Calcified cysticercotic lesions and intractable epilepsy: a cross sectional study of 512 patients

Velasco, Tonicarlo Rodrigues; Zanello, Paulo A.; Dalmagro, Charles L.; Araújo, David; Santos, Antônio Carlos dos; Bianchin, Marino M.; Alexandre, Veriano; Walz, Roger; Assirati, João Alberto; Carlotti, Carlos Gilberto; Takayanagui, O. M.; Sakamoto, Américo Ceiki; Leite, João P.

doi:10.1136/jnnp.2005.078675

Cited by 75 publications

(74 citation statements)

References 23 publications

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“…The current evidence regarding the epileptogenicity of NC, and specifically the role of CNLs in AED-resistant epilepsy, is scarce and based on anecdotal cases. We agree with Rathore et al 1 and others 6,7 that if the presence of CNLs is a cause for AED-resistant epilepsy, it is exceptionally rare. We would propose conducting a prospective cohort study to assess the association of different evolutive phases of the parasite and the development of seizures, as well as the evolution of NC cysts after medical (and/or surgical) treatment.…”

Section: To the Editorssupporting

confidence: 67%

Should calcified neurocysticercosis lesions be surgically removed?

Carpio

Romo

2014

Epilepsia

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Section: To the Editorssupporting

confidence: 67%

Should calcified neurocysticercosis lesions be surgically removed?

Carpio

Romo

2014

Epilepsia

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“…23 Data from a tertiary care epilepsy surgical service in Brazil suggest that hippocampal atrophy in patients with NCC is related to repetitive seizure activity. [4][5][6] Although this is a plausible pathogenic trigger for hippocampal atrophy, it is difficult to draw broad conclusions from a population limited to cases of medically intractable epilepsy. A plausible alternative involves inflammation-mediated damage as the causative mechanism for hippocampal atrophy.…”

Section: Discussionmentioning

confidence: 99%

“…3 Several clinical series and a few controlled studies suggest an association between neurocysticercosis (NCC) and hippocampal atrophy. [4][5][6][7] However, it is not yet clear whether this association is related to repetitive seizure activity or to mechanisms of local or remote inflammation. [8][9][10] We recently reported the association between calcified NCC and hippocampal atrophy in a population of 248 older adults living in rural Ecuador.…”

Section: Introductionmentioning

confidence: 99%

The Association Between Neurocysticercosis and Hippocampal Atrophy is Related to Age

Brutto¹,

Issa²,

Salgado³

et al. 2016

Am J Trop Med Hyg

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Abstract. Neurocysticercosis (NCC) has been associated with hippocampal atrophy, but the prevalence and pathogenic mechanisms implicated in this relationship are unknown. Using a population-based, case-control study design, residents in a rural village (Atahualpa) aged ≥ 40 years with calcified NCC were identified as cases and paired to NCCfree individuals (control subjects) matched by age, sex, and level of education. Cases and control subjects underwent magnetic resonance imaging for hippocampal rating according to the Scheltens' scale for medial temporal atrophy and were interviewed to identify those with a clinical seizure disorder. The prevalence of hippocampal atrophy was compared between cases and control subjects by the use of the McNemar's test for correlated proportions. Seventy-five individuals with calcified NCC and their matched control subjects were included in the analysis. Hippocampal atrophy was noted in 26 (34.7%) cases and nine (12%) control subjects (odds ratio: 4.4; 95% confidence interval: 1.6-14.9, P < 0.0021). Stratification of pairs according to tertiles of age revealed an age-related trend in this association, which became significant only in those aged ≥ 68 years (P = 0.027). Only five cases and one control had recurrent seizures (P = 0.221); three of these five cases had hippocampal atrophy, and the single control subject had normal hippocampi. This study confirms an association between NCC and hippocampal atrophy, and shows that this association is stronger in older age groups. This suggests that NCC-related hippocampal atrophy takes a long time to develop.

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“…Because of the high prevalence of NC and epilepsy, a causal, as well as incidental relationship between the two conditions might exist 34,35 . NC is also an uncommon cause of intractable epilepsy, even in endemic regions and may only represent a coexistent pathology as demonstrated by a cross-sectional study investigating the etiology of intractable epilepsy in 512 patients in Brazil 36 .…”

Section: Mri Of Vesicular Cysticerci (A) Mri Of Colloidal Cysticercimentioning

confidence: 99%

The relationship between neurocysticercosis and epilepsy: an endless debate

Carpio

Romo

2014

Arq. Neuro-Psiquiatr.

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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.Keywords: cysticercosis, Taenia solium, seizure, parasitic. RESUMOA neurocisticercose (NC) ou infecção cerebral pela Taenia solium é importante problema de saúde pública em todo o mundo. Entre as sequelas neurológicas da NC, as crises convulsivas têm sido descritas como os sintomas mais frequentes. Crises convulsivas sintomáticas agudas resultam, muitas vezes, da degeneração de cistos viáveis; entretanto, nem todos os pacientes com NC e crises agudas ou provocadas desenvolvem epilepsia (i.e., crises recorrentes não provocadas). Pode haver uma relação entre epilepsia e NC, causal ou incidental, devido à alta prevalência de ambas. O potencial epileptogênico dos cistos calcificados assim como a possível associação entre NC e esclerose hipocampal ainda necessitam de futuras pesquisas. O tratamento anti-helmíntico da NC resulta no desaparecimento de cistos viáveis em cerca de 1/3 dos pacientes com a doença parenquimatosa, mas não foi demonstrada redução nas taxas de recorrência das crises convulsivas em estudos randomizados controlados. A prevenção é crítica para reduzir o contingente de crises convulsivas e epilepsia relacionadas à NC.

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Calcified cysticercotic lesions and intractable epilepsy: a cross sectional study of 512 patients

Cited by 75 publications

References 23 publications

Should calcified neurocysticercosis lesions be surgically removed?

Should calcified neurocysticercosis lesions be surgically removed?

The Association Between Neurocysticercosis and Hippocampal Atrophy is Related to Age

The relationship between neurocysticercosis and epilepsy: an endless debate

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