1
|
Human Neurocysticercosis: An Overview. Pathogens 2022; 11:pathogens11101212. [PMID: 36297269 PMCID: PMC9607454 DOI: 10.3390/pathogens11101212] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/20/2022] Open
Abstract
Human cysticercosis is caused by ingestion of T. solium eggs from taenia carriers. Neurocysticercosis (NCC), defined as the infection of the CNS and the meninges by the larval stage of Taenia solium, is the most common helminthic infection of the CNS worldwide. Parasites may lodge in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that account for the pleomorphism of this disease. Seizures/epilepsy are the most common clinical manifestation, but other patients present with headache, focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of NCC is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. However, neuroimaging studies are fundamental for diagnosis because immunological test and clinical manifestations only provide circumstantial evidence of NCC. The introduction of cysticidal drugs changed the prognosis of most NCC patients. These drugs have been shown to reduce the burden of infection and to improve the clinical course of the disease in many patients. Efforts should be directed to eradicate the disease through the implementation of control programs against all the steps in the life cycle of T. solium, including carriers of the adult tapeworm, infected pigs, and eggs in the environment.
Collapse
|
2
|
Neurocysticercosis in the Tropics (and Beyond). CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
3
|
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.
Collapse
|
4
|
Angwafor SA, Bell GS, Ngarka L, Otte W, Tabah EN, Nfor LN, Njamnshi TN, Njamnshi AK, Sander JW. Incidence and prevalence of epilepsy and associated factors in a health district in North-West Cameroon: A population survey. Epilepsy Behav 2021; 121:108048. [PMID: 34083120 DOI: 10.1016/j.yebeh.2021.108048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
This population-based cross-sectional survey with a follow-up case-control study assessed the prevalence, incidence, and risk factors for epilepsy in a rural health district in the North-West Region of Cameroon. Community-based epilepsy screening targeted all inhabitants, six years and older, in all 16 health areas in the Batibo Health District. During door-to-door visits, trained fieldworkers used a validated questionnaire to interview consenting household heads to screen for epilepsy in eligible residents. Trained physicians subsequently assessed people with suspected seizures. After clinical assessment, they confirmed or refuted the diagnosis and estimated the date of epilepsy onset. A trained nurse interviewed people with epilepsy and randomly selected healthy individuals, obtaining relevant demographic details and information on exposure to risk factors for epilepsy. Out of 36,282 residents screened, 524 had active epilepsy. The age-standardized prevalence of active epilepsy was 33.9/1,000 (95% CI: 31.0-37.1/1,000). We estimated the one-year age-standardized epilepsy incidence at 171/100,000 (95%CI: 114.0-254.6). Active epilepsy prevalence varied widely between health areas, ranging between 12 and 75 per 1,000. The peak age-specific prevalence was in the 25-34 age group. In adults, multivariate analysis showed that having a relative with epilepsy was positively associated with epilepsy. Epilepsy characteristics in this population, geographical heterogeneity, and the age-specific prevalence pattern suggest that endemic neurocysticercosis and onchocerciasis may be implicated. Further investigations are warranted to establish the full range of risk factors for epilepsy in this population.
Collapse
Affiliation(s)
- Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom; Faculty of Health Sciences, University of Bamenda, Cameroon
| | - Gail S Bell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom
| | - Leonard Ngarka
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland
| | - Willem Otte
- Department of Pediatric Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Earnest N Tabah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University Of Dschang, Cameroon & Department of Disease Control, Ministry of Public Health, Yaounde, Cameroon
| | - Leonard N Nfor
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland
| | - Theophilus N Njamnshi
- Department of Medical Laboratory Science, School of Health and Medical Science, Kumbo, Catholic University of Cameroon, Bamenda, Cameroon
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland.
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), Heemstede, Netherlands
| |
Collapse
|
5
|
Schmidt V, O’Hara MC, Ngowi B, Herbinger KH, Noh J, Wilkins PP, Richter V, Kositz C, Matuja W, Winkler AS. Taenia solium cysticercosis and taeniasis in urban settings: Epidemiological evidence from a health-center based study among people with epilepsy in Dar es Salaam, Tanzania. PLoS Negl Trop Dis 2019; 13:e0007751. [PMID: 31809501 PMCID: PMC6897529 DOI: 10.1371/journal.pntd.0007751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/05/2019] [Indexed: 01/11/2023] Open
Abstract
In Africa, urbanization is happening faster than ever before which results in new implications for transmission of infectious diseases. For the zoonotic parasite Taenia solium, a major cause of acquired epilepsy in endemic countries, the prevalence in urban settings is unknown. The present study investigated epidemiological, neurological, and radiological characteristics of T. solium cysticercosis and taeniasis (TSCT) in people with epilepsy (PWE) living in Dar es Salaam, Tanzania, one of the fastest growing cities worldwide. A total of 302 PWE were recruited from six health centers in the Kinondoni district of Dar es Salaam. Serological testing for T. solium cysticercosis-antigen (Ag) and -antibodies (Abs) and for T. solium taeniasis-Abs was performed in all PWE. In addition, clinical and radiological examinations that included cranial computed tomography (CT) were performed. With questionnaires, demographic data from study populations were collected, and factors associated with TSCT were assessed. Follow-up examinations were conducted in PWE with TSCT. T. solium cysticercosis-Ag was detected in three (0.99%; 95% CI: 0–2.11%), -Abs in eight (2.65%; 95% CI: 0.84–4.46%), and taeniasis-Abs in five (1.66%; 95% CI: 0.22–3.09%) of 302 PWE. Six PWE (1.99%; 95% CI: 0.41–3.56%) were diagnosed with neurocysticercosis (NCC). This study demonstrates the presence of TSCT in Dar es Salaam, however, NCC was only associated with a few cases of epilepsy. The small fraction of PWE with cysticercosis- and taeniasis-Abs may suggest that active transmission of T. solium plays only a minor role in Dar es Salaam. A sufficiently powered risk analysis was hampered by the small number of PWE with TSCT; therefore, further studies are required to determine the exact routes of infection and risk behavior of affected individuals. Taenia solium cysticercosis and taeniasis is a zoonotic disease complex which affects thousands of people in sub-Saharan Africa. This parasite has a human-pig life cycle and has been considered a public health problem mainly in rural areas. As African towns and suburbs grow rapidly and disproportionally, adequate infrastructure such as sewage systems and clean water often lack while population density, trade, and travel increase. This may lead to the appearance of parasitic diseases formerly considered `rural´ in urban settings. In this study, we searched for evidence of T. solium infections in the Kinondoni district of Dar es Salaam, Tanzania. We focused on people with epilepsy (PWE) since epilepsy is one of the most common and severe disorders associated with T. solium neurocysticercosis and tested all of them serologically for T. solium cysticercosis and taeniasis. We further investigated neurological and radiological characteristics. Our findings show that in our study area in Dar es Salaam 2.65% of PWE had contracted T. solium infection at some stage. Neurocysticercosis, as confirmed by neuroimaging, was found only in 1.99% of PWE. This, in combination with the relatively small number of PWE detected with taeniasis antibodies (1.66%), points towards the fact that active transmission of T. solium seems to play only a minor role in this urban setting, suggesting that infections may mainly be contracted in rural areas. Further large-scale studies are required to investigate the infection pathways and risk behavior related to T. solium infections within urban areas of sub-Saharan Africa.
Collapse
Affiliation(s)
- Veronika Schmidt
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- * E-mail:
| | - Marie-Claire O’Hara
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Neurology, Elbe Klinikum Stade, Stade, Germany
| | - Bernard Ngowi
- Muhimbili Medical Research Centre, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
- College of Health and Allied Sciences, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - John Noh
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Patricia Procell Wilkins
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Vivien Richter
- Department of Neurology and Epileptology, Evangelical Hospital Alsterdorf, Hamburg, Germany
| | - Christian Kositz
- Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Schwitzerland
| | - William Matuja
- Department of Neurology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea Sylvia Winkler
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
6
|
Thurman DJ, Faught E, Helmers S, Kim H, Kalilani L. New-onset lesional and nonlesional epilepsy in the US population: Patient characteristics and patterns of antiepileptic drug use. Epilepsy Res 2019; 157:106210. [PMID: 31605878 DOI: 10.1016/j.eplepsyres.2019.106210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/02/2019] [Accepted: 09/24/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Describe treatment patterns in patients from the United States with new-onset epilepsy, comparing those with and without lesional epilepsy. METHODS In this observational study we used Truven Health MarketScan databases derived from commercial health insurance, Medicare and Medicaid claims covering at least 5 years, commencing in 2008. We identified incident epilepsy cases based on International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating epilepsy or recurrent seizures, taking into account antiepileptic drug (AED) claims, consistent with International League Against Epilepsy Commission on Epidemiology recommendations. We identified patients with lesional epilepsy when associated diagnoses indicated central nervous system infection, neoplasm, traumatic brain injury, stroke, senile dementia and static encephalopathy. Lesional and nonlesional cohorts were matched 1:1 on baseline characteristics of age, sex and insurance type for group comparisons. RESULTS In unmatched cohorts lesional epilepsy patients (N = 15,302) were more commonly older (mean age 48.7 years) compared with nonlesional epilepsy patients (N = 15,970; mean age 18.5 years). Among lesional patients <20 years of age, the leading putative etiology was static encephalopathy, while among ages ≥20 years and older, the leading putative etiology was stroke or cerebrovascular disease. In matched cohorts (7063 patients each), those with lesional epilepsy were significantly less likely to be untreated at 1 year versus those with nonlesional epilepsy (37.2% vs 56.1%). In children and adults among matched cohorts, levetiracetam was the most common AED prescribed for initial AED therapy for the lesional (39.5%) and nonlesional (32.1%) groups. Lesional epilepsy patients on monotherapy were only slightly less likely than nonlesional epilepsy patients to be on the same AED 1 year after treatment initiation (55.6% vs 59.7%). SIGNIFICANCE Compared with patients with lesional epilepsy, a higher proportion of patients with nonlesional epilepsy remain untreated 1 year after diagnosis. There were differences in AED selection by epilepsy etiology; levetiracetam is the most commonly prescribed drug for both cohorts.
Collapse
Affiliation(s)
- David J Thurman
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA 30329, USA.
| | - Edward Faught
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA 30329, USA.
| | - Sandra Helmers
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA 30329, USA
| | - Hyunmi Kim
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA, 30322, USA.
| | - Linda Kalilani
- UCB Pharma, 8010 Arco Corporate Drive, Raleigh NC 27617, USA.
| |
Collapse
|
7
|
Singhi P, Malhi P, Suthar R, Deo B, Khandelwal NK. Long-term Cognitive Outcome of Children With Parenchymal Neurocysticercosis: A Prospective Observation Study. J Child Neurol 2018; 33:468-473. [PMID: 29687740 DOI: 10.1177/0883073818766985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To study the cognitive profile and scholastic performance of children with parenchymal neurocysticercosis. A total of 500 children with a diagnosis of neurocysticercosis and epilepsy registered in our pediatric neurocysticercosis clinic between January 1996 and December 2002 were enrolled. Patients were evaluated for their scholastic performance using their school grades. Cognitive assessment was done using Parental interview and the "Draw-a-Man" test. Poor scholastic performance was seen in 22.2% (111) children. Draw-a-Man test was done in 148 children; 18.2% (27/148) had scores equivalent to IQ <70. Intermittent headache, behavior problems, and poor memory were reported in 40% (201) children. Multiple lesions, lower socioeconomic status, and calcified lesions on follow-up were associated with academic underachievement ( P < .05). About a fourth of children with neurocysticercosis had cognitive impairment during follow-up. This was mostly seen in children from lower socioeconomic status and in those with multiple-lesion neurocysticercosis.
Collapse
Affiliation(s)
- Pratibha Singhi
- 1 Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabhjot Malhi
- 1 Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- 1 Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Brijendra Deo
- 1 Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - N K Khandelwal
- 2 Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
8
|
Gripper LB, Welburn SC. The causal relationship between neurocysticercosis infection and the development of epilepsy - a systematic review. Infect Dis Poverty 2017; 6:31. [PMID: 28376856 PMCID: PMC5381143 DOI: 10.1186/s40249-017-0245-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/13/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Neurocysticercosis (NCC) is a parasitic infection of the human central nervous system, the most common form of which involves infection of the brain parenchyma with the larval form of the Taenia solium tapeworm. A causal relationship between such an NCC infection and the development of epilepsy in infected individuals is acknowledged, in part supported by high levels of comorbidity in endemic countries worldwide. METHODS This study undertook a systematic review and critical analysis of the NCC-epilepsy relationship with the primary objective of quantifying the risk of developing epilepsy following NCC infection. A secondary aim was to analyse the proportions of NCC-associated epilepsy within different populations. Significant emphasis was placed on the importance of neuroimaging (CT or MRI) availability and use of clear guidelines for epilepsy diagnosis, in order to avoid overestimations of prevalence rates of either condition; a limitation identified in several previous studies. RESULTS A common odds ratio of 2.76 was identified from meta-analysis of case-control studies, indicating that an individual infected with NCC has almost a three times higher risk of developing epilepsy than an uninfected individual. Furthermore, meta-analysis of studies identified a common proportion of 31.54% of epilepsy cases associated with NCC infection which suggests that amongst epileptic populations in at risk countries, approximately one-third may be associated with NCC infection. CONCLUSION A significant finding was the lack of good clinical data to enable accurate determination of a causal relationship. Even studies that were included had noticeable limitations, including a general lack of consistency in diagnostics, and lack of accurate epidemiological data. This review highlights a need for consistency in research in this field. In the absence of reliable estimates of its global burden, NCC will remain of low priority in the eyes of funding agencies - a truly neglected disease.
Collapse
Affiliation(s)
- Lucy B. Gripper
- Division of Infection and Pathway Medicine, Edinburgh Infectious Diseases, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB Scotland UK
| | - Susan C. Welburn
- Division of Infection and Pathway Medicine, Edinburgh Infectious Diseases, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB Scotland UK
| |
Collapse
|
9
|
Gasparetto EL, Alves-Leon S, Domingues FS, Frossard JT, Lopes SP, Souza JMD. Neurocysticercosis, familial cerebral cavernomas and intracranial calcifications: differential diagnosis for adequate management. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:495-500. [DOI: 10.1590/0004-282x20160054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/22/2015] [Indexed: 11/21/2022]
Abstract
ABSTRACT Neurocysticercosis (NCC) is an endemic disease and important public health problem in some areas of the World and epilepsy is the most common neurological manifestation. Multiple intracranial lesions, commonly calcified, are seen on cranial computed tomography (CT) in the chronic phase of the disease and considered one of the diagnostic criteria of the diagnosis. Magnetic resonance imaging (MRI) is the test that better depicts the different stages of the intracranial cysts but does not show clearly calcified lesions. Cerebral cavernous malformations (CCM), also known as cerebral cavernomas, are frequent vascular malformations of the brain, better demonstrated by MRI and have also epilepsy as the main form of clinical presentation. When occurring in the familial form, cerebral cavernomas typically present with multiple lesions throughout the brain and, very often, with foci of calcifications in the lesions when submitted to the CT imaging. In the countries, and geographic areas, where NCC is established as an endemic health problem and neuroimaging screening is done by CT scan, it will be important to consider the differential diagnosis between the two diseases due to the differences in adequate management.
Collapse
|
10
|
Torous VF, Darras N. A lumbar canal cystic mass lesion in a man with a history of chronic lower back pain. Neuropathology 2015; 36:103-6. [PMID: 26177559 DOI: 10.1111/neup.12228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/31/2015] [Accepted: 04/30/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Vanda Farahmand Torous
- Beth Israel Deaconess Medical Center, Department of Pathology and Laboratory medicine, Boston, Massachusetts, United States
| | - Natasha Darras
- Beth Israel Deaconess Medical Center, Department of Pathology and Laboratory medicine, Boston, Massachusetts, United States
| |
Collapse
|
11
|
Sahu PS, Patro S, Jena PK, Swain SK, Das BK. Imaging and Serological-Evidence of Neurocysticercosis Among Patients with Seizures in Odisha, an Unexplored Eastern Coastal Province in India. J Clin Diagn Res 2015; 9:DC06-10. [PMID: 26155476 DOI: 10.7860/jcdr/2015/12609.5967] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/14/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Neurocysticercosis being a potential to human transmitted disease, is the major cause of seizures and a public health problem in tropical countries. Though India is known to be highly endemic, there are many provinces where reports are still unavailable thereby underestimating its actual burden. MATERIALS AND METHODS Anti-Cysticercus IgG antibodies in sera from cases presenting with seizures were screened by ELISA in a preliminary study in Odisha state which is a province in Eastern coastal India that was never explored before. Patients presenting with recent onset of seizures within age group 5 to 50 years, either local residents of Odisha or inhabitants from other parts of the country living for at least one year period in the study area were included. RESULTS The present study showed 43.75% cases with seizures to be confirmed neurocysticercosis (NCC) based on serology and brain imaging. However, statistically no association was established between anti-Cysticercus antibody detection and radio imaging characteristics (location, number of lesions, and stage). CONCLUSION This is the first study in Odisha presenting a series of cases with serological evidence of exposure to the parasite along with imaging characteristics which was consistent with NCC. It is recommended that NCC must be considered for a differential diagnosis in each active epilepsy case irrespective of prior prevalence information in all unexplored provinces in India and other endemic regions; also a compulsory reporting is warranted in order to aid in quantifying its actual burden.
Collapse
Affiliation(s)
- Priyadarshi Soumyaranjan Sahu
- Assistant Professor, Department of Immunology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India. Division of Pathology, School of Medicine, International Medical University , Kuala Lumpur, Malaysia
| | - Shubhransu Patro
- Associate Professor, Department of Internal Medicine, Kalinga Institute of Medical Sciences, KIIT University , Bhubaneswar, Odisha, India
| | - Payod Kumar Jena
- Consultant Neurologist, Department of Neurology, Kalinga Institute of Medical Sciences, KIIT University , Bhubaneswar, Odisha, India
| | - Santosh Kumar Swain
- Assistant Professor, Department of Internal Medicine, SCB Medical College and Hospital , Cuttack, Odisha, India
| | - Bidyut Kumar Das
- Professor, Department of Internal Medicine, SCB Medical College and Hospital , Cuttack, Odisha, India
| |
Collapse
|
12
|
Sahu PS, Seepana J, Padela S, Sahu AK, Subbarayudu S, Barua A. Neurocysticercosis in children presenting with afebrile seizure: clinical profile, imaging and serodiagnosis. Rev Inst Med Trop Sao Paulo 2014; 56:253-8. [PMID: 24879004 PMCID: PMC4085870 DOI: 10.1590/s0036-46652014000300011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 10/04/2013] [Indexed: 11/22/2022] Open
Abstract
Neurocysticercosis (NCC) is one of the major causes of childhood seizures
in developing countries including India and Latin America. In this study neurological
pediatric cases presenting with afebrile seizures were screened for anti-Cysticercus
antibodies (IgG) in their sera in order to estimate the possible burden of
cysticercal etiology. The study included a total of 61 pediatric afebrile seizure
subjects (aged one to 15 years old); there was a male predominance. All the sera were
tested using a pre-evaluated commercially procured IgG-ELISA kit (UB-Magiwell
Cysticercosis Kit ™). Anti-Cysticercus antibody in serum was positive in 23 of 61 (37.7%)
cases. The majority of cases with a positive ELISA test presented with generalized
seizure (52.17%), followed by complex partial seizure (26.08%), and simple partial
seizure (21.73%). Headaches were the major complaint (73.91%). Other presentations
were vomiting (47.82%), pallor (34.78%), altered sensorium (26.08%), and muscle
weakness (13.04%). There was one hemiparesis case diagnosed to be NCC. In this study
one child without any significant findings on imaging was also found to be positive
by serology. There was a statistically significant association found between the
cases with multiple lesions on the brain and the ELISA-positivity (p
= 0.017). Overall positivity of the ELISA showed a potential cysticercal etiology.
Hence, neurocysticercosis should be suspected in every child presenting with afebrile
seizure especially with a radio-imaging supportive diagnosis in tropical developing
countries or areas endemic for taeniasis/cysticercosis.
Collapse
Affiliation(s)
| | - Jyotsna Seepana
- Department of Microbiology, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh-534005, India
| | - Sudarsini Padela
- Department of Paediatrics, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh-534005, India
| | - Abani Kanta Sahu
- Department of Paediatrics, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh-534005, India
| | - Swarna Subbarayudu
- Department of Microbiology, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh-534005, India
| | - Ankur Barua
- Division of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| |
Collapse
|
13
|
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.
Collapse
Affiliation(s)
- Arturo Carpio
- University of Cuenca, Ecuador; Columbia University, USA
| | | |
Collapse
|
14
|
Bharucha N, Odermatt P, Preux PM. Methodological difficulties in the conduct of neuroepidemiological studies in low- and middle-income countries. Neuroepidemiology 2013; 42:7-15. [PMID: 24356059 DOI: 10.1159/000355921] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The majority of people with epilepsy (PWE) live in low- and middle-income countries (LMICs). However, they remain largely untreated and the bulk of resources are used to treat patients in the developed world. This disparity constitutes a challenge for neuroepidemiological studies on a global scale. In the past, several studies have focused on diverse populations in disparate countries at various periods of time and for particular purposes. The specificity of different contexts and circumstances makes it difficult to analyse PWE as a group either qualitatively or quantitatively. Such methodological limitations are further complicated by a lack of logistical support. There is a lack of interest in conducting studies, which results in inadequate funding and, in addition, there is the considerable challenge of publishing research reports from LMICs in peer-reviewed international journals. METHODS This paper focuses on methodological problems related to studies in LMICs and attempts to give the reasons for their limitations using epilepsy as an example. RESULTS Regional conditions and environmental factors must be given careful consideration in the research design because of the importance of understanding the challenges of living in these environments. There are further limitations to the successful implementation of studies. Existing information on epilepsy is often not readily accessible; there is a lack of census data, and migratory patterns into cities make enumeration and sampling even more challenging. As there is usually no well-developed healthcare system a door-to-door screening process is often the only way to identify those with convulsive epilepsy. The questionnaire and study design should preferably be adapted from standardized protocols, and pre-tested and validated in local conditions. CONCLUSIONS Systematic reviews and meta-analyses of studies in LMICs can provide data on the burden, risk factors, treatment and outcome of epilepsy only if the primary studies used are properly conducted using uniform and comparable methodology. The use of consistent replicable neuroepidemiological methods in primary studies and systematic reviews enable reduction of the treatment gap and better epilepsy care.
Collapse
Affiliation(s)
- Nadir Bharucha
- Department of Neurology, Bombay Hospital Institute of Medical Sciences, Medical Research Centre, Bombay Hospital, Mumbai, India
| | | | | |
Collapse
|
15
|
Winkler AS. Neurocysticercosis in sub-Saharan Africa: a review of prevalence, clinical characteristics, diagnosis, and management. Pathog Glob Health 2012; 106:261-74. [PMID: 23265550 PMCID: PMC4005109 DOI: 10.1179/2047773212y.0000000047] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Neurocysticercosis has been recognized as a major cause of secondary epilepsy worldwide. So far, most of the knowledge about the disease comes from Latin America and the Indian subcontinent. Unfortunately, in sub-Saharan Africa the condition was neglected for a long time, mainly owing to the lack of appropriate diagnostic tools. This review therefore focuses on the prevalence of neurocysticercosis in sub-Saharan Africa, the clinical picture with emphasis on epilepsy, as well as the diagnosis and treatment of neurocysticercosis and its related epilepsy/epileptic seizures in African resource-poor settings.
Collapse
|
16
|
Gardner E, Chang M, Mancuso P, Chaney SE. Neurocysticercosis in pregnancy: not just another headache. Nurs Womens Health 2012; 16:118-124. [PMID: 22900769 DOI: 10.1111/j.1751-486x.2012.01717.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Infection with pork tapeworm, or Taenia solium, affects approximately 50 million people worldwide. The most important and potentially devastating form of the infestation, neurocysticercosis, occurs when the parasite invades the central nervous system. There has been a significant increase in the number of cases in the United States due to immigration from endemic areas. This case study of a pregnant woman in the 35th week of gestation exemplifies the serious consequences of this infection in pregnancy, and discusses an evidence-based approach to the diagnosis, treatment and eradication of this preventable disease.
Collapse
|
17
|
Singla M, Prabhakar S, Modi M, Medhi B, Khandelwal N, Lal V. Short-course of prednisolone in solitary cysticercus granuloma: a randomized, double-blind, placebo-controlled trial. Epilepsia 2011; 52:1914-7. [PMID: 21777229 DOI: 10.1111/j.1528-1167.2011.03184.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the effect of administration of a short course of prednisolone on seizure and radiologic outcome in patients with solitary cysticercus granuloma (SCG). METHODS One hundred forty-eight subjects presenting with new-onset seizures (<15 days duration) and with SCG demonstrated on imaging studies were randomly allocated to either treatment with prednisolone (40-60 mg/day for 2 weeks) or placebo in addition to standard antiepileptic drug therapy. The subjects were followed up for seizure recurrence for 9 months. Repeat computed tomography (CT, at 3 months) and magnetic resonance imaging (MRI, at 6 months) to evaluate resolution and calcification of the lesion. KEY FINDINGS There was no difference in the proportion of subjects with seizure recurrence during the follow-up period in the treatment (n = 16, 21.9%) and control (n = 19, 25.33%) groups (p = 0.7). However, generalized seizures occurred in a significantly lesser proportion of subjects in the treatment group (n = 3, 15.79%) in comparison to the control group (n = 12, 60.00%) (p = 0.015). There were no significant differences in the proportion of subjects with complete resolution of the SCG on repeat CT at 3 months [treatment group (27, 46.7%) and control group (23, 39.8%); p = 0.453] and repeat MRI at 6 months [treatment group (28, 46.7%) and control group (21, 38.9%); p = 0.402]. SIGNIFICANCE The administration of a short course of prednisolone does not offer significant improvement in seizure control, although a benefit in terms of reducing the likelihood of generalized seizures is possible. Furthermore, it does not improve the chances of resolution of the SCG on follow-up imaging studies.
Collapse
Affiliation(s)
- Monika Singla
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | | | | | |
Collapse
|
18
|
Relative seroprevalence of cysticercus antigens and antibodies and antibodies to Taenia ova in a population sample in south India suggests immunity against neurocysticercosis. Trans R Soc Trop Med Hyg 2011; 105:153-9. [DOI: 10.1016/j.trstmh.2010.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 10/27/2010] [Accepted: 10/27/2010] [Indexed: 11/18/2022] Open
|
19
|
Singh G, Rajshekhar V, Murthy JMK, Prabhakar S, Modi M, Khandelwal N, Garcia HH. A diagnostic and therapeutic scheme for a solitary cysticercus granuloma. Neurology 2011; 75:2236-45. [PMID: 21172847 DOI: 10.1212/wnl.0b013e31820202dc] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Solitary cysticercus granuloma (SCG) is one of the most common forms of presentation of neurocysticercosis (NCC). The diagnostic workup and management approach to this condition remain uncertain and controversial. OBJECTIVE To review evidence and develop a consensus approach to the diagnosis and treatment of SCG. METHODS A multidisciplinary expert group meeting was convened in order to review and discuss various aspects of management of patients with SCG. Evidence reviewed was classified and a consensus was evolved according to standard protocols. RESULTS SCG is commonly recognized on CT as an enhancing lesion measuring <20 mm. Further evaluation with MRI does not add much information. The use of antihelminthic agents (specifically, albendazole in combination with corticosteroids) and corticosteroids alone have been shown to improve radiologic resolution and seizure outcome in patients with SCG. However, the sizes of the effects are modest. By convention, all patients with SCG presenting with seizures are initiated on antiepileptic drugs (AEDs). Available evidence suggests that withdrawal of AEDs after complete resolution of the SCG is safe. There is a high risk of seizure relapse after AED withdrawal in patients with calcific residue following resolution of the SCG. The duration of AED prophylaxis in these individuals is unclear. CONCLUSIONS It is desirable to have large, multicenter trials with sufficiently long follow-up, comparing outcomes with the use of antihelminthics with or without corticosteroids and corticosteroids alone in order to dissect out the benefits accrued due to each of these classes of drugs.
Collapse
Affiliation(s)
- G Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, Punjab, India
| | | | | | | | | | | | | |
Collapse
|
20
|
Ndimubanzi PC, Carabin H, Budke CM, Nguyen H, Qian YJ, Rainwater E, Dickey M, Reynolds S, Stoner JA. A systematic review of the frequency of neurocyticercosis with a focus on people with epilepsy. PLoS Negl Trop Dis 2010; 4:e870. [PMID: 21072231 PMCID: PMC2970544 DOI: 10.1371/journal.pntd.0000870] [Citation(s) in RCA: 284] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 10/04/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The objective of this study is to conduct a systematic review of studies reporting the frequency of neurocysticercosis (NCC) worldwide. METHODS/PRINCIPAL FINDINGS PubMed, Commonwealth Agricultural Bureau (CAB) abstracts and 23 international databases were systematically searched for articles published from January 1, 1990 to June 1, 2008. Articles were evaluated for inclusion by at least two researchers focusing on study design and methods. Data were extracted independently using standardized forms. A random-effects binomial model was used to estimate the proportion of NCC among people with epilepsy (PWE). Overall, 565 articles were retrieved and 290 (51%) selected for further analysis. After a second analytic phase, only 4.5% of articles, all of which used neuroimaging for the diagnosis of NCC, were reviewed. Only two studies, both from the US, estimated an incidence rate of NCC using hospital discharge data. The prevalence of NCC in a random sample of village residents was reported from one study where 9.1% of the population harboured brain lesions of NCC. The proportion of NCC among different study populations varied widely. However, the proportion of NCC in PWE was a lot more consistent. The pooled estimate for this population was 29.0% (95%CI: 22.9%-35.5%). These results were not sensitive to the inclusion or exclusion of any particular study. CONCLUSION/SIGNIFICANCE Only one study has estimated the prevalence of NCC in a random sample of all residents. Hence, the prevalence of NCC worldwide remains unknown. However, the pooled estimate for the proportion of NCC among PWE was very robust and could be used, in conjunction with estimates of the prevalence and incidence of epilepsy, to estimate this component of the burden of NCC in endemic areas. The previously recommended guidelines for the diagnostic process and for declaring NCC an international reportable disease would improve the knowledge on the global frequency of NCC.
Collapse
Affiliation(s)
- Patrick C. Ndimubanzi
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Hélène Carabin
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Christine M. Budke
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine, Texas A&M University, College Station, Texas, United States of America
| | - Hai Nguyen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Ying-Jun Qian
- National Institute of Parasitic Diseases, Shangai, People's Republic of China
| | - Elizabeth Rainwater
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Mary Dickey
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Stephanie Reynolds
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Julie A. Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| |
Collapse
|
21
|
Winkler AS, Willingham AL, Sikasunge CS, Schmutzhard E. Epilepsy and neurocysticercosis in sub-Saharan Africa. Wien Klin Wochenschr 2010; 121 Suppl 3:3-12. [PMID: 19915809 DOI: 10.1007/s00508-009-1242-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Over the last decades, studies in sub-Saharan Africa have indicated that epilepsy is a highly prevalent neurological disorder. Causes may be varied with infections of the central nervous system playing an important role. Neurocysticercosis (NCC) has recently been recognised as an emerging public health problem and a growing concern throughout sub-Saharan Africa and has been estimated to be responsible for 30-50% of acquired epilepsy. NCC is closely linked with porcine cysticercosis and human taeniosis, the former reaching a prevalence of almost 50% in some pig populations. In this review, we first summarize prevalence data on epilepsy and highlight some special aspects of the disorder within sub-Saharan Africa. We then focus on the prevalence of NCC, clinical signs and symptoms and diagnostic criteria for NCC with special reference to sub-Saharan Africa. This is followed by a section on the latest developments regarding serodiagnosis of cysticercosis and a section on care management of people infected with NCC. NCC clearly represents a major risk factor of epilepsy, thus detecting and treating NCC may help cure epilepsy in millions of people in sub-Saharan Africa.
Collapse
Affiliation(s)
- Andrea Sylvia Winkler
- Interdisciplinary Centre for Palliative Medicine and Department of Neurology, Ludwig-Maximilians-University, Munich, Germany.
| | | | | | | |
Collapse
|
22
|
de Souza A, Nalini A, Kovoor J, Yeshraj G, Siddalingaiah H, Thennarasu K. Natural history of solitary cerebral cysticercosis on serial magnetic resonance imaging and the effect of albendazole therapy on its evolution. J Neurol Sci 2010; 288:135-41. [DOI: 10.1016/j.jns.2009.09.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 09/19/2009] [Accepted: 09/21/2009] [Indexed: 10/20/2022]
|
23
|
|
24
|
Abstract
Neurocysticercosis (NCC) is a common cause of seizures and neurologic disease. Although there may be variable presentations depending on the stage and location of cysts in the nervous system, most children (> 80%) present with seizures particularly partial seizures. About a third of cases have headache and vomiting. Diagnosis is made by either CT or MRI. Single enhancing lesions are the commonest visualization of a scolex confirms the diagnosis. Some cases have multiple cysts with a characteristic starry-sky appearance. Management involves use of anticonvulsants for seizures and steroids for cerebral edema. The use of cysticidal therapy continues to be debated. Controlled studies have shown that cysticidal therapy helps in increased and faster resolution of CT lesions. Improvement in long-term seizure control has not yet been proven. Children with single lesions have a good outcome and seizure recurrence rate is low. Children with multiple lesions have recurrent seizures. Extraparenchymal NCC has a guarded prognosis but it is rare in children. In endemic areas NCC must be considered in the differential diagnosis of seizures and various other neurological disorders.
Collapse
|
25
|
Winkler AS, Blocher J, Auer H, Gotwald T, Matuja W, Schmutzhard E. Epilepsy and neurocysticercosis in rural Tanzania-An imaging study. Epilepsia 2009; 50:987-93. [DOI: 10.1111/j.1528-1167.2008.01867.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
26
|
Randomized controlled trial of albendazole in new onset epilepsy and MRI confirmed solitary cerebral cysticercal lesion: Effect on long-term seizure outcome. J Neurol Sci 2009; 276:108-14. [DOI: 10.1016/j.jns.2008.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 09/03/2008] [Accepted: 09/11/2008] [Indexed: 11/17/2022]
|
27
|
Handique SK, Das RR, Saharia B, Das P, Buragohain R, Saikia P. Coinfection of Japanese encephalitis with neurocysticercosis: an imaging study. AJNR Am J Neuroradiol 2008; 29:170-5. [PMID: 17928378 DOI: 10.3174/ajnr.a0769] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Coinfection of neurocysticercosis (NCC) and Japanese encephalitis (JE) has been advocated as more than a chance occurrence resulting in poor outcome. We undertook this study to determine whether the association of the 2 infections is more than a chance occurrence, to define the imaging characteristics of coinfections, and to explore the synergistic effect of NCC in JE. MATERIALS AND METHODS Sixty-two patients with JE were studied by MR imaging and CT. CT was done in 53 and MR imaging in 53 patients. The diagnosis of JE was established by CSF JE virus immunoglobulin M capture (MAC) enzyme-linked immunosorbent assay (ELISA). NCC was diagnosed from imaging. A control group of 385 patients was evaluated by imaging for prevalence of NCC in the general population. RESULTS A significantly high association of NCC with JE (19.3%) was observed in comparison with prevalence of NCC in control subjects (1.04%; P = .0003). JE lesions in coinfection were significantly asymmetric with lateralization to the side of the brain having the maximum NCC or a cyst with edema. The JE lesions in coinfections were more florid, with a significantly higher proportion of abnormal CT scans and more abnormal MR imaging. Coinfections were significantly more common in children. Significantly lower CSF MAC-ELISA units in patients with coinfection reflected low CSF IgM levels, suggesting altered immune status. CONCLUSION In our series, there was a strong association between JE and NCC, and, thus, this coinfection was more than a chance occurrence.
Collapse
Affiliation(s)
- S K Handique
- Departments of Radiology and Imaging, Institute of Neurological Sciences, Dispur, Assam, India.
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
INTRODUCTION Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system. It is a major public health problem in developing countries, however, rarely reported in Saudi Arabia. As far as our knowledge, this is the first case report of NCC in Saudi Arabia. An increasing number of immigrants from endemic areas is the cause. CASE REPORTS Here, we report three interesting cases of NCC in three adult females with very unusual clinical presentation. These include: (case 1) progressive spasticity of the four limbs with severe pseudobulbar manifestations, precipitancy of micturition, cognitive impairment and no eye involvement; (case 2) dystonic movement of right upper and lower limbs together with weight gain, lethargy, mental dullness and goitre; and (case 3) depressive manifestations together with disturbance of writing, mild deep sensory loss, limb-kinetic apraxia, lack of coordination and dystonia of the right upper limb. The clinical details and possible mechanisms for the uncommon presentations are discussed. CONCLUSION NCC should be kept in mind and raise a high level of suspicion for unusual neurological manifestations in Saudian patients particularly as there has been increasing percentage of immigration from endemic areas during the last few years.
Collapse
Affiliation(s)
- S A Hamed
- Department of Neuroscience, Saudi German Hospital-Aseer, Khamis Mushayt, Saudi Arabia.
| | | |
Collapse
|