Reduction in rate of epilepsy from neurocysticercosis by community interventions: The Salamá, Honduras Study

Abstract

SUMMARYPurpose: Epilepsy is highly prevalent in developing countries like Honduras, with few studies evaluating this finding. This population-based study evaluated the impact of an 8-year public health and educational intervention program in reducing symptomatic epilepsies in rural Salamá, Honduras. Methods: We used the capture and recapture method including review of charts, previous databases, key informants from the community, and a second house-to-house survey for epilepsy. Epilepsy incidence and prevalence day after the interventions was May 5, 2005. Residents with active epilepsy with onset after May 1997 were offered neurologic evaluation, electroencephalography, and brain tomography. New data over 8 years were compared to preintervention data from the initial baseline 1997 study utilizing prevalence ratios and confidence intervals. Other calculations utilized chi square or Fisher's exact tests.Key Findings: Thirty-three of 36 patients with onset of active epilepsy after 1997 accepted evaluations to determine etiology. Symptomatic etiology was found in 58.3%. Neurocysticercosis (NCC) was again the most frequent cause (13.9%), followed by perinatal insults (11.1%). Epilepsy secondary to NCC was significantly reduced from 36.9% in 1997 (p = 0.02). The incidence (35.7/100,000) and prevalence (11.8/1,000) of active epilepsy were not significantly reduced when compared to the incidence (92.7/ 100,000) and prevalence (15.4/1,000) of active epilepsy in 1997. Significance: Our cohort appears to indicate that health and educational community interventions can reduce preventable epilepsy from NCC in a hyperendemic population in a low-resource, developing country. Plans are underway for the Honduran Government to institute this rural model countrywide.

Edema surrounding calcified intracranial cysticerci: clinical manifestations, natural history, and treatment

“…The first full descriptions were published by Sheth et al 37 who described a complicated case and Nash and Patronas 38 who published a detailed history of three patients, one with recurrent episodes over 10 years. Subsequently, a number of cases or series describing perilesional edema episodes were reported from different geographic locations, 10,25,[39][40][41][42][43][44] indicating that the phenomenon is a relatively common general finding in neurocysticercosis. Episodes of perilesional edema have been reported from many endemic regions worldwide but the natural history and characteristics of those severely affected have not been well studied (Table 1).…”

Clinical Manifestations, Diagnosis, and Treatment of Neurocysticercosis

“…The appropriate use of brain imaging studies for diagnosis, the effective and convenient drug therapy and, far more important, the sanitary measures to prevent the propagation of the complex Teniasis/cysticercosis in humans and of cysticercosis in pigs [46] have contributed to a far better picture of NCC than three decades ago. It is important to stress the fact that NCC is a highly vulnerable disease by a simple sanitary measure [1,42].…”

“…It is important to stress the fact that NCC is a highly vulnerable disease by a simple sanitary measure [1,42]. Its disappearance in vast regions demonstrates the fact that education and sanitation are the most effective actions to eliminate cysticercosis [13,46,47].…”

Neurocysticercosis

“…It is rare in developed countries, where it can occur in travellers or immigrants from endemic countries. CNS infection is very frequent in endemic areas, with prevalence of specific serum antibodies above 10 % in many of these populations, and 10-20 % of the general population showing residual intraparenchymal brain calcifications on CT scan [1,2]. In a systematic review, the pooled estimate for the proportion of NCC among patients with epilepsy was 29 % [3].…”