Predictors of Lesion Calcification in Patients with Solitary Cysticercus Granuloma and New-Onset Seizures

Abstract

Abstract. Solitary cysticercus granuloma is a common neuroimaging abnormality in Indian patients with new-onset epilepsy. Calcific transformation of cysticercus granuloma is frequently associated with seizure recurrence. We evaluated predictors of lesion calcification in patients with solitary cysticercus granuloma and new-onset seizures. One hundred twenty-two patients, with new-onset seizures and a solitary cysticercus granuloma of the brain, were enrolled. All patients were clinically and radiologically evaluated and were treated with antiepileptic drug drugs. No patient received albendazole or corticosteroids. The follow-up period was of 1 year. Follow-up computed tomography was performed after 3 and 6 months. In 68 (54.8%) patients, solitary cysticercus granuloma had transformed into a calcified lesion. On logistic regression analysis, moderate-to-severe edema was a significant factor that predicted calcific transformation of the cysticercus granuloma (odds ratio: 3.325; 95% confidence interval: 1.502-7.362). During 1 year of follow-up, 19 (15.6%) patients experienced seizure recurrence. In 16 patients with seizure recurrence, cysticercus granuloma had transformed in to a calcified lesion. In conclusion, in solitary cysticercus granuloma, calcification of the lesion can be predicted if larger amount of perilesional edema is present. Calcification of the granuloma significantly predicts seizure recurrence.

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

“…Previous studies that looked at the relationship among ALB, cyst phase, and seizure outcomes were all conducted among individuals with SCG. 14,15,29,30 Those studies suggest that although ALB hastens resolution of SCGs, it does not seem to alter the long-term seizure outcome. In contrast to previous studies that followed individual NC cyst evolution in SCG, our study also included participants with multiple cysts.…”

“…Previous studies that looked at the relationship among ALB, cyst phase, and seizure outcomes were all conducted among individuals with SCG . Those studies suggest that although ALB hastens resolution of SCGs, it does not seem to alter the long‐term seizure outcome.…”

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

“…Residual calcifications have been found in approximately 55% of Indian patients presenting with a single degenerating brain cyst and not receiving cysticidal drugs. 42 In multicystic infections, seen more frequently in Latin America than in India, this prevalence is likely to be higher. It is possible that in our series, there is a subgroup of individuals who completely cleared their NCC infections, which might be either included in the group of PWE or in that of people without epilepsy.…”

A prospective cohort study to assess the frequency and risk factors for calcification in single lesion parenchymal neurocysticercosis

“…Transformation to a calcified lesion is a risk factor for seizure recurrence in individuals with parenchymal NCC [12,24,25]. In our previous study among 500 children with parenchymal NCC, seizure recurrences were significantly higher in children with lesion calcification during follow-up [26].…”

“…The scolex represents the larva itself and it has a solid component, causing water restriction and the appearance of diffusion restriction on DWI images [42] Another observation was that the size of the lesion also predicted lesion calcification. Lesions <7.5 mm in size had a higher percentage of resolution, while the larger lesions showed more calcification [24,35]. This is another important point, that the larger lesions tend to degenerate slowly and more often have calcification.…”