Does treatment change the outcome of seizures and computerized tomographic lesions in intracranial granulomas?

Abstract

In children, intracranial granuloma diagnosed on computerized tomography (CT) scan and presenting with seizures as the sole manifestation has traditionally been treated with antitubercular (ATB) therapy or albendazole (Alb) in addition to antiepileptic drugs (AED). This study was conducted to determine whether AED therapy alone or specific treatment (ATB + Alb) influences the outcome of seizures and the CT lesion. Sixty-eight children presenting with seizures along with intracranial granuloma on CT scan were selected for the study. They were randomly divided into two groups. Group A (n = 34) was treated with AED alone and group B (n = 34) received antitubercular therapy and albendazole in addition to AED. Seizure type was noted and electroencephalogram (EEG) and CT scan were done in all. They were followed up for a period of 2 to 9 years, during which a record of seizure count and type was maintained. CT scans were repeated at 3 monthly intervals and EEGs were repeated whenever indicated. Four patients in each group were lost to follow-up. Seizures persisted in four out of 30 in group A and six out of 30 in group B. There was no statistically significant difference (p > 0.05) in the outcome of seizures in the two groups. Taking the whole group together (n = 60), of the 13 who had presented with multiple seizures at onset, epilepsy was a sequela in five (p < 0.05); and of the 17 in whom the lesion had calcified, seizures persisted in seven (p < 0.05), irrespective of treatment modality. In conclusion, though specific treatment did not alter the outcome of seizures, children with multiple seizures at presentation and calcification of CT lesion had epilepsy as a sequela.

Clinical profile and outcome of pediatric neurocysticercosis: A study from Western Nepal

“…Probably these calcified foci or perilesional gliosis acted as the trigger for recurrence of seizures. This significant improvement in EEG is not in accordance with some previous studies [14,15] and probably may be due to the high incidence of active and transitional lesions which responded favorably to therapy.…”

“…Persistent headache, vomiting and focal neurologic deficit were probably due to residual cysts acting as space occupying lesions, whereas persistent calcified lesions were responsible for seizures. Opinions also vary on the use of anticonvulsants for control of seizures and the probability of seizure-free period after discontinuation of these drugs [13][14][15]. In the present study, carbamazepine was used for 6 months in all barring those showing toxicity, in whom phenytoin was added.…”

Calcific neurocysticercosis and epileptogenesis

“…Similarly, in an unpublished study of a prospectively evaluated rural Honduran population with neurocysticercosis and epilepsy, Medina et al found that 76% had only calcifications, 9% cystic lesions, and 15% mixed lesions. There are at least three pieces of evidence that suggest calcified lesions play a role in epileptogenesis: 1) high prevalences of typical cerebral calcifications in patients with seizures or epilepsy in the absence of other etiologies,21,22 2) a positive correlation between endemic populations with increased proportions of calcification and seizure activity, and 3) an increased risk of continued seizure activity due to single cysticercal granuloma that calcify 23,24…”

Diagnosis and Treatment of Neurocysticercosis

“…Strong evidence supports the role of calcified lesions in seizures; there is a high prevalence of cerebral calcifications in patients with seizures in the absence of other etiologies, and there is a positive correlation between endemic populations with increased proportions of calcification and seizure activity. In addition, individuals with calcified granulomas have increased risk of ongoing seizure [14–17]. …”