Dual/double pathology in neurocysticercosis causing drug resistant epilepsy – Chance association or causal?

Mhatre, Radhika; Poyuran, Rajalakshmi; Arivazhagan, Arimappamagan; Sinha, Sanjib; Kulanthaivelu, Karthik; Kenchaiah, Raghavendra; Asranna, Ajay; Chowdary, Ravindranadh Mundlamuri; Saini, Jitender; Bharath, Rose Dawn; Zanzmera, Paresh; Raghavendra, S.; Sadashiva, Nishanth; Rajan, Jamuna; Satishchandra, Parthasarathy; Malla, Bhaskara Rao; Sk, Shankar; Mahadevan, Anita

doi:10.1016/j.eplepsyres.2020.106472

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…Rathore et al ( 38 ) observed that patients with MTLE-HS and cNCC had a lower incidence of febrile seizures, older age at IPI, and more diffuse epileptiform discharges compared to patients with MTLE-HS alone, findings in line with some of our previous results ( 35 , 40 , 79 ). A possible cause-effect of NCC and MTLE-HS has also been suggested by some other authors ( 12 , 74 , 75 , 77 , 78 ).…”

Section: Discussionsupporting

confidence: 65%

“…According to this hypothesis, NCC would be a type of CNS infection that could act as an IPI leading to hippocampal damage and MTLE-HS later in life due to inflammatory mechanisms or repetitive seizures. These two mechanisms are not mutually exclusive and both could contribute to the development of HS and MTLE-HS ( 33 – 45 , 74 , 75 , 77 , 78 ). Some case reports seem to point in this direction.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the Association of Calcified Neurocysticercosis and Mesial Temporal Lobe Epilepsy With Hippocampal Sclerosis in a Large Cohort of Patients With Epilepsy

et al. 2022

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BackgroundNeurocysticercosis (NCC) is a parasitic infection of the central nervous system that has been associated with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). However, this association has not been completely established.ObjectiveTo evaluate the prevalence of calcified NCC (cNCC), its characteristics and a possible association between cNCC and MTLE-HS in a cohort of 731 patients with epilepsy.MethodsWe review clinical, EEG and neuroimaging findings of 731 patients with epilepsy. From these, 659 had CT-scans and 441 patients had complete neuroimaging with CT-scans and MRI. In these patients, we review the prevalence and characteristic of epilepsy in cNCC and in MTLE-HS patients.ResultsForty-two (6.4%) of the 659 patients studied with CT-scans had cNCC. cNCC lesions were more frequent in women than in men (n = 33–78.6% vs. n = 09–21.4%, respectively; OR = 3.64;(95%CI = 1.71–7.69); p < 0.001). cNCC was more often in patients who developed epilepsy later in life, in older patients, in patients who had a longer history of epilepsy, and in those with a lower educational level. MTLE–HS was observed in 93 (21.1%) of 441 patients that had complete neuroimaging, and 25 (26.9%) of these 93 patients also had cNCC. Calcified NCC was observed in only 17 (4.9%) of the remaining 348 patients that had other types of epilepsy rather than MTLE-HS. Thus, in our cohort, cNCC was more frequently associated with MTLE-HS than with other forms of epilepsy, O.R. = 11.90;(95%CI = 6.10–23.26); p < 0.0001).ConclusionsAs expected, in some patients the epilepsy was directly related to cNCC lesional zone, although this was observed in a surprisingly lower number of patients. Also, cNCC lesions were observed in other forms of epilepsy, a finding that could occur only by chance, with epilepsy probably being not related to cNCC at all. In this cohort, cNCC was very commonly associated with MTLE-HS, an observation in agreement with the hypothesis that NCC can contribute to or directly cause MTLE-HS in many patients. Given the broad world prevalence of NCC and the relatively few studies in this field, our findings add more data suggesting a possible and intriguing frequent interplay between NCC and MTLE-HS, two of the most common causes of focal epilepsy worldwide.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Evaluating the Association of Calcified Neurocysticercosis and Mesial Temporal Lobe Epilepsy With Hippocampal Sclerosis in a Large Cohort of Patients With Epilepsy

et al. 2022

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“…After reviewing NCC cases between 2005 and 2019, researchers found that 12 patients underwent anterior temporal lobectomy and amygdalohippocampectomy (193). Neuropathological results showed that 11 of the cases were HS type 1.…”

Section: Neurocysticercosismentioning

confidence: 99%

Pathological Targets for Treating Temporal Lobe Epilepsy: Discoveries From Microscale to Macroscale

et al. 2022

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Temporal lobe epilepsy (TLE) is one of the most common and severe types of epilepsy, characterized by intractable, recurrent, and pharmacoresistant seizures. Histopathology of TLE is mostly investigated through observing hippocampal sclerosis (HS) in adults, which provides a robust means to analyze the related histopathological lesions. However, most pathological processes underlying the formation of these lesions remain elusive, as they are difficult to detect and observe. In recent years, significant efforts have been put in elucidating the pathophysiological pathways contributing to TLE epileptogenesis. In this review, we aimed to address the new and unrecognized neuropathological discoveries within the last 5 years, focusing on gene expression (miRNA and DNA methylation), neuronal peptides (neuropeptide Y), cellular metabolism (mitochondria and ion transport), cellular structure (microtubule and extracellular matrix), and tissue-level abnormalities (enlarged amygdala). Herein, we describe a range of biochemical mechanisms and their implication for epileptogenesis. Furthermore, we discuss their potential role as a target for TLE prevention and treatment. This review article summarizes the latest neuropathological discoveries at the molecular, cellular, and tissue levels involving both animal and patient studies, aiming to explore epileptogenesis and highlight new potential targets in the diagnosis and treatment of TLE.

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“…Increasing evidence is pointing to calcified neurocysticercosis as a cause of hippocampal atrophy/ sclerosis and associated refractory epilepsy [30,44,45]. There are increasing numbers of calcified NCC cases with refractory epilepsy that have improved or resolved with surgical removal of the epileptiform focus [46].…”

Section: Calcified Neurocysticercosismentioning

confidence: 99%

Neurocysticercosis: an update on diagnosis, treatment, and prevention

Pineda-Reyes

White

2022

Current Opinion in Infectious Diseases

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Neurocysticercosis (NCC) is an important cause of neurological disease worldwide, including imported cases in nonendemic countries.Purpose of reviewThe purpose of this review is to update information on diagnosis, management, and prevention of neurocysticercosisRecent findingsWHO and Infectious Diseases Society of America/American Society of Tropical Medicine and Hygiene guidelines emphasize the importance of corticosteroids and antiparasitic drugs for viable parenchymal disease and single enhancing lesions. Subarachnoid NCC is associated with a high fatality rate unless optimally treated. Advances in subarachnoid NCC include use of prolonged antiparasitic and anti-inflammatory courses and the increasing use of antigen-detection and quantitative PCR assays in diagnosis and follow-up. Emerging data support the safety and efficacy of minimally invasive surgery in ventricular cases. Calcified neurocysticercosis continues to be associated with a high burden of disease. Field studies are demonstrating the feasibility of eradication using a combination of mass chemotherapy for human tapeworms and vaccination/treatment of porcine cysticercosis.SummaryNCC remains an important and challenging cause of neurological disease with significant morbidity despite advances in treatment and prevention.

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Dual/double pathology in neurocysticercosis causing drug resistant epilepsy – Chance association or causal?

Cited by 9 publications

References 24 publications

Evaluating the Association of Calcified Neurocysticercosis and Mesial Temporal Lobe Epilepsy With Hippocampal Sclerosis in a Large Cohort of Patients With Epilepsy

Evaluating the Association of Calcified Neurocysticercosis and Mesial Temporal Lobe Epilepsy With Hippocampal Sclerosis in a Large Cohort of Patients With Epilepsy

Pathological Targets for Treating Temporal Lobe Epilepsy: Discoveries From Microscale to Macroscale

Neurocysticercosis: an update on diagnosis, treatment, and prevention

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