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Carpio A, Romo ML, Hauser WA, Kelvin EA. New understanding about the relationship among neurocysticercosis, seizures, and epilepsy. Seizure 2021; 90:123-129. [DOI: 10.1016/j.seizure.2021.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 02/08/2023] Open
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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 2020; 113:781-788. [PMID: 31433058 DOI: 10.1093/trstmh/trz073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [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 168th Street, Columbia University, New York, New York 10032, USA
| | | | - W Allen Hauser
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, 630 168th 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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Zhang H, Kelvin EA, Carpio A, Allen Hauser W. A multistate joint model for interval-censored event-history data subject to within-unit clustering and informative missingness, with application to neurocysticercosis research. Stat Med 2020; 39:3195-3206. [PMID: 32584425 DOI: 10.1002/sim.8663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/15/2020] [Accepted: 05/19/2020] [Indexed: 11/06/2022]
Abstract
We propose a multistate joint model to analyze interval-censored event-history data subject to within-unit clustering and nonignorable missing data. The model is motivated by a study of the neurocysticercosis (NC) cyst evolution at the cyst-level, taking into account the multiple cysts phases with intermittent missing data and loss to follow-up, as well as the intra-brain clustering of observations made on a predefined data collection schedule. Of particular interest in this study is the description of the process leading to cyst resolution, and whether this process varies by antiparasitic treatment. The model uses shared random effects to account for within-brain correlation and to explain the hidden heterogeneity governing the missing data mechanism. We developed a likelihood-based method using a Monte Carlo EM algorithm for the inference. The practical utility of the methods is illustrated using data from a randomized controlled trial on the effect of antiparasitic treatment with albendazole on NC cysts among patients from six hospitals in Ecuador. Simulation results demonstrate that the proposed methods perform well in the finite sample and misspecified models that ignore the data complexities could lead to substantial biases.
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Affiliation(s)
- Hongbin Zhang
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health, City University of New York, New York, New York, United States
| | - Elizabeth A Kelvin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health, City University of New York, New York, New York, United States
| | - Arturo Carpio
- School of Medicine, University of Cuenca, Cuenca, Ecuador
| | - W Allen Hauser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States
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Herrador Z, Pérez-Molina JA, Henríquez Camacho CA, Rodriguez-Guardado A, Bosch-Nicolau P, Calabuig E, Domínguez-Castellano A, Pérez-Jacoiste MA, Ladrón de Guevara MC, Mena A, Ruiz-Giardin JM, Torrús D, Wikman-Jorgensen P, Benito A, López-Vélez R. Imported cysticercosis in Spain: A retrospective case series from the +REDIVI Collaborative Network. Travel Med Infect Dis 2020; 37:101683. [PMID: 32335208 DOI: 10.1016/j.tmaid.2020.101683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 02/21/2020] [Accepted: 04/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neurocysticercosis (NCC) is the most common parasitic neurological disease worldwide and a major cause of epilepsy. Spain is the country reporting the highest number of NCC imported cases in Europe. METHODOLOGY Retrospective case series of NCC patients registered in the +REDIVI Network from October 1, 2009 to July 2018. A specific questionnaire, including clinical and diagnostic characteristics, was created and sent to the collaborator centers. RESULTS 46 cases were included in the analysis. 55% were male, mean age of 40 years. 95.6% were migrants. The median duration since migration from an endemic area was 10 years. Predominant nationalities were Ecuadorians (50%) and Bolivians (30.4%). Frequent locations were parenchymal (87%), subarachnoid (26.1%) and intraventricular cysts (10.9%). Serological analysis was performed in 91.3%, being 54.8% positive. Most prevalent clinical manifestations were persistent headache (60.9%), epilepsy (43.5%) and visual changes (13%). Patients were mainly treated with albendazole (76.1%), corticosteroids (67.4%), and anticonvulsionants (52.2%). 82.5% had a favorable clinical outcome. CONCLUSIONS Most NCC cases were long-standing migrants. Few clinical differences were observed depending on the cysticerci location. The treatment was often not according to current recommendations, and no uniform criteria were followed when it came to the therapeutic regimen. NCC case management in Spain (including clinician awareness and laboratory capacity improvements) needs to be strengthened.
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Affiliation(s)
- Zaida Herrador
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain; Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.
| | - José A Pérez-Molina
- Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain; National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRICYS, Madrid, Spain
| | - César Augusto Henríquez Camacho
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRICYS, Madrid, Spain
| | | | | | | | | | | | | | - Ana Mena
- Hospital Universitario Son Espases, Palma Mallorca, Spain
| | | | - Diego Torrús
- Hospital Universitario de Alicante, Alicante, Spain
| | - Philip Wikman-Jorgensen
- Hospital Universitario de Elda, Alicante, Spain; Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIO, Spain
| | - Agustín Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain; Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain
| | - Rogelio López-Vélez
- Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain; National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRICYS, Madrid, Spain
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Del Brutto OH, Arroyo G, Del Brutto VJ, Zambrano M, García HH. On the relationship between calcified neurocysticercosis and epilepsy in an endemic village: A large-scale, computed tomography-based population study in rural Ecuador. Epilepsia 2017; 58:1955-1961. [PMID: 28850668 DOI: 10.1111/epi.13892] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Using a large-scale population-based study, we aimed to assess prevalence and patterns of presentation of neurocysticercosis (NCC) and its relationship with epilepsy in community-dwellers aged ≥20 years living in Atahualpa (rural Ecuador). METHODS In a three-phase epidemiological study, individuals with suspected seizures were identified during a door-to-door survey and an interview (phase I). Then, neurologists evaluated suspected cases and randomly selected negative persons to estimate epilepsy prevalence (phase II). In phase III, all participants were offered noncontrast computed tomography (CT) for identifying NCC cases. The independent association between NCC (exposure) and epilepsy (outcome) was assessed by the use of multivariate logistic regression models adjusted for age, sex, level of education, and alcohol intake. CT findings were subsequently compared to archived brain magnetic resonance imaging in a sizable subgroup of participants. RESULTS Of 1,604 villagers aged ≥20 years, 1,462 (91%) were enrolled. Forty-one persons with epilepsy (PWE) were identified, for a crude prevalence of epilepsy of 28 per 1,000 population (95% confidence interval [CI] = 20.7-38.2). A head CT was performed in 1,228 (84%) of 1,462 participants, including 39 of 41 PWE. CT showed lesions consistent with calcified parenchymal brain cysticerci in 118 (9.6%) cases (95% CI = 8.1-11.4%). No patient had other forms of NCC. Nine of 39 PWE, as opposed to 109 of 1,189 participants without epilepsy, had NCC (23.1% vs. 9.2%, p = 0.004). This difference persisted in the adjusted logistic regression model (odds ratio = 3.04, 95% CI = 1.35-6.81, p = 0.007). SIGNIFICANCE This large CT-based study demonstrates that PWE had three times the odds of having NCC than those without epilepsy, providing robust epidemiological evidence favoring the relationship between NCC and epilepsy.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espiritu Santo-Ecuador, Guayaquil, Ecuador
| | - Gianfranco Arroyo
- School of Public Health and Management, Cayetano Heredia University, Lima, Perú
| | | | | | - Héctor H García
- Center for Global Health, Tumbes and the Department of Microbiology, School of Sciences, Cayetano Heredia University, Lima, Perú.,Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Perú
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