The role of the irritative zone and of the number and distribution of calcifications in the severity of epilepsy associated with intracranial calcifications

Kowacs, Pedro André; Rogacheski, Ênio; Muzzio, Juliano André; Werneck, Lineü Cesar

doi:10.1590/s0004-282x2006000600003

Cited by 17 publications

(10 citation statements)

References 33 publications

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“…Calcifications are usually considered to be an indication of cyst resolution, and continued seizures associated with calcified cysts may be considered to be unprovoked and therefore epilepsy. Perilesional edema associated with calcified lesions has been described 12,14,[38][39][40] and may explain these seizures.…”

Section: Discussionmentioning

confidence: 99%

Exploring the complex associations over time among albendazole treatment, cyst evolution, and seizure outcomes in neurocysticercosis

et al. 2019

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Objective To develop a causal model for the occurrence of neurocysticercosis (NC)‐related seizures and test hypotheses generated from the model. Methods We used data from a randomized controlled trial comparing albendazole with placebo among patients newly diagnosed with NC. Based on our causal model, we explored the associations among albendazole treatment, NC cyst evolution, and seizure outcomes over 24 months of follow‐up using generalized linear mixed effect models. Results We included 153 participants, of whom 51% received albendazole. The association between seizure outcomes and treatment over time demonstrated lack of linearity and heterogeneity, requiring the inclusion of time‐treatment interaction terms for valid modeling. Participants in the albendazole group had fewer seizures overall and of partial onset at all time points compared with the placebo group, but the difference increased over the first few months following treatment, then decreased over time. Generalized seizures exhibited a more complex association; those in the albendazole group had fewer seizures compared with those in the placebo group for the first few months after treatment, and then the association reversed and those in the placebo arm had fewer seizures. Adjusting for the number of NC cysts in each phase resulted in an attenuation of the strength of association between albendazole and seizure outcomes, consistent with mediation. Among participants in whom all cysts had disappeared (n = 21), none continued to have seizures. Significance Albendazole treatment is associated with a possible reduction in focal seizures in the short term (3‐6 months), perhaps by hastening the resolution of the cysts. However, the effect is not discernible over the long term, because most cysts either calcify or resolve completely, regardless of whether treated with albendazole. The stage of evolution of the cysticercus is an important consideration in the evaluation of albendazole effect on seizure outcome.

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Section: Discussionmentioning

confidence: 99%

Exploring the complex associations over time among albendazole treatment, cyst evolution, and seizure outcomes in neurocysticercosis

et al. 2019

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“…Moreover, some authors still argue that cysticercotic lesions in the brain can be innocent bystanders present in many PWE living in regions where this parasitic disease is endemic. 31,32 Although this is theoretically possible-and must occur in a reduced percentage of cases-several pieces of evidence favor a causal relationship between NCC and recurrent nonprovoked seizures. Published evidence include abundant descriptions of cases with focal epilepsies related to the location of a single parasite in the brain parenchyma, [33][34][35][36][37] the higher prevalence of epilepsy in cysticercosis-endemic areas when compared with nonendemic regions, 38 and the occurrence of inflammatory changes surrounding parenchymal brain cysticerci immediately after a seizure in up to 50% cases.…”

Section: Discussionmentioning

confidence: 99%

On the relationship between calcified neurocysticercosis and epilepsy in an endemic village: A large‐scale, computed tomography–based population study in rural Ecuador

Brutto

Arroyo²,

Brutto

et al. 2017

Epilepsia

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SUMMARY Objective Using a large-scale population-based study, we aimed to assess prevalence and patterns of presentation of neurocysticercosis (NCC) and its relationship with epilepsy in community-dwellers aged ≥20 years living in Atahualpa (rural Ecuador). Methods In a three-phase epidemiological study, individuals with suspected seizures were identified during a door-to-door survey and an interview (Phase I). Then, neurologists evaluated suspected cases and randomly selected negative persons to estimate epilepsy prevalence (Phase II). In Phase III, all participants were offered non-contrast CT for identifying NCC cases. The independent association between NCC (exposure) and epilepsy (outcome) was assessed by the use of multivariate logistic regression models adjusted for age, sex, level of education and alcohol intake. CT findings were subsequently compared to archived brain MRIs in a sizable subgroup of participants. Results Of 1,604 villagers aged ≥20 years, 1,462 (91%) were enrolled. Forty-one persons with epilepsy (PWE) were identified, for a crude prevalence of epilepsy of 28 per 1,000 population (95% C.I.: 20.7 – 38.2). A head CT was performed in 1,228 (84%) out of 1,462 participants, including 39 of 41 PWE. CT showed lesions consistent with calcified parenchymal brain cysticerci in 118 (9.6%) cases (95% C.I.: 8.1% – 11.4%). No patient had other forms of NCC. Nine of 39 PWE, as opposed to 109 of 1,189 participants without epilepsy, had NCC (23.1% versus 9.2%, p=0.004). This difference persisted in the adjusted logistic regression model (OR: 3.04; 95% C.I.: 1.35 – 6.81; p=0.007). Significance This large CT-based study demonstrates that PWE had three times the odds of having NCC than those without epilepsy, providing robust epidemiological evidence favoring the relationship between NCC and epilepsy.

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“…Not infrequently, patients with NCC-associated epilepsy in endemic regions lack correlation between the location of the parasites, the semiology of seizures, and EEG findings, raising doubts on seizure causality and leading to hypothesize that in these cases, both conditions might merely occur by chance [23, 24]. While this is possible and might occur in a minority of cases, there is robust evidence favoring a causal relationship between NCC and seizures, including the higher prevalence of epilepsy in cysticercosis-endemic areas when compared with non-endemic regions areas [15–18, 19•] and the occurrence of focal inflammatory changes surrounding parenchymal brain cysticerci immediately after a seizure in about 50 % cases [25].…”

Section: Ncc Seizures and Epilepsymentioning

confidence: 99%

Update on Cysticercosis Epileptogenesis: the Role of the Hippocampus

Brutto

Engel

Eliashiv

et al. 2015

Curr Neurol Neurosci Rep

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Neurocysticercosis (NCC) is the most common helminthic infection of the nervous system and a frequent cause of reactive seizures and epilepsy worldwide. In many cases, multiple episodes of focal seizures related to an identifiable parenchymal brain cyst (and likely attributable to local damage) continue for years after the cyst resolves. However, cases where seizure semiology, interictal EEG abnormalities, and parasites location do not correlate raise concerns about the causal relationship between NCC and either reactive seizures or epilepsy, as well as the epileptogenic potential of parasites. Neurosurgical series of patients with intractable epilepsy and cross-sectional population-based studies have shown a robust association between NCC and hippocampal sclerosis (HS), which might contribute to the above-referred inconsistencies. Current information does not allow to define whether in patients with NCC, HS could result from recurrent seizure activity from a local or distant focus or from chronic recurrent inflammation. In either case, HS may become the pathological substrate of subsequent mesial temporal lobe epilepsy (MTLE). Longitudinal clinical- and population-based cohort studies are needed to evaluate the causal relationship between NCC and HS and to characterize this association with the occurrence of MTLE. If a cause-and-effect relationship between NCC and HS is demonstrated, NCC patients could be assessed to examine neuronal mechanisms of hippocampal epileptogenesis in comparison with animal models, to identify biomarkers of hippocampal epileptogenesis, and to develop novel interventions to prevent epilepsy in NCC and perhaps in other forms of acquired epilepsy.

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The role of the irritative zone and of the number and distribution of calcifications in the severity of epilepsy associated with intracranial calcifications

Cited by 17 publications

References 33 publications

Exploring the complex associations over time among albendazole treatment, cyst evolution, and seizure outcomes in neurocysticercosis

Exploring the complex associations over time among albendazole treatment, cyst evolution, and seizure outcomes in neurocysticercosis

On the relationship between calcified neurocysticercosis and epilepsy in an endemic village: A large‐scale, computed tomography–based population study in rural Ecuador

Update on Cysticercosis Epileptogenesis: the Role of the Hippocampus

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