Clinical profile and follow-up of 51 pediatric neurocysticercosis cases: A study from Eastern India

Abstract

Introduction:Our present observational study attempted to evaluate the clinical profiles, diagnosis, treatment and follow-up results of 51 pediatric neurocysticercosis patients over a mean duration of five years (from January 2006 to December 2010).Materials and Methods:Diagnosis was mainly based on clinical features, computed tomography (CT)/magnetic resonance imaging scan and exclusion of other causes. Patients with active, transitional cysts and seizure were treated with albendazole for 28 days, steroids and anticonvulsants.Results:A total of 38 patients completed this study. Mean age of the presentation was 8.47 ± 3.19 years 52.6% of the patients were female. Overall patients presented with generalized seizure in 55.3%, focal in 31.6%, headache ± vomiting in 63.2%, focal neurodeficit in 10.5% and combination of symptoms in 60.5% cases. Contrast CT brain showed a solitary lesion in 27 (71.1%) and multiple in the rest. At presentation lesions were transitional in 58.2%, inactive in 20% and mixed in 14.6%. After a mean of 2 years, seizure persisted in 9 (23.7%) and headache in 8 (21.1%) of whom six had normal electroencephalography (EEG) while one each showed focal slowing, generalized slowing and epileptiform discharges. During the follow-up, CT scan brain 44.7% lesions calcified, 31.6% disappeared, 10.5% regressed and the rest persisted.Conclusion:Solitary ring enhancing lesions (transitional stage) involving the parietal lobe was the commonest CT picture at presentation. Generalized tonic-clonic seizure was the most common type of seizure. Number of lesions, persistence of lesion, number of seizures, EEG abnormality at presentation were not found to be prognostically significant (P > 0.05).

Study of clinical and radiological profile of children with neurocysticercosis

“…10 In present study, out of 50 children who presented with neurocysticercosis, 23 had a lesion in vesicular stage, followed by 16 children with the lesion in nodular calcified stage while 5 children had lesions in granular nodular stage and only three children had a lesion in colloidal vesicular stage.…”

“…10 In a Previous study from Chandigarh by Singhi P et al, 53.2% patients were documented as pure vegetarians.…”

“…10 A lumbar puncture was done on children showing signs of meningeal irritation which yielded results within normal limits. Tuberculosis is a common cause of granuloma producing a symptomatology and causing a diagnostic dilemma.…”

Inflammation is a key risk factor for persistent seizures in neurocysticercosis

“…Previous studies of the association between disease burden and seizure severity in NCC patients have had mixed results,4, 31 and thus it is possible that other factors can modify the strength of this association. Our study results suggest that the degree of the inflammatory response to the parasite may be one of these factors.…”

Multiple ring enhancing lesions in a patient with unilateral limb jerking

“…In one study among pediatric patients, a solitary ring enhancing lesion in the parietal lobe was the most common finding in pediatric neurocysticercosis patients [3]. In another instance, FDG-PET was used to exclude malignancy and support the diagnosis of neurocysticercosis in a patient with REL in the right temporal lobe and seizures [4].…”