Seizures associated with calcifications and edema in neurocysticercosis

Antoniuk, Sérgio Antônio; Bruck, Isac; Santos, Luís; Pintarelli, Vitor Last; Navolar, Fabiano Bassetti B.; Brackmann, Paulo Celso; Morais, Rodrigo Leite de

doi:10.1016/s0887-8994(01)00324-1

Cited by 36 publications

(22 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mechanism by which the calcified lesions cause seizures or epilepsy is not known 1,39,40 , but it has been attributed to residual perilesional gliosis that results in chronic epileptogenic foci 34 . Calcified lesions are frequently encountered in CT scans of asymptomatic individuals, and studies from Latin American countries report that the majority are incidental lesions, which questions the true epileptogenicity of calcified lesions 15,34,41 .…”

Section: Epileptogenesis Of Neurocysticercosis Lesionsmentioning

confidence: 99%

The relationship between neurocysticercosis and epilepsy: an endless debate

Carpio

Romo

2014

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

Neurocysticercosis (NC), or cerebral infection with Taenia solium, is an important public health problem worldwide. Among the neurological sequelae of NC, seizures have been described as the most common symptom. Acute symptomatic seizures often result from degeneration of a viable cyst; however, not all of these patients with acute or provoked seizures will develop epilepsy (i.e., recurrent unprovoked seizures). Because of the high prevalence of epilepsy and NC, a causal, as well as incidental relationship between the two may exist. The epileptogenicity of calcified cysts as well as the potential association between NC and hippocampal sclerosis necessitates future research. Antihelminthic treatment of NC results in disappearance of viable cysts in about one-third of patients with parenchymal disease, but a reduction in seizure recurrence has not been demonstrated in randomized controlled trials. Prevention is critical to reduce the burden of seizure and epilepsy related to NC.Keywords: cysticercosis, Taenia solium, seizure, parasitic. RESUMOA neurocisticercose (NC) ou infecção cerebral pela Taenia solium é importante problema de saúde pública em todo o mundo. Entre as sequelas neurológicas da NC, as crises convulsivas têm sido descritas como os sintomas mais frequentes. Crises convulsivas sintomáticas agudas resultam, muitas vezes, da degeneração de cistos viáveis; entretanto, nem todos os pacientes com NC e crises agudas ou provocadas desenvolvem epilepsia (i.e., crises recorrentes não provocadas). Pode haver uma relação entre epilepsia e NC, causal ou incidental, devido à alta prevalência de ambas. O potencial epileptogênico dos cistos calcificados assim como a possível associação entre NC e esclerose hipocampal ainda necessitam de futuras pesquisas. O tratamento anti-helmíntico da NC resulta no desaparecimento de cistos viáveis em cerca de 1/3 dos pacientes com a doença parenquimatosa, mas não foi demonstrada redução nas taxas de recorrência das crises convulsivas em estudos randomizados controlados. A prevenção é crítica para reduzir o contingente de crises convulsivas e epilepsia relacionadas à NC.

show abstract

Section: Epileptogenesis Of Neurocysticercosis Lesionsmentioning

confidence: 99%

The relationship between neurocysticercosis and epilepsy: an endless debate

Carpio

Romo

2014

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…1 Seizures, the most frequent manifestation of NCC, arise when viable cysts degenerate during the course of natural infection 2 or as a consequence of treatment with anthelminthic medication. 3 Seizures commonly occur in the presence of calcified granulomas [4][5][6][7][8][9] and are frequently localized to them. [10][11][12] Moreover, recurrent, transient episodes of perilesional edema (PEC) and enhancement, both maximally centered around the calcifications, have been described.…”

Section: Introductionmentioning

confidence: 99%

A Calcified Taenia solium Granuloma Associated with Recurrent Perilesional Edema Causing Refractory Seizures: Histopathological Features

Ooi¹,

Wijemanne²,

Thomas³

et al. 2011

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

We describe the first detailed histological description of an excised calcified Taenia solium granuloma from a patient who developed recurrent seizures associated with perilesional edema surrounding a calcified cysticercus (PEC). The capsule, around a degenerated cysticercus, contained marked mononuclear infiltrates that extended to adjacent brain, which showed marked astrocytosis, microgliosis, and inflammatory perivascular infiltrates. The presence of large numbers of mononuclear cells supports an inflammatory cause of PEC. Immunosuppression or anti-inflammatory measures may be able to treat and prevent PEC and recurrent seizures.

show abstract

“…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).…”

mentioning

confidence: 99%

“…It may be helpful in the treatment of perilesional edema as well but the benefit is unclear. Current information suggests that perilesional edema episodes usually resolve spontaneously 38,40 without corticosteroid treatment and furthermore corticosteroid treatment may induce or worsen perilesional edema and/or symptoms due to rebound upon cessation. 51 If the process of perilesional edema around calcifications is immunologically based and caused by intermittent acute inflammatory responses, then it may be useful to suppress the immune response in order to prevent and/or treat this phenomenon.…”

mentioning

confidence: 99%

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

Nash

2012

Pathogens and Global Health

View full text Add to dashboard Cite

Calcified granulomas are the most common radiological finding in neurocysticercosis (10-20% of endemic populations). A small proportion serves as foci of seizure activity, which results in large numbers of persons with epilepsy. Calcified granulomas are not all the same. Some demonstrate blood-brain barrier dysfunction (magnetic resonance imaging enhancement) most likely due to the presence of inflammation, visualizable scolices, and/or gliosis. About half the patients with a recent history of seizures, positive serology, and only calcified lesions develop perilesional edema at the time of a seizure recurrence. The natural history, treatment, and pathophysiology of this phenomenon are not well studied. Episodes are usually associated with seizures or other neurological manifestations, resolve by 4-6 weeks, sometimes occur repeatedly, and usually involve a subset of the same calcifications. Treatment is supportive. Histopathological examination of one calcification associated with multiple perilesional edema episodes revealed significant inflammation and supports the concept that perilesional edema is inflammatory in nature. This most likely is due to host responses to released or newly recognized parasite antigen and/or upregulation of the host immune response. Immunosuppressive and anti-inflammatory agents may be useful in prevention and/or treatment of this phenomenon.

show abstract

Seizures associated with calcifications and edema in neurocysticercosis

Cited by 36 publications

References 9 publications

The relationship between neurocysticercosis and epilepsy: an endless debate

The relationship between neurocysticercosis and epilepsy: an endless debate

A Calcified Taenia solium Granuloma Associated with Recurrent Perilesional Edema Causing Refractory Seizures: Histopathological Features

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

Contact Info

Product

Resources

About