The abnormal characteristics of GBM alter neuronal network function to result in metabolically vulnerable and hyperexcitable peri-tumoral tissue, properties the tumor then exploits to favor its own growth even post-resection. It is evident that there is a complex, dynamic interplay between GBM and epilepsy that promotes the progression of both pathologies. This interaction is only more complicated by the concomitant presence of spreading depolarization (SD). The spontaneous, high-frequency nature of GBM-associated epileptiform activity and SD-associated direct current (DC) shifts require technologies capable of recording brain signals over a wide bandwidth, presenting major challenges for comprehensive electrophysiological investigations. This review will initially provide a detailed examination of the underlying mechanisms that promote network hyperexcitability in GBM. We will then discuss how an investigation of these pathologies from a network level, and utilization of novel electrophysiological tools, will yield a more-effective, clinically-relevant understanding of GBM-related epileptogenesis. Further to this, we will evaluate the clinical relevance of current preclinical research and consider how future therapeutic advancements may impact the bidirectional relationship between GBM, SDs, and seizures.
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Affiliation(s)
- Kate E. Hills
- Nanomedicine Lab, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Kostas Kostarelos
- Nanomedicine Lab, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Catalan Institute for Nanoscience and Nanotechnology (ICN2), Edifici ICN2, Campus UAB, Barcelona, Spain
| | - Robert C. Wykes
- Nanomedicine Lab, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- *Correspondence: Robert C. Wykes
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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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Andrade-Mogrovejo DA, Gonzales-Gustavson E, Ho-Palma AC, Prada JM, Bonnet G, Pizzitutti F, Gomez-Puerta LA, Arroyo G, O’Neal SE, Garcia HH, Guitian J, Gonzalez A. Development of a dose-response model for porcine cysticercosis. PLoS One 2022; 17:e0264898. [PMID: 35286329 PMCID: PMC8920259 DOI: 10.1371/journal.pone.0264898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 02/21/2022] [Indexed: 01/11/2023] Open
Abstract
Taenia solium is an important cause of acquired epilepsy worldwide and remains endemic in Asia, Africa, and Latin America. Transmission of this parasite is still poorly understood despite the design of infection experiments to improve our knowledge of the disease, with estimates for critical epidemiological parameters, such as the probability of human-to-pig infection after exposure to eggs, still lacking. In this paper, a systematic review was carried out and eight pig infection experiments were analyzed to describe the probability of developing cysts. These experiments included different pathways of inoculation: with ingestion of proglottids, eggs, and beetles that ingested eggs, and direct injection of activated oncospheres into the carotid artery. In these experiments, different infective doses were used, and the numbers of viable and degenerated cysts in the body and brain of each pig were registered. Five alternative dose-response models (exponential, logistic, log-logistic, and exact and approximate beta-Poisson) were assessed for their accuracy in describing the observed probabilities of cyst development as a function of the inoculation dose. Dose-response models were developed separately for the presence of three types of cysts (any, viable only, and cysts in the brain) and considered for each of the four inoculation methods ("Proglottids", "Eggs", "Beetles" and "Carotid"). The exact beta-Poisson model best fit the data for the three types of cysts and all relevant exposure pathways. However, observations for some exposure pathways were too scarce to reliably define a dose-response curve with any model. A wide enough range of doses and sufficient sample sizes was only found for the "Eggs" pathway and a merged "Oral" pathway combining the "Proglottids", "Eggs" and "Beetles" pathways. Estimated parameter values from this model suggest that a low infective dose is sufficient to result in a 50% probability for the development of any cyst or for viable cyst infections. Although this is a preliminary model reliant on a limited dataset, the parameters described in this manuscript should contribute to the design of future experimental infections related to T. solium transmission, as well as the parameterization of simulation models of transmission aimed at informing control.
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Affiliation(s)
- Daniel A. Andrade-Mogrovejo
- Department of Animal and Public Health, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Eloy Gonzales-Gustavson
- Department of Animal and Public Health, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Tropical and Highlands Veterinary Research Institute, Universidad Nacional Mayor de San Marcos, Lima, Peru
- * E-mail:
| | - Ana C. Ho-Palma
- Department of Human Medicine, School of Human Medicine, Universidad Nacional del Centro del Perú, Huancayo, Peru
| | - Joaquín M. Prada
- Department of Veterinary Epidemiology and Public Health, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Gabrielle Bonnet
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
| | - Francesco Pizzitutti
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
| | - Luis A. Gomez-Puerta
- Department of Animal and Public Health, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Gianfranco Arroyo
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, San Martín de Porres, Peru
| | - Seth E. O’Neal
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, San Martín de Porres, Peru
| | - Hector H. Garcia
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, San Martín de Porres, Peru
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru
| | - Javier Guitian
- Veterinary Epidemiology, Economics and Public Health Group, Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hertfordshire, United Kingdom
| | - Armando Gonzalez
- Department of Animal and Public Health, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Espino P, Couper R, Burneo J. An update on Neurocysticercosis-related epilepsy. Clin Neurol Neurosurg 2022; 213:107139. [DOI: 10.1016/j.clineuro.2022.107139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/07/2021] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
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Narain K, Devi KR, Borbora D, Upadhyay N, Goswami D, Rajguru SK. High prevalence of neurocysticercosis among patients with epilepsy in a tertiary care hospital of Assam, India. Trop Parasitol 2022; 12:15-20. [PMID: 35923269 PMCID: PMC9341139 DOI: 10.4103/tp.tp_72_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/19/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Neurocysticercosis (NCC) is a parasitic disease of the central nervous system, which is caused by the metacestode of the pork tapeworm, Taenia solium. The present unicentric, hospital-based, cross-sectional study was undertaken to assess the contribution of NCC as a cause of active epilepsy among patients attending a tertiary health care center in Assam, India. Materials and Methods: Over a period of 2 years, 152 active epilepsy patients were investigated based on clinical, epidemiological, neuroimaging (contrast-enhanced computerized tomography), and immunological techniques to establish the diagnosis of NCC. A precoded questionnaire was administered to patients and/or guardians to collect detailed medical history. Results: Ninety-three cases (61.2%) fulfilled either definitive or probable diagnostic criteria for NCC. Anti-cysticercus immunoglobulin G antibodies were detected by ELISA and enzyme electro-immune transfer blot in 69 (45.4%) active epilepsy patients. Seroprevalence was higher in males, 46.6% (54/116); than in females, 41.7% (15/36), and increased significantly with age; peaking in the 20–39 years age group (36/76; χ2 = 5.64; P = 0.02). Among the seropositive cases, 54 (78.3%) were diagnosed with NCC. A significantly higher number of seropositive individuals were diagnosed with NCC in the 20–39 years age group as compared to the 40 years and above age group (χ2 = 6.28; P = 0.01). The association between seropositivity for NCC, and the number of lesions in the brain was statistically significant (χ2 = −8.33; P = 0.003). Conclusions: This study indicates that NCC is a major cause of active epilepsy in Assam. A high prevalence of pediatric NCC is also a major concern.
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Hyperendemicity of cysticercosis in Madagascar: Novel insights from school children population-based antigen prevalence study. PLoS One 2021; 16:e0258035. [PMID: 34597322 PMCID: PMC8486106 DOI: 10.1371/journal.pone.0258035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/16/2021] [Indexed: 12/05/2022] Open
Abstract
Objective Taenia solium (Ts) cysticercosis is a neglected zoonotic disease particularly prevalent in Madagascar. Few data are available for children, current data mainly rely on antibody prevalence. We sought to determine the Ts-antigen seroprevalence–determining active cysticercosis—amongst school children from various cities in Madagascar (excluding the capital) and evaluated associated risk factors. Methods In seven cities in Madagascar, the presence of cysticercosis in school children (n = 1751) was investigated in 2007 using the B158/B60 antigen (Ag)-ELISA. Results The overall prevalence based on Ag detection was 27.7% [95%CI: 10–37%]. Risk factors associated with Ag positivity were age, biotope, altitude and annual average rainfall. Conclusion These results highlight the high prevalence of active cysticercosis in Madagascar among school children in an urban setting. This high prevalence as well as the risk factors unraveled point to the emergency to implement appropriate Public Health measure son a national scale.
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Soumahoro MK, Melki J, Assi B, Kangah YL, Camara M, Tazemda-Kuitsouc GB, Nowakowski M, Yapo-Ehounoud C, Sonan T, Bellalou J, Jambou R. Seroprevalence of Cysticercosis among Epileptic Patients Attending Neurological Units in the Urban Area of Abidjan. Microorganisms 2021; 9:1712. [PMID: 34442791 PMCID: PMC8398218 DOI: 10.3390/microorganisms9081712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/26/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022] Open
Abstract
Cysticercosis is one of the main causes of secondary epilepsy in sub-Saharan Africa. To estimate the seroprevalence of cysticercosis among epileptic patients, we conducted a cross-sectional study of patients attending neurology consultation in Abidjan, Côte d'Ivoire. Methods: Patients' socio-demographic and lifestyle data were collected as well as blood samples for serological testing using ELISA and Western blot based on IgG antibodies detection. For qualitative variables comparison, Chi2 or Fisher tests were used; a Student's t-test was used to compare quantitative variables. A multivariate logistic regression model was fit to identify risks factors. Results: Among 403 epileptic patients included in the study, 55.3% were male; the median age was 16.9 years; 77% lived in Abidjan; 26.5% were workers. Most patients included in the study had tonic-clonic seizures (80%), and 11.2% had focal deficit signs. The seroprevalence of cysticercosis was 6.0%. The risk was higher in patients over 30 years old (aOR = 5.1 (1.3-20.0)) than in patients under 16. The risk was also considerably high in patients who reported epileptics in the family (aOR = 5 (1.7-14.6)). The risk was three-fold less in females than in males. Conclusions: This study highlighted the exposure of epileptic patients to Taenia solium larvae in an urban area. The risk of positive serology was increased with age, male gender, and family history of epilepsy.
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Affiliation(s)
- Man-Koumba Soumahoro
- Department of Epidemiology—Clinical Research, Institut Pasteur de Côte d’Ivoire, Abidjan 01 BP 490, Côte d’Ivoire; (Y.L.K.); (G.B.T.-K.)
| | - Jihen Melki
- Department of Parasitology, Institut Pasteur de Côte d’Ivoire, Abidjan 01 BP 490, Côte d’Ivoire;
| | - Berthe Assi
- Neurology Department, Cocody University Hospital, Abidjan 01 BP V 13, Côte d’Ivoire; (B.A.); (C.Y.-E.)
| | - Yves Landry Kangah
- Department of Epidemiology—Clinical Research, Institut Pasteur de Côte d’Ivoire, Abidjan 01 BP 490, Côte d’Ivoire; (Y.L.K.); (G.B.T.-K.)
| | - Mamadou Camara
- Neurology Unit, Adjamé General Hospital, Abidjan 03 BP 1856, Côte d’Ivoire;
| | - Gildas Boris Tazemda-Kuitsouc
- Department of Epidemiology—Clinical Research, Institut Pasteur de Côte d’Ivoire, Abidjan 01 BP 490, Côte d’Ivoire; (Y.L.K.); (G.B.T.-K.)
| | - Mireille Nowakowski
- Recombinant Protein Platform, Institut Pasteur, 75015 Paris, France; (M.N.); (J.B.)
| | - Constance Yapo-Ehounoud
- Neurology Department, Cocody University Hospital, Abidjan 01 BP V 13, Côte d’Ivoire; (B.A.); (C.Y.-E.)
| | - Thérèse Sonan
- Neurology Department, Yopougon University Hospital, Abidjan 21 BP 632, Côte d’Ivoire;
| | - Jacques Bellalou
- Recombinant Protein Platform, Institut Pasteur, 75015 Paris, France; (M.N.); (J.B.)
| | - Ronan Jambou
- Department of Parasitology, Institut Pasteur de Côte d’Ivoire, Abidjan 01 BP 490, Côte d’Ivoire;
- Global Health Department, Institut Pasteur, 75015 Paris, France
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Devi KR, Borbora D, Upadhyay N, Goswami D, Rajguru SK, Narain K. Neurocysticercosis in patients with active epilepsy in the tea garden community of Assam, Northeast India. Sci Rep 2021; 11:7433. [PMID: 33795818 PMCID: PMC8016991 DOI: 10.1038/s41598-021-86823-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/19/2021] [Indexed: 11/09/2022] Open
Abstract
Neurocysticercosis is a significant cause of epilepsy in the tropics. The present cross-sectional survey was conducted in the socioeconomically backward tea garden community of Assam to gauge the prevalence of neurocysticercosis in patients with active epilepsy and to determine the associated risk factors. In a door to door survey, a total of 1028 individuals from every fifth household of the study Teagarden were enrolled to identify self-reported seizure cases, followed by a neurological examination to confirm the diagnosis of active epilepsy. Patients with active epilepsy underwent clinical, epidemiological, neuroimaging (contrast-enhanced computerized tomography) and immunological evaluations to establish the diagnosis of neurocysticercosis. Clinically confirmed 53 (5.16%) active epilepsy were identified; 45 agreed to further assessment for neurocysticercosis and 19 (42.2%) cases fulfilled either definitive or probable diagnostic criteria for neurocysticercosis. Patients with epilepsy due to neurocysticercosis were more likely to suffer from taeniasis (20.0% vs 0.0%), rear pigs (57.9% vs 15.4%) or have pigs in their neighbourhood (78.9% vs 53.8%) relative to epileptic patients without neurocysticercosis. Rearing pigs (aOR 14.35, 95% CI: 3.98–51.75) or having pigs in the neighbourhood (aOR 12.34, 95% CI: 2.53–60.31) were independent risk factors of neurocysticercosis. In this community, the prevalence of taeniasis (adult worm infection) was 6.6% based on microscopy. The study reports a high prevalence of active epilepsy in the tea garden community of Assam and neurocysticercosis as its primary cause. The high prevalence of taeniasis is also a significant concern.
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Affiliation(s)
- K Rekha Devi
- ICMR-Regional Medical Research Centre, N. E. Region, Dibrugarh, Assam, 786001, India
| | - Debasish Borbora
- ICMR-Regional Medical Research Centre, N. E. Region, Dibrugarh, Assam, 786001, India.,Department of Biotechnology, Gauhati University, Guwahati, Assam, 781014, India
| | - Narayan Upadhyay
- Department of Neurology, Assam Medical College and Hospital, Dibrugarh, Assam, 786002, India
| | - Dibyajyoti Goswami
- ICMR-Regional Medical Research Centre, N. E. Region, Dibrugarh, Assam, 786001, India
| | - S K Rajguru
- ICMR-Regional Medical Research Centre, N. E. Region, Dibrugarh, Assam, 786001, India
| | - Kanwar Narain
- ICMR-Regional Medical Research Centre, N. E. Region, Dibrugarh, Assam, 786001, India.
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Rubio C, Luna R, Ibarra-Velasco M, Lee Á. Epilepsy: A bibliometric analysis (1968-2020) of the Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez" in Mexico. Epilepsy Behav 2021; 115:107676. [PMID: 33360176 DOI: 10.1016/j.yebeh.2020.107676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 01/23/2023]
Abstract
The Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez" (INNN) is one of the main institutions in Latin America treating epilepsy; and bibliometric analysis has an increasing role in analyzing the literature, acting as a Google Maps of medical research. We tracked the scientific output in Scopus and the impact of the institution from its foundation to July 2020 in the field of epilepsy. We roughly separated this group by clinical and experimental approach, identifying core journals, type of article, increase with time, and number of citations. A total of 228 papers, from a total of 3,034 produced by the INNN in that period, were found. Additionally, we identified that neurocysticercosis, pharmacology, genetics, and proteins involved in epilepsy were the most investigated topics. Also, there is a sustained growth in the number of papers per year since 1985. The number of authors per paper ranges from one to 15, and neuroscience journals are the preferred target of researchers, with a predilection for "Epilepsy and Behavior".
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Affiliation(s)
- Carmen Rubio
- Instituto Nacional de Neurología y Neurocirugía, Departamento de Neurofisiología, Mexico
| | - Rudy Luna
- Instituto Nacional de Neurología y Neurocirugía, Departamento de Neurofisiología, Mexico
| | | | - Ángel Lee
- Comisión Coordinadora de Institutos Nacionales de Salud, Mexico.
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15
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Carpio A. The Association between Neurocysticercosis and Epilepsy. Am J Trop Med Hyg 2020; 103:1335-1336. [PMID: 32896235 PMCID: PMC7470567 DOI: 10.4269/ajtmh.20-0569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/17/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arturo Carpio
- School of Medicine
- University of Cuenca
- Cuenca, Ecuador
- G. H. Sergievsky Center
- Columbia University
- New York, New York
- E-mail:
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16
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Coral-Almeida M, Henriquez-Trujillo AR, Asanza S, Erazo C, Paucar M, Calvopiña M. Assessing the burden and spatial distribution of Taenia solium human neurocysticercosis in Ecuador (2013-2017). PLoS Negl Trop Dis 2020; 14:e0008384. [PMID: 32511228 PMCID: PMC7302800 DOI: 10.1371/journal.pntd.0008384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 06/18/2020] [Accepted: 05/12/2020] [Indexed: 12/30/2022] Open
Abstract
Background Estimating the burden of neglected tropical diseases is a valuable tool to support policymakers in the resource allocation for control and elimination of these diseases. Spatial analysis allows to identify the geographical distribution patterns of infectious and parasitic diseases within a country and allows to assess their possible correlation with other health disorders. Despite being neurocysticercosis (NCC) considered as the most important parasitic disease of the nervous system, few efforts have been addressed to assess the real burden of NCC in endemic countries, to date, there are no studies estimating the burden of NCC in South America. In this study we aimed to use the Disability Adjust Life Years (DALY) and spatial indicators as tools to measure the impact of human neurocysticercosis in Ecuador between 2013 and 2017. Methods Mortality, morbidity and spatial data from the national agency of statistics were used to estimate the burden of disease of NCC during a five-year period (2013–2017). NCC cases and its two main sequelae, epilepsy and migraine headache, were stratified by sex and age group to calculate the DALY associated to NCC using the DALY package in R. SATSCAN software was used to assess spatial clusters of NCC and its possible neurological sequelae as epilepsy, status epilepticus, migraine and hydrocephalus. Principal findings The burden of human neurocysticercosis ranged from 56201 [95% CI 29961–89333] to 59612 [95% CI 31854–94689] DALY per year, corresponding to 3.54 to 3.56 DALY per 1000 population. Average yearly incidence rates per 10 000 person-years were 0.23 [95% CI 0.21–0.26] for NCC, 4.89 [95% CI 4.78–5.00] for epilepsy, 0.130 [95% CI 0.11–0.15] for status epilepticus, 0.62 [95% CI 0.58–0.66] for migraine headache, and 1.02 [95% CI 0.98–1.07] for hydrocephalus. Most important significant spatial clusters (p<0.0001) were located in the southern region of the highlands of the country. Conclusion/Significance This is the first study in South America to calculate estimates for burden of NCC and one of the few using spatial analysis to show the importance of sequelae other than epilepsy that play an important role in the impact of human neurocysticercosis. Taenia solium-neurocysticercosis (NCC) is a neglected parasite infection in humans causing a variety of neurological sequelae like epilepsy, and chronic headache. The purpose of this study was to estimate the burden of NCC in Ecuador using official nation-wide databases from the National Institute of Statistics and Census (INEC) for the period of 2013–2017, and to assess for spatial clusters of four neurological disorders associated with NCC. The burden of NCC measured in Disability Adjusted Life Years (DALY) was estimated in 3.54 to 3.56 DALY per 1000 population. Several significant spatial clusters for augmented risk of disease were identified along the country for NCC and its sequelae, most of which converged in the southern Sierra provinces. Our study suggests a possible spatial correlation between the presence of NCC cases and a higher prevalence of neurological conditions like epilepsy, status epilepticus, migraine, and hydrocephalus in several ‘hot spots’ of the southern provinces of Ecuador, indicating possible areas where the application of preventive measures is necessary to reduce cysticercosis transmission rates.
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Affiliation(s)
- Marco Coral-Almeida
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
- * E-mail:
| | | | - Sofia Asanza
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| | - Celia Erazo
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| | - Michelle Paucar
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| | - Manuel Calvopiña
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
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Del Brutto OH. A Personal Account Regarding the Origin and Evolution of Controversies in the Management of Neurocysticercosis. Am J Trop Med Hyg 2020; 100:780-782. [PMID: 30761985 DOI: 10.4269/ajtmh.18-0921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A panel of experts from the Infectious Disease Society of America and The American Society of Tropical Medicine and Hygiene recently published guidelines for management of neurocysticercosis, showing that clinical manifestations as well as the stage of involution and the anatomical location of parasites must be taken into account before the start of a rational therapy. Soon thereafter, isolated opinions attempted to discredit these guidelines, arguing insufficient or inadequate evidence and suggesting that they should not be followed worldwide. In view of these conflicting reports, it is appropriate to review the origin and evolution of the controversy on the medical treatment of neurocysticercosis.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador
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18
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Tan YT, Zhang SJ, Shu K, Lei T, Niu HQ. Microsurgical Treatment of Epilepsy with Parenchymal Neurocysticercosis. Curr Med Sci 2019; 39:984-989. [PMID: 31845231 DOI: 10.1007/s11596-019-2132-1] [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: 09/17/2019] [Revised: 11/25/2019] [Indexed: 12/01/2022]
Abstract
Parenchymal neurocysticercosis is the most common form of neurocysticercosis in the central nervous system (CNS), which mainly causes epilepsy and usually responses well to routine medications. However, there are appreciable cases of relapses refractory to medical treatment. We investigated microsurgical treatment of epilepsy with parenchymal neurocysticercosis. Nine cases of epilepsy caused by parenchymal neurocysticercosis from 2002 to 2018 were analyzed retrospectively. Cysts in 7 cases were completely removed. No case died of operation and no new dysfunction of the nervous system was observed after surgery. Among the other 9 cases, 8 cases became seizure-free or controlled by medicine according to the postoperative follow-up for 6 months to 9 years. One case was lost for follow-up. It was suggested that epilepsy with parenchymal neurocysticercosis can usually be controlled after routine medications. However, surgery is still indicated in some cases and careful microsurgery is associated with satisfactory clinical outcomes in appropriately selected cases.
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Affiliation(s)
- Yu-Tang Tan
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Suo-Jun Zhang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ting Lei
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong-Quan Niu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Montgomery MA, Ramos M, Kelvin EA, Carpio A, Jaramillo A, Hauser WA, Zhang H. A longitudinal analysis of albendazole treatment effect on neurocysticercosis cyst evolution using multistate models. Trans R Soc Trop Med Hyg 2019; 113:781-788. [PMID: 31433058 PMCID: PMC6903786 DOI: 10.1093/trstmh/trz073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/23/2019] [Accepted: 07/07/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In neurocysticercosis, the larval form of the pork tapeworm Taenia solium appears to evolve through three phases-active, degenerative and sometimes calcification-before disappearance. The antihelmintic drug, albendazole, has been shown to hasten the resolution of active cysts in neurocysticercosis. Little is known about the time cysts take to progress through each phase, with or without treatment. METHODS We reconfigured brain imaging data from patient level to cyst level for 117 patients in a randomized clinical trial of albendazole in which images were taken at baseline, 1, 6, 12 and 24 mo. Applying a multistate model, we modelled the hazard of a cyst evolving to subsequent cyst phases before the next imaging (vs no change). We examined the impact of albendazole treatment overall and by patient and cyst characteristics on the hazard. RESULTS Albendazole accelerated the evolution from the active to degenerative phase (HR=2.7, 95% CI 1.3 to 6.5) and from the degenerative phase to disappearance (HR=1.9, 95% CI 1.1 to 3.9). Albendazole's impact was stronger for patients who were male, did not have calcified cysts at baseline and who had multiple cysts in different locations. CONCLUSIONS This research provides a better understanding of where in the cyst trajectory albendazole has the greatest impact.
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Affiliation(s)
- Michelle A Montgomery
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, New York 10027, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, New York 10027, USA
| | - Marcel Ramos
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, New York 10027, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, New York 10027, USA
| | - Elizabeth A Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, New York 10027, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, New York 10027, USA
| | - Arturo Carpio
- School of Medicine, University of Cuenca, Av 12 de Abril s/n Ciudadela Universitaria, 010201 Cuenca, Ecuador
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, 630 168 Street, Columbia University, New York, New York 10032, USA
| | | | - W Allen Hauser
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, 630 168 Street, Columbia University, New York, New York 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, New York 10032, USA
| | - Hongbin Zhang
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, New York 10027, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, New York 10027, USA
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20
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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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Abstract
Prevention and management of opportunistic infections in children is particularly relevant in an era demonstrating an increased prevalence of immunocompromising conditions. The presence of an unusual organism which results in serious infection in a child should therefore always raise the consideration of immune compromise. The more common opportunistic infections have become easier to recognize in recent times due to improved awareness and more refined diagnostic testing. Targeted treatment is usually followed by long-term prophylactic medication. The impact of these conditions on patient outcome is of clear significance and certainly warrants further discussion.
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Thurman DJ, Begley CE, Carpio A, Helmers S, Hesdorffer DC, Mu J, Touré K, Parko KL, Newton CR. The primary prevention of epilepsy: A report of the Prevention Task Force of the International League Against Epilepsy. Epilepsia 2018; 59:905-914. [PMID: 29637551 PMCID: PMC7004820 DOI: 10.1111/epi.14068] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 02/05/2023]
Abstract
Among the causes of epilepsy are several that are currently preventable. In this review, we summarize the public health burden of epilepsy arising from such causes and suggest priorities for primary epilepsy prevention. We conducted a systematic review of published epidemiologic studies of epilepsy of 4 preventable etiologic categories-perinatal insults, traumatic brain injury (TBI), central nervous system (CNS) infection, and stroke. Applying consistent criteria, we assessed the quality of each study and extracted data on measures of risk from those with adequate quality ratings, summarizing findings across studies as medians and interquartile ranges. Among higher-quality population-based studies, the median prevalence of active epilepsy across all ages was 11.1 per 1000 population in lower- and middle-income countries (LMIC) and 7.0 per 1000 in high-income countries (HIC). Perinatal brain insults were the largest attributable fraction of preventable etiologies in children, with median estimated fractions of 17% in LMIC and 15% in HIC. Stroke was the most common preventable etiology among older adults with epilepsy, both in LMIC and in HIC, accounting for half or more of all new onset cases. TBI was the attributed cause in nearly 5% of epilepsy cases in HIC and LMIC. CNS infections were a more common attributed cause in LMIC, accounting for about 5% of all epilepsy cases. Among some rural LMIC communities, the median proportion of epilepsy cases attributable to endemic neurocysticercosis was 34%. A large proportion of the overall public health burden of epilepsy is attributable to preventable causes. The attributable fraction for perinatal causes, infections, TBI, and stroke in sum reaches nearly 25% in both LMIC and HIC. Public health interventions addressing maternal and child health care, immunizations, public sanitation, brain injury prevention, and stroke prevention have the potential to significantly reduce the burden of epilepsy.
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Affiliation(s)
- David J. Thurman
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Charles E. Begley
- Health Science Center at Houston School of Public Health, University of Texas, Houston, TX, USA
| | - Arturo Carpio
- Faculty of Medical Sciences, University of Cuenca, Cuenca, Ecuador
| | - Sandra Helmers
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Dale C. Hesdorffer
- Gertrude H. Sergievsky Center and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Jie Mu
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Kamadore Touré
- Department of Neurology, Fann University Hospital, Dakar, Senegal
| | - Karen L. Parko
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Charles R. Newton
- Kenya Medical Research Institute–Wellcome Trust Collaborative Program, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
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23
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Duque KR, Burneo JG. Clinical presentation of neurocysticercosis-related epilepsy. Epilepsy Behav 2017; 76:151-157. [PMID: 28882721 DOI: 10.1016/j.yebeh.2017.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 11/15/2022]
Abstract
Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and a major risk factor for seizures and epilepsy. Seizure types in NCC vary largely across studies and seizure semiology is poorly understood. We discuss here the studies regarding seizure types and seizure semiology in NCC, and examine the clinical presentation in patients with NCC and drug-resistant epilepsy. We also provide evidence of the role of MRI and EEG in the diagnosis of NCC-related epilepsy. Focal seizures are reported in 60-90% of patients with NCC-related epilepsy, and around 90% of all seizures registered prospectively are focal not evolving to bilateral tonic-clonic seizures. A great number of cases suggest that seizure semiology is topographically related to NCC lesions. Patients with hippocampal sclerosis and NCC have different clinical and neurophysiological characteristics than those with hippocampal sclerosis alone. Different MRI protocols have allowed to better differentiate NCC from other etiologies. Lesions' stages might account on the chances of finding an interictal epileptiform discharge. Studies pursuing the seizure onset in patients with NCC are lacking and they are specially needed to determine both whether the reported events of individual cases are seizures, and whether they are related to the NCC lesion or lesions. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy".
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Affiliation(s)
- Kevin R Duque
- Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru; Hypnos Center for Sleep Medicine, Clínica San Felipe, Lima, Peru.
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine, Western University, London, Canada.
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Singh G, Sharma R. Controversies in the treatment of seizures associated with neurocysticercosis. Epilepsy Behav 2017; 76:163-167. [PMID: 28673685 DOI: 10.1016/j.yebeh.2017.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/16/2017] [Indexed: 01/08/2023]
Abstract
Seizures are the commonest manifestation of brain parenchymal cysticercosis. In terms of pathophysiological basis and prognostic significance of the seizures, a distinction might be applied between viable cysts, solitary cysticercus granuloma and calcific cysticerci. A number of uncertainties shroud the management of seizures in people with neurocysticercosis (NCC). Although antihelminthic treatment is effective in eliminating viable cysts and possibly cysticercus granulomas, its effect on seizure outcome remains uncertain. Corticosteroids and combinations of antihelminthic and corticosteroid treatments reduce the incidence of seizures in the short term at least. Although antiepileptic drugs (AEDs) are routinely employed in the treatment of seizures associated with NCC, there is no clear consensus regarding the choice and optimal duration of AED treatment. Long-term AED treatment is warranted in people with calcific residue following involution of brain parenchymal cysticercosis. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy".
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, India.
| | - Ravina Sharma
- Department of Neurology, Dayanand Medical College, Ludhiana, India
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Verma A, Kumar A. Clinical and etiological profile of epilepsy in elderly: a hospital-based study from rural India. Acta Neurol Belg 2017; 117:139-144. [PMID: 27878560 DOI: 10.1007/s13760-016-0719-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 10/29/2016] [Indexed: 11/25/2022]
Abstract
To determine the clinical profile and etiology of epilepsy in elderly patients in rural population of India which is in a phase of demographic transition with steadily growing geriatric population. A cross-sectional, prospective, hospital-based clinicoepidemiological study was performed from October 2014 to November 2015. Patients having onset of epilepsy after 60 years were incorporated in the study. We excluded the acute symptomatic seizures. One hundred and ten patients were enrolled and were divided into three standard subgroups: subgroup A (aged 60-70), subgroup B (aged 71-80), and subgroup C (aged 81-90). Out of 110 patients, 72 (65.45%) were male and 38 (34.54%) were female. The most common etiology was cerebrovascular disease (46.36%), followed by focal cerebral calcifications single or multiple (11.81%), tumors (9.09%), trauma (6.36%) dementias (6.36%) and unknown (16.63%). In our study, the frequency of epilepsy decreases with advancing age which was 77.27% in group A (less than 70 years), 16.36% in group B and 6.36% in group C (70-90 years).The most common type of seizure in the group studied was focal 59.09% followed by generalized seizures 37.27%. Hypertension was the most common co-morbidity found in 40 (36.36%) patients. The present study proposes that epilepsy in the elderly patients have etiological relationship with stroke, focal cerebral calcifications, tumors and dementias. CNS infections account for a significant number of cases of remote symptomatic epilepsy in elderly in our region where neurocysticercosis is endemic.
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Affiliation(s)
- Archana Verma
- Department of Neurology, UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, 206301, India.
| | - Alok Kumar
- Forensic Medicine and Toxicology, UP RIMS & R, Saifai, Etawah, Uttar Pradesh, 206130, India
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Varghese V, Chandra SR, Christopher R, Rajeswaran J, Prasad C, Subasree R, Issac TG. Cognitive Dysfunction and its Determinants in Patients with Neurocysticercosis. Indian J Psychol Med 2016; 38:142-6. [PMID: 27114627 PMCID: PMC4820554 DOI: 10.4103/0253-7176.178809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Neurocysticercosis (NCC) is the most common parasitic infection of man. In addition to a headache, seizures, and focal deficits, this is associated with significant cognitive dysfunction. Many studies revealed that the number and location of lesions are not always responsible for cognitive dysfunction. Cholinesterase and pseudocholinesterase are found in the walls of the cysticercus which could contribute to cholinergic depletion and thus cognitive dysfunction. PATIENTS AND METHODS A total of 43 patients who presented with NCC were evaluated for cognitive deficits, as well as cholinesterase levels in cerebrospinal fluid (CSF) with control CSF from patients undergoing spinal anesthesia. Blood levels of interleukin-10 and tumor necrosis factor alpha were also estimated and correlated with cognitive deficits. RESULTS There is a mild increase in the acetylcholinesterase in CSF of patients compared to controls, but it did not correlate with cognitive deficits. There is an increase in interleukins to a significant level which correlates with vesicular stage of the organism and cognitive impairment. The number of lesions also correlated with cognitive impairment even though the location did not. The domains of cognitive deficits seen are sustained attention, category fluency, verbal working memory, planning, set shifting, verbal learning, visual memory, and construction. DISCUSSION AND CONCLUSION NCC is associated with multi-domain cognitive impairment correlates with vescicular stage, proinflammatory cytokines and number of lesions but not location, vesicular stage, and proinflammatory cytokines.
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Affiliation(s)
- Vinod Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Chandrajit Prasad
- Department of NIIR, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - R Subasree
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Thomas Gregor Issac
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Tokushige SI, Nagashima Y, Maekawa R, Shiio Y. Sequential magnetic resonance imaging changes in neurocysticercosis. ANZ J Surg 2016; 88:512-514. [PMID: 26924337 DOI: 10.1111/ans.13453] [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)
| | - Yu Nagashima
- Department of Neurology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Risa Maekawa
- Department of Neurology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Yasushi Shiio
- Department of Neurology, Tokyo Teishin Hospital, Tokyo, Japan
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Machado DC, Camilo GB, Alves UD, de Oliveira CE, de Oliveira RV, Lopes AJ. Imaging aspects of the racemose neurocysticercosis. Arch Med Sci 2015; 11:1356-60. [PMID: 26788103 PMCID: PMC4697069 DOI: 10.5114/aoms.2015.56366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/14/2014] [Indexed: 01/11/2023] Open
Affiliation(s)
- Dequitier Carvalho Machado
- Postgraduate Program in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Radiology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gustavo Bittencourt Camilo
- Postgraduate Program in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Radiology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ursula David Alves
- Department of Radiology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Agnaldo José Lopes
- Postgraduate Program in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Pamplona J, Braz A, Conceição C, Rios C, Reis J. A rare case of racemose neurocysticercosis and its complications. Case report. Neuroradiol J 2015; 28:418-20. [PMID: 26416817 DOI: 10.1177/1971400915595305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Neurocysticercosis is a central nervous system infection caused by the pork tapeworm Taenia solium. The disease is endemic in Central and South America, Asia and Africa. Racemose neurocysticercosis refers to cysts in the subarachnoid space and is characterized by proliferative lobulated cysts without a scolex. We report a case of a 43-year-old woman with an eight-month history of headaches, ataxia and loss of vision. CT and MRI showed an intraventricular cyst, causing entrapment of Monro foramina and hydrocephalus, smaller cysts at subarachnoid space in temporal lobes, Sylvian fissures, supra-selar and perimesencephalic cisterns, and an intra-orbital cyst. Additionally, there were acute ischemic vascular lesions on the left thalamus and corpus callosum splenium and subacute ischemic lesions of both occipital lobes. The diagnosis of racemose cysticercosis was made after biopsy and drainage of the intraventricular cyst. It is important to recognize neurocysticercosis as a differential diagnosis in intra-cranial cysts, not only intraparenchymal cysts.
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Affiliation(s)
- Jaime Pamplona
- Neuroradiology Department - Centro Hospitalar Lisboa Central, Portugal
| | - Ana Braz
- Neuroradiology Department - Centro Hospitalar Lisboa Central, Portugal
| | - Carla Conceição
- Neuroradiology Department - Centro Hospitalar Lisboa Central, Portugal
| | - Cristina Rios
- Neuroradiology Department - Centro Hospitalar Lisboa Central, Portugal
| | - João Reis
- Neuroradiology Department - Centro Hospitalar Lisboa Central, Portugal
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Carpio A, Romo ML. Multifactorial basis of epilepsy in patients with neurocysticercosis. Epilepsia 2015; 56:973-4. [PMID: 26040532 DOI: 10.1111/epi.12978] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Arturo Carpio
- School of Medicine, University of Cuenca, Cuenca, Ecuador. .,GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A..
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de Oliveira Taveira M, Morita ME, Yasuda CL, Coan AC, Secolin R, Luiz Cunha da Costa A, Cendes F. Neurocysticercotic Calcifications and Hippocampal Sclerosis: A Case-Control Study. PLoS One 2015; 10:e0131180. [PMID: 26132287 PMCID: PMC4488485 DOI: 10.1371/journal.pone.0131180] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 05/31/2015] [Indexed: 11/18/2022] Open
Abstract
Objective The exact role of calcified neurocysticercotic lesions (CNLs) in epilepsy is yet unknown and controversial. Although the relationship between CNLs, epilepsy and mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) has already been addressed, to our knowledge, no study has actually provided strong statistical evidence, nor reported the ODDS ratio for these associations. Therefore, we designed this case-control study to assess the likelihood of having MTLE-HS versus other forms of epilepsy in the presence of CNLs. Methods In this case-control study we included 119 consecutive patients with epilepsy and 106 disease controls (headache) with previous CT scans. We subdivided cases into MTLE-HS and other epilepsies. We used brain CT scans to define presence or absence of CNLs. After exploratory analyses, we used logistic regression to analyze the association between CNLs, epilepsy subgroups and disease controls. Results CNLs were found in 31.09% of cases and in 11.32% of controls (p<0.001). The initial analysis comparing epilepsy versus controls revealed a significant association between CNLs and epilepsy (OR = 5.32; 95%CI = 2.43-11.54; p<0.001). However, when we compared MTLE-HS versus other epilepsies versus controls we confirmed that CNLs were associated with MTLE-HS (OR = 11.27, 95%CI = 4.73-26.85; p<0.001) but other epilepsies were not. We found no difference in the CNLs load and no difference in the location of the CNLs when we compared patients with MTLE-HS, other epilepsies and disease controls. Significance The inclusion of controls allowed us to estimate the likelihood of having epilepsy in the presence of CNLs. We found that patients with CNLs were 11 times more likely to have MTLE-HS; however, the presence of CNLs did not change the odds of having other types of epilepsy. These findings raise the possibility of neurocysticercosis playing a role in the pathophysiology of MTLE-HS and need further confirmation in other series.
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Affiliation(s)
| | | | - Clarissa Lin Yasuda
- Department of Neurology, University of Campinas—UNICAMP, Campinas, SP, Brazil
| | - Ana Carolina Coan
- Department of Neurology, University of Campinas—UNICAMP, Campinas, SP, Brazil
| | - Rodrigo Secolin
- Department of Medical Genetics, University of Campinas—UNICAMP, Campinas, SP, Brazil
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas—UNICAMP, Campinas, SP, Brazil
- * E-mail:
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Epidemiological Survey on Porcine Cysticercosis in Nay Pyi Taw Area, Myanmar. J Vet Med 2015; 2015:340828. [PMID: 26464951 PMCID: PMC4590850 DOI: 10.1155/2015/340828] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/06/2015] [Accepted: 02/16/2015] [Indexed: 12/02/2022] Open
Abstract
Cross-sectional surveys were conducted to determine the prevalence and associated risk factors of Taenia solium cysticercosis in pigs within Nay Pyi Taw area, Myanmar. Meat inspection in three slaughterhouses, ELISA test, and questionnaire surveys were conducted in this study. Three hundred pigs were inspected in slaughterhouses and 364 pigs were randomly selected and examined from 203 households from three townships in Nay Pyi Taw area. The prevalence of porcine cysticercosis in meat inspection was 23.67% (71/300). Seroprevalence of T. solium cysticercosis in pigs in the study area was 15.93% (58/364). Significant associated risk factors with T. solium cysticercosis were gender (OR = 3.0; 95% CI = 1.7–5.4), increased age (OR = 2.3; 95% CI = 1.2–4.2), husbandry system (OR = 5.1; 95% CI = 2.4–11.2), feed type (OR = 16.9; 95% CI = 2.3–124.3), not using anthelmintics in pigs (OR = 11.9; 95% CI = 5.0–28.5), not using anthelmintics in owner (OR = 2.5; 95% CI = 1.4–4.4), no hand-washing before feeding (OR = 31.5; 95% CI = 4.3–230.9), and pork consumption of owner (OR = 37.4; 95% CI = 9.0–156.1) in the study area. This is the first report of porcine cysticercosis in Myanmar.
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Prasad R, Shambhavi, Mishra OP, Upadhyay SK, Singh TB, Singh UK. Cognitive and behaviour dysfunction of children with neurocysticercosis: a cross-sectional study. J Trop Pediatr 2014; 60:358-62. [PMID: 24929075 DOI: 10.1093/tropej/fmu029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Eighty-three confirmed cases of neurocysticercosis diagnosed as per modified delBrutto criteria were enrolled in the study (Group-I) to observe cognitive and behavioural changes. Controls consisted of two groups: children with idiopathic generalized tonic-clonic seizure (Group-II) and normal children with non-specific cough (Group-III). Cases and controls were subjected to cognitive and behaviour assessment. There was significant difference in the intelligence quotient (IQ) of cases in domains of visual perception, immediate recall, analysis synthesis and reasoning, verbal ability, memory and spatial ability. In the age group of 6-18 years, cases had significantly more behaviour problems than control without seizure, in domains of anxious depressed, withdrawn depressed, somatic problems, social problems and rule-breaking behaviour. Neurocysticercosis causes decline in cognitive function and behaviours in older children, which should be recognized early for appropriate management and to avoid undue parental anxiety.
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Affiliation(s)
- Rajniti Prasad
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, India
| | - Shambhavi
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, India
| | - Om P Mishra
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, India
| | - Shashi K Upadhyay
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, India
| | - Tej B Singh
- Department of Biostatistics, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, India
| | - Utpal Kant Singh
- Department of Pediatrics, Nalanda Medical College, Patna 800013, Bihar, India
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Gulati S, Jain P, Sachan D, Chakrabarty B, Kumar A, Pandey R, Gupta AK. Seizure and radiological outcomes in children with solitary cysticercous granulomas with and without albendazole therapy: A retrospective case record analysis. Epilepsy Res 2014; 108:1212-20. [DOI: 10.1016/j.eplepsyres.2014.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 03/14/2014] [Accepted: 04/27/2014] [Indexed: 11/16/2022]
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Coral-Almeida M, Rodríguez-Hidalgo R, Celi-Erazo M, García HH, Rodríguez S, Devleesschauwer B, Benítez-Ortiz W, Dorny P, Praet N. Incidence of human Taenia solium larval Infections in an Ecuadorian endemic area: implications for disease burden assessment and control. PLoS Negl Trop Dis 2014; 8:e2887. [PMID: 24852050 PMCID: PMC4031064 DOI: 10.1371/journal.pntd.0002887] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 04/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human cysticercosis is a zoonotic disease causing severe health disorders and even death. While prevalence data become available worldwide, incidence rate and cumulative incidence figures are lacking, which limits the understanding of the Taenia solium epidemiology. METHODOLOGY/PRINCIPAL FINDINGS A seroepidemiological cohort study was conducted in a south-Ecuadorian community to estimate the incidence rate of infection with and the incidence rate of exposure to T. solium based on antigen and antibody detections, respectively. The incidence rate of infection was 333.6 per 100,000 person-years (95% CI: [8.4-1,858] per 100,000 person-years) contrasting with a higher incidence rate of exposure 13,370 per 100,000 person-years (95% CI: [8,730-19,591] per 100,000 person-years). The proportion of infected individuals remained low and stable during the whole study year while more than 25% of the population showed at least one antibody seroconversion/seroreversion during the same time period. CONCLUSIONS/SIGNIFICANCE Understanding the transmission of T. solium is essential to develop ad hoc cost-effective prevention and control programs. The estimates generated here may now be incorporated in epidemiological models to simulate the temporal transmission of the parasite and the effects of control interventions on its life cycle. These estimates are also of high importance to assess the disease burden since incidence data are needed to make regional and global projections of morbidity and mortality related to cysticercosis.
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Affiliation(s)
- Marco Coral-Almeida
- Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium
- Universidad Central del Ecuador, Centro Internacional de Zoonosis (CIZ), Ciudadela Universitaria, Quito, Ecuador
- Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium
- * E-mail:
| | - Richar Rodríguez-Hidalgo
- Universidad Central del Ecuador, Facultad de Medicina Veterinaria y Zootecnia, Ciudadela Universitaria, Quito, Ecuador
- Universidad Central del Ecuador, Núcleo de Investigadores, Ciudadela Universitaria, Quito, Ecuador
| | - Maritza Celi-Erazo
- Universidad Central del Ecuador, Centro Internacional de Zoonosis (CIZ), Ciudadela Universitaria, Quito, Ecuador
| | - Héctor Hugo García
- Universidad Peruana Cayetano Heredia, Lima, Perú
- Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | | | - Brecht Devleesschauwer
- Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium
- Université catholique de Louvain, Institute of Health and Society, Brussels, Belgium
| | - Washington Benítez-Ortiz
- Universidad Central del Ecuador, Centro Internacional de Zoonosis (CIZ), Ciudadela Universitaria, Quito, Ecuador
- Universidad Central del Ecuador, Facultad de Medicina Veterinaria y Zootecnia, Ciudadela Universitaria, Quito, Ecuador
| | - Pierre Dorny
- Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium
- Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Nicolas Praet
- Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium
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Carpio A, Romo ML. The relationship between neurocysticercosis and epilepsy: an endless debate. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:383-90. [DOI: 10.1590/0004-282x20140024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/17/2014] [Indexed: 11/22/2022]
Abstract
Neurocysticercosis (NC), or cerebral infection with Taenia solium, is an important public health problem worldwide. Among the neurological sequelae of NC, seizures have been described as the most common symptom. Acute symptomatic seizures often result from degeneration of a viable cyst; however, not all of these patients with acute or provoked seizures will develop epilepsy (i.e., recurrent unprovoked seizures). Because of the high prevalence of epilepsy and NC, a causal, as well as incidental relationship between the two may exist. The epileptogenicity of calcified cysts as well as the potential association between NC and hippocampal sclerosis necessitates future research. Antihelminthic treatment of NC results in disappearance of viable cysts in about one-third of patients with parenchymal disease, but a reduction in seizure recurrence has not been demonstrated in randomized controlled trials. Prevention is critical to reduce the burden of seizure and epilepsy related to NC.
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Affiliation(s)
- Arturo Carpio
- University of Cuenca, Ecuador; Columbia University, USA
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Cherian A, Syam UK, Sreevidya D, Jayaraman T, Oommen A, Rajshekhar V, Radhakrishnan K, Thomas SV. Low seroprevalence of systemic cysticercosis among patients with epilepsy in Kerala--South India. J Infect Public Health 2014; 7:271-6. [PMID: 24684839 DOI: 10.1016/j.jiph.2013.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/07/2013] [Accepted: 08/12/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Neurocysticercosis (NCC) is considered to be rare in Kerala state, India, although it is an important cause of epilepsy in many other parts of India. Our objective was to test this notion by determining the seroprevalence of cysticercosis (CC) in an unselected sample of persons with epilepsy and comparing it to that of persons without epilepsy living in Kerala. METHODS Individuals with active epilepsy (AE) who had never resided outside Kerala state for more than one month and were attending our center for epilepsy care constituted the cases. Sex-matched persons without epilepsy who had never resided outside Kerala state for more than one month constituted the controls. The demographic details, occupation, and food habits (for the cases and controls), as well as clinical characteristics and imaging (for cases only) were recorded. Sera separated from blood drawn by venipuncture from the cases and controls were assayed for cysticercal antibodies by enzyme-linked immunoelectrotransfer blot (EITB). RESULTS Of the 80 persons with AE, 12 were seropositive for cysticercus antibodies (15%; 95% CI: 8.8-24.4); among the 68 controls, 7 were seropositive (10.3%; 95% CI: 5.1-19.8). The odds ratio (OR) for seropositivity in the epilepsy group (1.54) was not statistically significant (95% CI: 0.6-4.2). Among the 69 patients who had a brain computed tomography (CT) scan or magnetic resonance imaging (MRI), none had features diagnostic of NCC. Gender, diet (vegetarian vs non-vegetarian, consumption of raw vegetables), drinking water status (clean vs unclean), residence (rural vs urban), exposure to manure, and animal rearing including pigs did not have any association with seropositivity. CONCLUSION Among the residents of Kerala, most epilepsy is not related to cysticercosis.
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Affiliation(s)
- Ajith Cherian
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - U K Syam
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - D Sreevidya
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - T Jayaraman
- Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, India
| | - Anna Oommen
- Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, India
| | | | - Sanjeev V Thomas
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
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Abstract
Therapy for neurocysticercosis has advanced during the last 20 years with the advent of albendazole (Zentel) and praziquantel (Cysticide). Albendazole is the current medication of choice for the treatment of neurocysticercosis and is recommended for symptomatic patients with multiple viable cysts in the brain parenchyma. Albendazole may also be useful in extraparenchymal cysticercosis, especially in the subarachnoid racemose form, when complete surgical resection of the cysts is usually impracticable. Currently, there is an intense debate over the value and safety of anticysticercal therapy. Causes for failure of anticysticercal therapy include high inter-individual variability in plasma concentration of albendazole sulfoxide and the complex interactions of several drugs with the albendazole metabolite. Furthermore, albendazole sulfoxide is an enantiomeric mixture of (+)- and (-)-albendazole sulfoxide with accumulation of the (+)-enantiomer in the cerebrospinal fluid. However, the question over which enantiomer is effective against cysticerci remains to be clarified.
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Affiliation(s)
- Osvaldo Massaiti Takayanagui
- Department of Neurology, Faculty of Medicine at Ribeirão Preto, University of São Paulo, 14048 900 Ribeirão Preto, Sao Paulo, Brazil.
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Singh AK, Prasad KN, Prasad A, Tripathi M, Gupta RK, Husain N. Immune responses to viable and degenerative metacestodes of Taenia solium in naturally infected swine. Int J Parasitol 2013; 43:1101-7. [DOI: 10.1016/j.ijpara.2013.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 11/28/2022]
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Abstract
Cysticercosis is one of the most common parasitic diseases of the nervous system in humans, and constitutes a major public health problem for most of the developing world. The clinical manifestations of neurocysticercosis (NCC) largely depend on the the host immune response against the parasite. NCC diagnosis is based upon neuroimaging studies (computerized tomography, magnetic resonance imaging) and antibody/antigen detection in the serum and the cerebrospinal fluid. Anticysticercal therapy has been marked by an intense controversy. Randomized controlled trials evaluating the clinical benefit of treatment have yield conflicting data with some studies indicating a benefit and others failing to show a difference. Prevention strategies must rely on multiple approaches, tailoring each to the special features of the particular endemic area.
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Rathore C, Thomas B, Kesavadas C, Abraham M, Radhakrishnan K. Calcified neurocysticercosis lesions and antiepileptic drug-resistant epilepsy: a surgically remediable syndrome? Epilepsia 2013; 54:1815-22. [PMID: 24032594 DOI: 10.1111/epi.12349] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE In contrast to the well-recognized association between acute symptomatic seizures and neurocysticercosis, the association between antiepileptic drug (AED)-resistant epilepsy and calcified neurocysticercosis lesions (CNLs) is poorly understood. We studied the association between AED-resistant epilepsy and CNLs, including the feasibility and outcome of resective surgery. METHODS From the prospective database maintained at our epilepsy center, we reviewed the data of all patients with AED-resistant epilepsy who underwent presurgical evaluation from January 2001 to July 2010 and had CNL on imaging. We used clinical, neuroimaging, and interictal, ictal, and intracranial electroencephalography (EEG) findings to determine the association between CNL and epilepsy. Suitable candidates underwent resective surgery. KEY FINDINGS Forty-five patients fulfilled the inclusion criteria. In 17 patients, CNL was proven to be the causative lesion for AED-resistant epilepsy (group 1); in 18 patients, CNL was associated with unilateral hippocampal sclerosis (HS; group 2); and in 10 patients, CNLs were considered as incidental lesions (group 3). In group 1 patients, CNLs were more common in frontal lobes (12/17), whereas in group 2 patients, CNLs were more commonly located in temporal lobes (11/18; p = 0.002). Group 2 patients were of a younger age at epilepsy onset than those in group 1 (8.9 ± 7.3 vs. 12.6 ± 6.8 years, p = 0.003). Perilesional gliosis was more common among patients in group 1 when compared to group 3 patients (12/17 vs. 1/10; p = 0.006). Fifteen patients underwent resective surgery. Among group 1 patients, four of five became seizure-free following lesionectomy alone. In group 2, four patients underwent anterior temporal lobectomy (ATL) alone, of whom one became seizure-free; five underwent ATL combined with removal of CNL (two of them after intracranial EEG and all of them became seizure-free, whereas one patient underwent lesionectomy alone and did not become seizure-free. SIGNIFICANCE In endemic regions, although rare, CNLs are potential cause for AED-resistant and surgically remediable epilepsy, as well as dual pathology. Presence of perilesional gliosis contributes to epileptogenicity of these lesions. For those patients with CNL and HS, resection of both lesions favors better chance of seizure-free outcome.
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Affiliation(s)
- Chaturbhuj Rathore
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Lopez JA, Garcia E, Cortes IM, Sotelo J, Tato P, Molinari JL. Neurocysticercosis: relationship between the developmental stage of metacestode present and the titre of specific IgG in the cerebrospinal fluid. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 98:569-79. [PMID: 15324464 DOI: 10.1179/000349804225021424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In double-blind, immunological assays, samples of cerebrospinal fluid (CSF) from 141 patients with neurocysticercosis (NCC) or other neurological disorders were tested for IgG reacting with the excretory/secretory (E/S) antigens of Taenia solium metacestodes. The results for the cases of NCC were then correlated with the developmental stage of the metacestodes present in each case, as assessed by computerized tomography and magnetic-resonance imaging. In the ELISA first used, the samples of CSF from most (88%) of the patients with the vesicular stage of NCC (some of whom also had the degenerate and/or calcified metacestodes) were found to contain the specific IgG. In electro-immunotransfer blot (EITB) assays, three of the E/S antigens, of 95, 49 and 29 kDA, were recognized by 86%-100% of the ELISA-positive CSF. When these three antigens were isolated and tested, as a pool, against all the CSF samples in double-blind ELISA, almost all (96.6%) of the CSF samples from patients with metacestodes at the vesicular stage were recognized. In the detection of individuals with vesicular metacestodes, the assay based on the three isolated antigens was significantly more sensitive than that based on the crude extract of E/S antigens (P < 0.05). In EITB assays based on the three antigens, the isolated proteins were again recognized by IgG in the CSF samples from those with vesicular metacestodes, but without the background 'noise' seen with the crude extract. In every assay employed, none of the CSF samples from NCC cases who only harboured degenerative and/or calcified metacestodes and none of those from patients who had other neurological disorders gave a positive result. The use in ELISA and EITB of antigens purified from crude extracts of metacestode E/S proteins could improve the immunodiagnosis of the vesicular stage of NCC, and allow better evaluation of NCC cases both pre- and post-treatment.
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Affiliation(s)
- J A Lopez
- Departamento de Genética Molecular, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Apartado Postal 72-242, 04510 México, D. F., Mexico
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Bucardo F, Meza-Lucas A, Espinoza F, García-Jerónimo RC, García-Rodea R, Correa D. The seroprevalence ofTaenia soliumcysticercosis among epileptic patients in León, Nicaragua, as evaluated by ELISA and western blotting. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 99:41-5. [PMID: 15701254 DOI: 10.1179/136485905x19856] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The Taenia solium taeniasis/cysticercosis complex is an important public-health problem in several countries, where many epileptic seizures appear to be associated with neurocysticercosis. As few data on this problem in Nicaragua exist, the seroprevalence of antibodies reacting with antigens from T. solium cysticerci was investigated among 88 Nicaraguan epileptics (45 males and 43 females, aged 6-53 years). In questionnaire-based interviews, each adult subject and a caregiver of each child investigated were asked about potential risk factors for taeniasis/cysticercosis. When a serum sample from each subject was then checked for anti-cysticercus antibodies, 8.0% of the subjects were found seropositive by ELISA and 14.8% by western blotting. Five samples (all from individuals who had been epileptic for > 5 years) were positive in both tests. When the level of association between each potential risk factor and seropositivity (in ELISA or by blotting) was evaluated, the only statistically significant association detected was that between a positive ELISA and the subject living in a household where pigs were raised (odds ratio = 5.18; 95% confidence interval = 0.8-41.6; P = 0.05). The bands most frequently recognized in the western blots (of 50, 42-39, 24 and 14 kDa) were those previously reported. The results indicate that, in the city of Léon, cysticercosis may be endemic and the cause of a significant proportion of the epilepsy recorded.
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Affiliation(s)
- F Bucardo
- Departamento de Microbiología y Parasitología, Universidad Nacional Autónoma de Nicaragua, León, Nicaragua
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Singh G, Burneo JG, Sander JW. From seizures to epilepsy and its substrates: neurocysticercosis. Epilepsia 2013; 54:783-92. [PMID: 23621876 DOI: 10.1111/epi.12159] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2013] [Indexed: 11/29/2022]
Abstract
Neurocysticercosis (NCC) is the main risk factor for late-onset seizures in many Taenia solium endemic countries and is also increasingly recognized in high income countries, where it was once thought to have been eliminated. The course and outcome of NCC-associated seizures and epilepsy are poorly understood. Substrates underlying NCC-associated seizures and epilepsy are unknown. Another unknown is if there is an association between NCC and hippocampal sclerosis (HS) and if it leads to intractable epilepsy. We review evidence regarding the structural basis of seizures and epilepsy in NCC and its association with HS. There are only a limited number of prospective studies of NCC-associated seizures and epilepsy. From these, it can be inferred that the risk of seizure recurrence is high following a first seizure, even though seizures are well-controlled with antiepileptic drugs. The single most important risk factor for ongoing or recurrent seizures is the persistence of either degenerating or residual calcified cysticercus cysts in the brain parenchyma on follow-up imaging studies. Medically intractable epilepsy requiring surgical treatment appears to be rare in people with NCC. In few cases that have been operated, gliosis around the cysticerci is the principal pathologic finding. Reports of the association between NCC and HS might be categorized into those in which the calcified cysticercus is located within the hippocampus and those in which the calcified cysticercus is located remote from the hippocampus. The former are convincing cases of medically intractable epilepsy with good seizure control following hippocampal resection. In the remaining, it is unclear whether a dual pathology relationship exists between HS and the calcified cysticercus. Carefully planned, follow-up studies incorporating high-resolution and quantitative imaging are desirable in order to clarify the outcome, the structural basis of NCC-associated epilepsy, and also its association with HS.
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, Punjab, India.
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Hunt RF, Boychuk JA, Smith BN. Neural circuit mechanisms of post-traumatic epilepsy. Front Cell Neurosci 2013; 7:89. [PMID: 23785313 PMCID: PMC3684786 DOI: 10.3389/fncel.2013.00089] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 05/22/2013] [Indexed: 01/13/2023] Open
Abstract
Traumatic brain injury (TBI) greatly increases the risk for a number of mental health problems and is one of the most common causes of medically intractable epilepsy in humans. Several models of TBI have been developed to investigate the relationship between trauma, seizures, and epilepsy-related changes in neural circuit function. These studies have shown that the brain initiates immediate neuronal and glial responses following an injury, usually leading to significant cell loss in areas of the injured brain. Over time, long-term changes in the organization of neural circuits, particularly in neocortex and hippocampus, lead to an imbalance between excitatory and inhibitory neurotransmission and increased risk for spontaneous seizures. These include alterations to inhibitory interneurons and formation of new, excessive recurrent excitatory synaptic connectivity. Here, we review in vivo models of TBI as well as key cellular mechanisms of synaptic reorganization associated with post-traumatic epilepsy (PTE). The potential role of inflammation and increased blood-brain barrier permeability in the pathophysiology of PTE is also discussed. A better understanding of mechanisms that promote the generation of epileptic activity versus those that promote compensatory brain repair and functional recovery should aid development of successful new therapies for PTE.
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Affiliation(s)
- Robert F Hunt
- Epilepsy Research Laboratory, Department of Neurological Surgery, University of California San Francisco, CA, USA
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Bianchin MM, Velasco TR, Santos ACD, Sakamoto AC. On the relationship between neurocysticercosis and mesial temporal lobe epilepsy associated with hippocampal sclerosis: coincidence or a pathogenic relationship? Pathog Glob Health 2013; 106:280-5. [PMID: 23265552 DOI: 10.1179/2047773212y.0000000027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Neurocysticercosis (NCC) and mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS) are two common worldwide forms of focal epilepsy. In regions where NCC is endemic, both diseases can be observed in the same patient. There is recent and growing evidence suggesting that NCC might contribute to or even cause MTLE-HS. In this article, we review the literature regarding NCC and temporal lobe epilepsy, specifically addressing the relationship between NCC and MTLE-HS. In addition, we review some scenarios where NCC seems to emerge as a causative agent or contributor to the development of MTLE-HS in some patients. This association is important because it may have an impact on the evaluation and treatment of a sizable proportion of patients with epilepsy. Insights from these clinical observations might also contribute to the understanding of the neurobiology of both NCC and MTLE-HS. We hope that our review might shed some light on this interesting interplay between two of the most common worldwide conditions associated with human focal epilepsy.
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Affiliation(s)
- Marino Muxfeldt Bianchin
- Basic Research and Advanced Investigations in Neurology, Division of Neurology, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Abstract
Radiology provides valuable gross pathologic information about central nervous system (CNS) infections. Major categories of infectious lesions of the brain and spinal cord are recognized by imaging such as diffuse, focal, or multifocal. This article discusses the pathologic basis of these radiographic findings. It illustrates examples with gross and microscopic photographs of CNS infections, and the tissue reactions to these infections. Where the organism can spread within the CNS, and cellular responses to the organism underlie both the radiographic and pathologic findings.
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Affiliation(s)
- Paul E McKeever
- Department of Pathology, University of Michigan Medical Center, Ann Arbor, MI 48109-5602, USA.
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Kelvin EA, Yung J, Fong MW, Carpio A, Bagiella E, Leslie D, Leon P, Andrews H, Allen Hauser W. The association of living conditions and lifestyle factors with burden of cysts among neurocysticercosis patients in Ecuador. Trans R Soc Trop Med Hyg 2012; 106:763-9. [PMID: 23102867 DOI: 10.1016/j.trstmh.2012.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 09/04/2012] [Accepted: 09/04/2012] [Indexed: 11/25/2022] Open
Abstract
We used baseline data on 154 symptomatic neurocysticercosis (NCC) patients in Ecuador to identify predictors of the burden of cysts. We ran logistic regression models with the burden of cysts as the outcome, defined as the number of cysts in the brain (1 vs >1), and having cysts in all 3 phases of evolution (active, transitional and calcifications) vs <3. These two outcomes are thought to be indicators of exposure dose and/or repeated exposure over time. The predictors examined were: living in a rural area, living on a dirt road, living in an adobe or wood house (vs brick/cement), no running water in the house, no bathroom in the house, having a domestic employee cook in the home, eating most meals at restaurants or street vendors, working in a manual labour job. We found that the odds of having multiple NCC cysts was higher among those working in manual labour (OR=3.5, p=0.004), and those who ate most meals outside the home had higher odds of having cysts in all 3 phases (OR=5.0, p=0.007). Burden of cysts may be a useful outcome when looking to identify exposure risk factors in the absence of an uninfected control group.
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Affiliation(s)
- Elizabeth A Kelvin
- CUNY School of Public Health at Hunter College, City University of New York, New York, NY 10035, USA.
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England MJ, Liverman CT, Schultz AM, Strawbridge LM. Epilepsy across the spectrum: promoting health and understanding. A summary of the Institute of Medicine report. Epilepsy Behav 2012; 25:266-76. [PMID: 23041175 PMCID: PMC3548323 DOI: 10.1016/j.yebeh.2012.06.016] [Citation(s) in RCA: 266] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 06/20/2012] [Indexed: 10/27/2022]
Abstract
Approximately 1 in 26 people will develop epilepsy at some point in their lives. Although epilepsy is one of the nation's most common neurological disorders, public understanding is limited. A complex spectrum of disorders, epilepsy affects an estimated 2.2 million people in the United States. Living with epilepsy is about more than just seizures; it is often defined in practical terms, such as challenges, uncertainties, and limitations in school, social situations, employment, driving, and independent living. People with epilepsy are also faced with health and community services that are fragmented, uncoordinated, and difficult to obtain. The Institute of Medicine's report (2012) [1], Epilepsy across the spectrum: promoting health and understanding, examines the public health dimensions of epilepsy with a focus on (a) public health surveillance and data collection and integration; (b) population and public health research; (c) health policy, health care, and human services; and (d) education for providers, people with epilepsy and their families, and the public. The report's recommendations range from the expansion of collaborative epilepsy surveillance efforts to the independent accreditation of epilepsy centers, to the coordination of public awareness efforts, and to the engagement of people with epilepsy and their families in education, dissemination, and advocacy activities. Given the current gaps in epilepsy knowledge, care, and education, there is an urgent need to take action-across multiple dimensions-to improve the lives of people with epilepsy and their families. The realistic, feasible, and action-oriented recommendations in this report can help enable short- and long-term improvements for people with epilepsy.
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Affiliation(s)
| | | | - Andrea M. Schultz
- The Institute of Medicine, 500 Fifth Street, NW, Washington, DC 20001, USA
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