[Prevalence of neurocysticercosis among epileptic in-patients in the west of Santa Catarina--southern Brazil]

Course and prognosis of adult-onset epilepsy in Brazil: A cohort study

BACKGROUND

Most of the epilepsy longitudinal studies have analyzed children. However, in endemic regions, such as Brazil, neurocysticercosis accounts for many adult-onset epilepsy cases. So, the main objective of this study was to identify the clinical predictors associated with drug-resistant adult-onset epilepsy in Brazil during a long-term follow-up.

METHODS

We followed 302 individuals with adult-onset epilepsy for 9.8 years in our University Hospital. Structured questionnaires about drug-resistant epilepsy were applied. The presence of drug-resistant epilepsy was the primary outcome. We used multilevel linear modeling in our data analysis.

RESULTS

Overall 47 (15.6%) individuals presented drug-resistant epilepsy and the etiology was structural in 70.2% of them, while infectious etiology was present in 8.5% of this group. Infectious etiology occurred in 25.9% (n = 66) of the patients from the nondrug-resistant group. Those with developmental delay were two times more likely to present seizures. Structural epilepsy etiology was associated with an increased chance of relapsing. Poor school performance and abnormal electroencephalogram were also associated with an increased chance of seizures.

CONCLUSION

The course of epilepsy was favorable in the majority of our patients, and drug-resistant epilepsy rates were similar to those found in other studies, although we evaluated older individuals with higher levels of infectious etiology. Also, we found that neurocysticercosis was associated with well-controlled epilepsy, while structural epilepsy was directly related to the occurrence of seizures. We also hypothesized that the smaller size of lesions found in neurocysticercosis could contribute to better treatment response.

Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide

OBJECTIVE

Central nervous system (CNS) infections cause significant morbidity and mortality and often require neurosurgical intervention for proper diagnosis and treatment. However, neither the international burden of CNS infection, nor the current capacity of the neurosurgical workforce to treat these diseases is well characterized. The objective of this study was to elucidate the global incidence of surgically relevant CNS infection, highlighting geographic areas for targeted improvement in neurosurgical capacity.

METHODS

A systematic literature review and meta-analysis were performed to capture studies published between 1990 and 2016. PubMed, EMBASE, and Cochrane databases were searched using variations of terms relating to CNS infection and epidemiology (incidence, prevalence, burden, case fatality, etc.). To deliver a geographic breakdown of disease, results were pooled using the random-effects model and stratified by WHO region and national income status for the different CNS infection types.

RESULTS

The search yielded 10,906 studies, 154 of which were used in the final qualitative analysis. A meta-analysis was performed to compute disease incidence by using data extracted from 71 of the 154 studies. The remaining 83 studies were excluded from the quantitative analysis because they did not report incidence. A total of 508,078 cases of CNS infections across all studies were included, with a total sample size of 130,681,681 individuals. Mean patient age was 35.8 years (range: newborn to 95 years), and the male/female ratio was 1:1.74. Among the 71 studies with incidence data, 39 were based in high-income countries, 25 in middle-income countries, and 7 in low-income countries. The pooled incidence of studied CNS infections was consistently highest in low-income countries, followed by middle- and then high-income countries. Regarding WHO regions, Africa had the highest pooled incidence of bacterial meningitis (65 cases/100,000 people), neurocysticercosis (650/100,000), and tuberculous spondylodiscitis (55/100,000), whereas Southeast Asia had the highest pooled incidence of intracranial abscess (49/100,000), and Europe had the highest pooled incidence of nontuberculous vertebral spondylodiscitis (5/100,000). Overall, few articles reported data on deaths associated with infection. The limited case fatality data revealed the highest case fatality for tuberculous meningitis/spondylodiscitis (21.1%) and the lowest for neurocysticercosis (5.5%). In all five disease categories, funnel plots assessing for publication bias were asymmetrical and suggested that the results may underestimate the incidence of disease.

CONCLUSIONS

This systematic review and meta-analysis approximates the global incidence of neurosurgically relevant infectious diseases. These results underscore the disproportionate burden of CNS infections in the developing world, where there is a tremendous demand to provide training and resources for high-quality neurosurgical care.

The association of living conditions and lifestyle factors with burden of cysts among neurocysticercosis patients in Ecuador

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.

Seroepidemiological study of human cysticercosis with blood samples collected on filter paper, in Lages, State of Santa Catarina, Brazil, 2004-2005

INTRODUCTION

Human serofrequency of antibodies against Taenia solium antigens was determined and risk factors for cysticercosis transmission were identified.

METHODS

Individuals (n=878) from periurban and rural locations of Lages, SC, were interviewed to gather demographic, sanitary and health information. Interviews and blood sample collections by finger prick on Whatman filter paper were performed from August 2004 to May 2005. Observation determined that 850 samples were suitable for analysis and were tested by ELISA using vesicular fluid of Taenia crassiceps heterologous antigen. To ensure the reliability of the results, 77 samples of the dried blood were matched with sera. The reactive samples were submitted to a serum confirmatory immunoblot (IB) test using purified Taenia crassiceps glycoproteins.

RESULTS

The ELISA results for the dried blood and serum samples were statistically consistent. ELISA was positive in 186 (21.9%) out of 850 individuals. A group of 213 individuals were asked to collect vein blood for IB (186 with positive result in ELISA and 27 with inappropriate whole blood samples) and 130 attended the request. The IB was positive in 29 (3.4%) out of 850 individuals. A significant correlation (p = 0.0364) was determined among individuals who tested positive in the IB assay who practiced both pig rearing and kitchen gardening.

CONCLUSIONS

ELISA with dried blood eluted from filter paper was suitable for cysticercosis population surveys. In Lages, human infection was associated with pig rearing and kitchen gardening. The prevalence index was compatible with other Latin American endemic areas.

Seizure in people with newly diagnosed active or transitional neurocysticercosis

PURPOSE

The aim of this study is to describe seizure as a presenting symptom in individuals with recently diagnosed neurocysticercosis (NCC).

METHODS

Using logistic regression, we examined the probability of having seizures as a presenting symptom among those with active or transitional NCC by host age and gender, and by number of cysts, location of the cysts in the brain, and phase of evolution of the encysted parasite.

RESULTS

We found that the odds of having seizures as presenting symptom for those in the youngest age group (3-24 years old) were 12.9 times that of the oldest participants (age 55-82 years) (p=0.006). People with cysts in parenchymal locations had a significantly higher odds of seizures compared to those with all their cysts elsewhere (ventricles or subarachnoid) (OR=6.2, p=0.028); and the number of cysts was significantly associated with having seizures (OR=1.1, p=0.026). Host gender and cyst phase were not significantly associated with having seizures after adjusting for confounders and covariates.

CONCLUSION

Children, those with cysts in parenchymal locations, and those with a higher number of cysts appear to be more likely to experience seizure when they have NCC cysts in the active or transitional stage.

[Cysticercosis' admissions in public health hospitals: Ceará State distribuition]

The geographic distribution of case registered in the System of Hospital Information of Ceará (1996-2004) and its relation with flock swine and availability of computerized tomography scan in patients' residence city, from those were studied. 424 Patients were admitted with cysticercosis (neurocysticercosis 98.3%) originating from 75 cities. No relation existed between computerized tomography in city of residence or swine flocks and cysticercosis prevelance.

Serodiagnosis of neurocysticercosis in patients with epileptic seizure using ELISA and immunoblot assay

Sera from 88 patients from Santa Catarina and São Paulo states of Brazil, with epileptic seizures who underwent cerebral computed tomography (CT) were analyzed for the detection of antibodies to T. solium cysticercus by ELISA and Immunoblot (IB) with the following antigens: Taenia solium cysticercus total saline (Tso), Taenia crassiceps cysticercus vesicular fluid (Tcra-vf) and T. crassiceps cysticercus glycoproteins (Tcra-gp). ELISA carried out with Tso, Tcra-vf and Tcra-gp antigens showed 95%, 90% and 80% sensitivities, respectively, and 68%, 85% and 93% specificities, respectively. In the epileptic patients group, ELISA positivity was 30%, 51% and 35% with Tso, Tcra-vf and Tcra-gp antigens respectively. Considering the IB as the confirmatory test, the positivity was 16% (14/88) in the epileptic patients total group and 22% (12/54) in the epileptic patients with positive CT and signals of cysticercosis. We found a significant statistical correlation among ELISA or IB results and the phase of the disease when any antigens were used (p < 0.05). We emphasize the need to introduce in the laboratory routine the search for neurocysticercosis (NC) in patients presenting with epileptic seizures because of the high risk of acquiring NC in our region and its potential cause of epilepsy.

Recombinant expression of Taenia solium TS14 antigen and its utilization for immunodiagnosis of neurocysticercosis

In order to evaluate the potential use of TS14 antigen in an enzyme-linked immunosorbent assay (ELISA) for immunodiagnosis of neurocysticercosis (NC), its open reading frame (ORF) was amplified by RT-PCR from mRNA isolated from Taenia solium cysticerci. The ORF was subcloned into the expression vector pET-28a, and was used to transform Escherichia coli BL21 (DE3) cells to produce TS14 antigen. The His-tagged expressed protein was purified on a nickel affinity column. Using the HISTS14 as antigen, ELISA was positive for 100% of cerebrospinal fluid (CSF) and 97% of serum samples from NC patients. No positive results were observed with sera and CSF samples from control groups. Cross-reactivity with sera from patients with schistosomiasis and Chagas' disease was not observed. Serum samples from patients with taeniasis were evaluated and 2 of 13 cases showed reactivity in this assay. Our data indicate the usefulness of HISTS14 in ELISA for an accurate and rapid assay for diagnosis of NC and seroepidemiological studies.

Movement disorders in Latin America

The authors review some particularities of movement disorders (MDs) in the ethnically diverse population of Latin America. Although idiopathic diseases are evenly prevalent, access to treatment encounters difficulties that are worth discussing. Infectious-parasitic diseases observed throughout the continent occasionally present as MDs, and will be individually reviewed. Inherited MDs with regional foci of increased prevalence, particularly spinocerebellar ataxias, will also be considered. Whereas there is no treatment for genetic disorders, most of the other conditions are preventable or amenable to adequate treatment. Hope for better health standards for the Latin American population lies in profound social and political changes that are still to come.

Estudo soroepidemiológico da cisticercose humana em um município do Estado do Piauí, Região Nordeste do Brasil

Integrando as pesquisas sobre parasitoses na região do entorno do Parque Nacional Serra da Capivara, Piauí, Brasil, realizadas entre 1999 e 2001, o presente estudo tem como objetivo avaliar a situação epidemiológica da cisticercose humana no Município de João Costa, no Nordeste do Brasil. Foram obtidas informações clínico-epidemiológicas e coletadas amostras de sangue para testes sorológicos imunoenzimáticos (ELISA e Western blot), empregando cisticercos de Taenia crassiceps como antígeno. Na primeira etapa, em 1999, foram investigadas 169 pessoas com história confirmada ou suspeita de infecção/doença pelo complexo teníase-cisticercose, e seus familiares. Na análise, 13,6% das pessoas apresentaram soros reagentes para cisticercose pelo método ELISA. Na segunda etapa, em 2001, foram avaliadas 92 amostras de soro de indivíduos reativos para cisticercose detectados no primeiro momento e seus familiares, sendo que 24,0% das amostras de soro foram reagentes para cisticercose pelo ELISA, e 29,0%, pelo WB. Nessa mesma etapa, realizou-se inquérito coprológico em 701 pessoas, incluindo voluntários. A prevalência de parasitoses intestinais foi de 51,0%, tendo sido observada uma maior prevalência de protozoários (95,0%) em relação aos helmintos (5,0%). Os resultados do estudo indicam o caráter endêmico da cisticercose na área, além da elevada freqüência de protozooses intestinais.

Interictal serum S100B levels in chronic neurocysticercosis and idiopathic epilepsy

OBJECTIVE

To assess whether serum S100B levels could reflect a glial response in patients with epilepsy secondary to neurocysticercosis (NCC) and with idiopathic epilepsy.

SUBJECTS AND METHODS

Serum S100B levels were measured using an immunoluminometric assay in 20 patients with focal epilepsy related to chronic NCC (NCC group), and 19 patients with focal epilepsy (EPI group), matched by epidemiological and clinical data. Epileptic patients were compared with 20 healthy controls (CON group) matched by age and sex.

RESULTS

No difference was observed in S100B levels among NCC, EPI and CON groups (P>0.39). Serum S100B levels were not affected by antiepileptic drugs, frequency and type of seizures. Preliminarily, significantly higher levels of S100B were observed in patients with bilateral electroencephalographic (EEG) findings than in patients with unilateral and normal EEG findings (P<0.05).

CONCLUSION

Serum S100B is normal in patients with focal epilepsy related or not to chronic NCC.

Aspectos clínico-epidemiológicos da neurocisticercose no Brasil: análise crítica

Com o objetivo de mostrar as características da neurocisticercose (NCC) no Brasil, realizou-se análise critica da literatura nacional que mostrou incidência de 1,5% nas necropsias e de 3,0% nos estudos clínicos, correspondendo a 0,3% das admissões em hospitais gerais. Em estudos soroepidemiológicos, a positividade para cisticercose foi de 2,3%. O paciente brasileiro com NCC pode apresentar um perfil clínico-epidemiológico geral (homem, 31-50 anos, procedência rural, manifestações epilépticas parciais complexas, LCR normal ou hiperproteinorraquia, calcificações ao exame de TC, constituindo a expressão da forma inativa da NCC) e outro de gravidade (mulher, 21-40 anos, procedência urbana, manifestações de cefaléia vascular e HIC, típica síndrome do LCR ou alteração de dois ou mais parâmetros, vesículas associadas ou não a calcificações ao exame de TC, constituindo a expressão da forma ativa da NCC). Os coeficientes de prevalência nacionais são muito subestimados, embora em duas cidades do interior de São Paulo tenham sido verificados os valores de 72:100.000 e 96:100.000/habitantes. Discutem-se aspectos relacionados à subestimação da prevalência desta neuroparasitose no Brasil.

Cognitive Performance of Patients with Epilepsy and Calcified Neurocysticercotic Lesions: A Case-Control Study

Neuropsychological tests were applied to 20 patients with focal epilepsy related to calcified neurocysticercosis (NCC) (mean: three lesions/patient; NCC group), 22 patients with focal epilepsy without NCC (EPI group), and 29 healthy controls matched for age, sex, and educational level. The EPI and NCC groups were matched for age at onset of epilepsy, epilepsy duration, frequency of attacks, seizure semiology, interictal EEG findings, and antiepileptic drugs used. There were no differences in the digit span, word span, calculus, and Mini-Mental State examination among the three groups studied. The NCC and EPI groups showed lower scores than controls in immediate and delayed verbal memory, famous faces test, spatial recognition span, abstractions and judgment, and visuoconstructional abilities. The EPI group, but not the NCC group, also had lower scores in a praxis tests. There were no differences between the NCC and EPI groups in any of the tests applied (P > 15), except for the spatial recognition span, which was lower in the former. Cognitive impairment is a prevalent neuropsychological feature of patients with epilepsy and NCC.

Condições mais frequentes em um ambulatório de perícia neurológica

OBJETIVO: Apresentar as condições nosológicas vistas em perícia neurológica em um ambulatório de referência estadual do Instituto Nacional de Seguridade Social (INSS), Florianópolis, Santa Catarina, Brasil, durante o período de outubro de 97 a maio de 98. MÉTODO: Revisão dos relatórios especializados das perícias solicitadas ao especialista em neurologia, com identificação dos diagnósticos finais dos 108 pacientes encaminhados para avaliação. RESULTADOS: Os diagnósticos mais comuns em ordem decrescente de frequência foram: epilepsia, doenças reumatológicas, distúrbios psiquiátricos, alterações neurológicas associadas a alcoolismo crônico, síndrome pós TCE e doença vascular cerebral. CONCLUSÕES: Doenças neurológicas podem determinar importante grau de incapacidade no trabalhador catarinense. Contudo, existe um subestimado potencial de recuperação funcional. Além disso, diversas condições não genuinamente neurológicas são encaminhadas para avaliação especializada.

[Etiology of the epileptic seizures in Recife city, Brazil: study of 249 patients]

The etiological causes of the epileptic seizures presenting by 249 patients were studied, in a neurological clinic in Recife City, Brazil. The cause of the seizure was not identified in 43.0% of the patients. As suspected causal factors we found: ischemic cerebrovascular disease (ICVD, 17.3%), cysticercosis (8.8%), head trauma (HT, 6.8%), brain tumors (6.8%), hemorrhagic cerebrovascular disease (HCVD, 4.8%), vascular malformation (3.6%), other causes (8. 4%). In the patients with age less than 15-year-old, the most frequent cause was cysticercosis (10.3%), following vascular malformation (5.1%), and ICVD (5.1%). In the group between 15 and 45 years of age the major cause of seizure was cysticercosis (11.6%), following HT (10.7%), ICVD (4.5%), and brain tumors (3.6%). On the other hand, in the patients with more than 45-year-old the main cause was ICVD (36.7%), following brain tumors (12.3%), HCVD (11.2%), and cysticercosis (5.1%). Im conclusion, cerebrovascular disease was the most prevalent cause of epileptic seizures, considering all groups of patients. Although, cysticercosis was main cause found in the patients with less than 45 years of age.

[Causes of late-onset epilepsy in an epilepsy clinic of Santa Catarina--Southern Brazil]

OBJECTIVE

To identify the most common etiologies of late-onset epilepsy in our society.

METHOD

Retrospective and descriptive study in the CME/SUS of Florianópolis from 1990 to 1998, evaluating 120 handbooks of patients with late-onset epilepsy, that is, those that had initiated epileptic seizures of the 18 years in ahead. The collected variables were: age of the first seizure, etiologies and morbid familial history.

RESULTS

The prevalence rate found for late-onset epilepsy was 29.48%. Most of the sample had partial symptomatic epilepsy and the most frequent and important were: cysticercosis with 20%, head trauma with 15%, febrile convulsions in infancy with 5% and 35% were classified as idiopatic.

CONCLUSION

Prevalence of late-onset epilepsy in our society is 29.48%, value slightly upper to the told one in developed countries (25%). Very probably, this difference is consequence of the epidemic character of cysticercosis among us. Moreover, head trauma and febrile convulsions are common etiologies. Prophylaxis of epilepsy is viable and urgently necessary in our society.

[Clinical-epidemiological study of patients with juvenile myoclonic epilepsy in Santa Catarina State, Brazil]

We aimed to characterize the clinical profile and to establish the prevalence of juvenile myoclonic epilepsy (JME) among 939 consecutive patients referred to our epilepsy clinic. Inclusion criteria in the study were: a) myoclonic jerks, preferably on awakening; b) beginning of the symptoms between 8 and 26 year-of-age; c) typical pattern of electroencephalographic discharges; and d) good response to sodium valproate (VPA). In a retrospective design, 26 cases of JME were identified (prevalence 2.8%). Most of these patients were female (73.1%). Mean age at onset of symptoms was 13 (range 7-18). Tonic-clonic seizures were reported in 92.3% and absence seizures in 19.2%. Besides, 92.3% of the patients had typical EEG epileptiform activity and 76.9% had good response to VPA with daily dose ranging from 500 mg to 1500 mg.