Neurocysticercosis in Children Presenting With Afebrile Seizure: Clinical Profile, Imaging and Serodiagnosis

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.

Study of partial seizures in children with respect to EEG and CT Scan

“…Similar observation is seen inBaheti R [10] were suffering from neurocyticercosis, majority that is 38 of the cases presented with a single ring enhancing lesion and 15 cases presented with more than two lesions based on CT scan report. The distribution of lesions in various parts of the brain showed that the majority were in the parietal lobe followed by frontal, occipital lobes in Sahu PS [17] study; this finding is similar with our study. The most common lobe involved in our study was parietal lobe (26) followed by frontal (15) and temporal (10).…”

Occurrence of neurocysticercosis in patients presenting with seizure and its serological evaluation

“…Sahu et al, in their study found positivity rate of 37.7% which is similar to ours (38%). 9 Chaudhary et al, reported this rate to be 42.9%, which is slightly higher than that observed in present study. 11 Kumar et al, on the other hand found positivity rate of 71% which is much higher than that observed in present study.…”

“…[2][3][4][5][6][7] In the recent years, neurocysticercosis has been recognized as one of the major diagnoses among patients with seizures in both adult as well as paediatric age groups. [8][9][10][11] In some recent studies in children, its occurrence in seizure affected children has been reported to be as high as 40%. 9,11 The increasing occurrence of neurocysticercosis in childhood seizures in recent years might be attributable to emergence of more sensitive imaging and immunological tests.…”

“…[8][9][10][11] In some recent studies in children, its occurrence in seizure affected children has been reported to be as high as 40%. 9,11 The increasing occurrence of neurocysticercosis in childhood seizures in recent years might be attributable to emergence of more sensitive imaging and immunological tests. 12 Neurocysticercosis (NCC), also termed as intracerebral cysticercosis is common parasitic (zoonotic=animal borne) infection that affects the nervous system which manifest as seizure disorder.…”

Parasitic disease in the pediatric intensive care unit - A review of severe manifestations of pediatric parasitic disease

“…As it often takes more than a decade for cysts to degenerate and initiate an immune reaction leading to seizures, the peak incidence of neurocysticercosis is in adolescents and adults; somewhat younger patients may be diagnosed in highly endemic areas [36,37]. The cardinal presentation of neurocysticercosis is epileptic seizures, the sole manifestation in almost 70% of patients [38].…”