No abstract

These findings confirm that T. solium NCC is a significant cause of epilepsy at the community level in Andean villages of Ecuador. It is important to initiate effective public health interventions to eliminate this infection, which may be responsible for at least half of the cases of reported epilepsy in Ecuador.

Intractable headaches have been described as the presenting complaint of many patients with T. solium neurocysticercosis. We conducted a house-to-house neuroepidemiological survey of 2,723 residents of an Andean community, known to be endemic for this infection. Migraine headaches were confirmed in 187 cases (68.7 per thousand), and tension headaches were diagnosed in 77 cases (28.3 per thousand). Fifty-seven migraine sufferers accepted computed tomography examination, and in 19 it revealed neurocysticercosis. In 11 out of 52 migraineurs who had their blood drawn, electron immunotransfer blot testing (EITB) was positive for anticysticercal antibodies. In a computer-generated random sample of this community, 109 headache-free individuals were examined by CT, and 87 had EITB. Of the 109 subjects examined by CT, 14 were positive for cysticercosis. Of the 87 individuals tested by EITB, 7 were positive. A statistically significant difference between the symptom-free general population and the migraine patients was obtained for both CT (odds ratio 3.39, P < 0.005) and EITB (odds ratio 3.07, P < 0.05) diagnosis of neurocysticercosis. Neurocysticercosis appears to be a significant risk factor for the presentation of migraine-type headaches in areas endemic for T. solium infection.

A census, uniform screening questionnaire, and simple screening neurologic examination were administered in a door-to-door survey to residents of Quiroga, Ecuador, a rural community in the Andes Mountains. The screening procedures had been pretested to assure a high level of sensitivity for detecting children and adults with major neurologic disease. A total of 1,113 participated in the study. Of these, 399 had responses or findings suggesting the presence of neurologic disease. These individuals were then examined by a neurologist, who used fixed diagnostic criteria. The prevalence ratios (per 1,000) for the most common neurologic conditions identified in this survey are: recurrent/persistent severe headache = 68.3, and epilepsy = 17.1.

One hundred consecutive patients presenting with symptoms and signs of neurocysticercosis, confirmed by neuroimaging techniques, were randomly assigned to treatment with either praziquantel 50 mg/kg/d for 15 d or albendazole 15 mg/kg/d for 30 d. All patients were treated in addition with steroids for 45 d. Follow-up was for 90 d for response to treatment and at least 1 year for recurrence. Although similar numbers of patients showed no improvement in neuroimaging criteria at 3 months, the response to albendazole was more pronounced with larger numbers showing marked improvement or disappearance of lesions. Resolution of the presenting neurological signs and symptoms was also more frequent in the albendazole group. Electroencephalographic changes also became normal. The use of steroid cover eliminated the headache frequently present during the first few days of treatment and permitted severe cases to be treated. Both albendazole and praziquantel appeared to be effective at the doses used, with albendazole showing a slightly better overall response.