The Course of Seizures after Treatment for Cerebral Cysticercosis

Vazquez, Victoria; Sotelo, Julio

doi:10.1056/nejm199209033271005

Cited by 178 publications

(67 citation statements)

References 28 publications

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“…Indeed, seizure s may be a late manifestation of neuro c y s t i c e rcosis e v e n after adequate treatment, because cicatricial tissue remains as a permanent sequela 25,26 . Two retrospective studies published in 1992 found striking diff erences in the evolution of seizures in favor of antiparasitic treatment 6,27 , but in 1995 a controlled trial showed no diff e rences among patients treated with albendazole, praziquantel or cort i c o s t e roids alone 2 8 . In Brazil, however, the majority of patients diagnosed as having round intracranial calcifications on CT-s c a n images and epilepsy had never been submitted to therapy with praziquantel or albendazol 2 , 9 , 2 9 .…”

Section: Resultsmentioning

confidence: 99%

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

Kowacs

Rogacheski

Muzzio

et al. 2006

Arq. Neuro-Psiquiatr.

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-Objective: To determine the influence of the location of the irritative zone, and the number and the distribution of the intracranial calcifications in the severity of epilepsy associated with intracranial calcifications. Method: We studied 47 patients with epilepsy and intracranial calcifications, 24 with normal (Group A) and 23 with abnormal interictal EEGs (Group B), a control group (n=21) with abnormal interictal EEGs and normal CT-scans (Group C). Clinical, electroencephalographic and neuro r a d i o l o g i c a l f e a t u reswere compared among gro u p s . Results: Temporal lobe interictal EEG abnormalities were found in 23/24 Group B patients, and in all Group C patients. Most Group B and Group C patients presented temporal lobe seizure symptomatology, whereas in most Group A patients symptomatology was ro l a n d i c (p=0.0001). Epilepsy was more severe in Group B and Group C patients than in Group A patients (p=0.0001 and p=0.0054). No relationship was found between the number of calcifications and epilepsy severity. Conclusion: An irritative zone at the temporal lobe is more relevant in determining the severity, symptomatology and frequency of seizures than the number and location of calcifications.KEY WORDS: epilepsy-localized, epilepsy-temporal lobe, neuro c y s t i c e rcosis, cysticercosis, calcificationsintracranial.Papel da zona irritativa e do número e distribuição das calcificações na gravidade da epilepsia associada com calcificações intracerebrais RESUMO -Objetivo: Testar a relevância do lobo temporal na epilepsia associada a neurocisticercose inativ a . Método: Foram selecionados 47 pacientes com epilepsia e calcificações intracerebrais, 22 com EEGs i n t e rcríticos normais (Grupo A) e anormais em 23 (Grupo B) e um grupo controle (n=21) com EEGs intercríticos anormais sem calcificações intracerebrais (Grupo C). Características clínicas, eletrencefalográficas e n e u roradiológicas foram comparadas entre os gru p o s . Resultados: Encontramos anormalidades eletre n c efalográficas temporais em 23/24 dos pacientes do Grupo B e em todos do Grupo C. Na maioria dos pacientes do Grupo B e Grupo C a sintomatologia ictal foi interpretada como temporal, porém no Grupo A como rolândica (p=0,0001) A epilepsia foi mais grave nos grupos Grupo B e Grupo C que no Grupo A (p=0,0001 e 0,0054). Não houve relação direta entre o número de calcificações e a gravidade da epilepsia. C o n c l u s ã o : Uma zona irritativa sobre o lobo temporal é mais relevante na gravidade, sintomas e freqüência das crises que o número e a localização das calcificações.PA L AV R A S -C H AVE: epilepsia localizada, epilepsia do lobo temporal, neuro c i s t i c e rcose, cisticercose, calcificações intracerebrais.

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Section: Resultsmentioning

confidence: 99%

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

Kowacs

Rogacheski

Muzzio

et al. 2006

Arq. Neuro-Psiquiatr.

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“…In countries where it is endemic, neurocysticercosis may affect 2-4% of the population. 1 In many Latin American countries, such as Ecuador, it is the major cause of late-onset epilepsy, accounting for more than 50% of such cases. 2 However, neurocysticercosis is not just found in remote areas or developing countries.…”

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confidence: 99%

Case-control study of seropositivity for cysticercosis in Cuenca, Ecuador.

Goodman¹,

Ballagh²,

Carpio³

1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. The prevalence of neurocysticercosis has been well documented in rural communities in Latin America using the enzyme-linked inmmunoelectrotransfer blot (EITB) assay. We studied the prevalence of neurocysticercosis in an urban, upper-middle class population in Cuenca, Ecuador. Family members of 34 index cases with parenchymal neurocysticercosis on a computed tomography (CT) scan and family members of 14 patients who had normal CT scans after a trauma or migraine were enrolled in the study. Serum was obtained from 226 individuals, 173 (72%) from the case families and 67 (28%) from the control families. Twelve percent of the case family members and 4% of the control family members were seropositive by the EITB assay. This was a statistically significant difference (P Ͻ 0.05) when age and education were held constant by logistic regression. Seropositivity was not related to age. No neurologic symptom proved predictive of serostatus and the only demographic variable that correlated with seropositivity was increased crowding. Positive serology in index cases did correlate with CT findings as follows: 86% of patients with active lesions, 67% with transitional lesions, and only 41% of patients with inactive lesions were positive by the EITB assay. Eighteen percent of family members with a positive EITB test result had parenchymal lesions on a subsequent CT scan. This study demonstrates a high rate of seropositivity of cysticercosis among urban, middle to upper-middle class individuals in a region endemic for Taenia solium. Household contacts of patients with neurocysticercosis had a three-fold higher risk of positive serology for cysticercosis, in comparison with controls.

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“…1 With cysticidal treatment, the natural history of the infection is accelerated. 2 A successfully treated lesion rapidly progresses from an inert cyst with a live scolex to involution and calcification. During the process of cyst death the host mounts an inflammatory response to released larval proteins, accompanied by a cellular infiltrate and edema.…”

Section: Introductionmentioning

confidence: 99%

“…Although seizures may persist after treatment, patients with calcified lesions are assumed to be cured of active disease. 2 We report a case of neurocysticercosis in which a patient who was assumed to be cured of active infection presented with sudden onset of headache, associated with inflammation and edema around lesions previously shown to be calcified. …”

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confidence: 99%

Reactivation of neurocysticercosis: case report.

Sheth¹,

Lee²,

Kucharczyk³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract.A 37-year-old woman with a known history of longstanding neurocysticercosis presented with a threeday history of new onset headache. Several years prior to her current presentation, she had undergone cysticidal treatment and was assumed to be cured of active disease. Computed tomography and magnetic resonance imaging studies done three months prior to presentation showed multiple intracerebral calcified lesions consistent with resolved neurocysticercosis. Physical and laboratory findings were noncontributory. Imaging studies showed the same previously calcified lesions, but they were now surrounded by large amounts of edema. This case represents a unique report of reactivation of neurocysticercosis and raises interesting questions about the natural history of this infection.Neurocysticercosis is caused by the larval stage of the tapeworm Taenia solium that inhabits the small bowel of an infected human host. Initial clinical manifestations of central nervous infection include seizures, focal neurologic deficits, and mental status changes. 1 With cysticidal treatment, the natural history of the infection is accelerated. 2 A successfully treated lesion rapidly progresses from an inert cyst with a live scolex to involution and calcification. During the process of cyst death the host mounts an inflammatory response to released larval proteins, accompanied by a cellular infiltrate and edema. Although seizures may persist after treatment, patients with calcified lesions are assumed to be cured of active disease. 2 We report a case of neurocysticercosis in which a patient who was assumed to be cured of active infection presented with sudden onset of headache, associated with inflammation and edema around lesions previously shown to be calcified. CASE REPORTA 37-year-old woman, originally from Ecuador and with a known history of neurocysticercosis, presented to the emergency department of The Toronto Hospital on January 7, 1997. The patient was well until early December 1996, when she developed a self-limited flu-like illness consisting of malaise, fever, and sore throat. Two weeks later, fever recurred along with erythema nodosum (her third recurrence since 1989) for which she was admitted to hospital for five days and treated with solumedrol and amoxicillin. One week after discharge from the hospital her headaches began. The headaches were frontal in location and occurred intermittently, associated with vomiting, slowed mentation, and episodic visual scintillations.Her medical history revealed that in 1987 she had been diagnosed with neurocysticercosis when she presented with severe headaches and grand mal seizures. Her computed tomography (CT) scan had shown numerous active cystic lesions and hydrocephalus. The patient underwent ventriculoperitoneal (VP) shunt placement in 1988 and cysticidal treatment with albendazole in 1991. Subsequently, she remained relatively asymptomatic, receiving phenobarbitol for seizure control. Over several years, on repeat imaging studies, numerous parenchymal lesions were noted ...

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The Course of Seizures after Treatment for Cerebral Cysticercosis

Abstract: After medical treatment of neurocysticercosis, there is usually remission or marked improvement in the associated seizure disorder.

Cited by 178 publications

References 28 publications

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

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

Case-control study of seropositivity for cysticercosis in Cuenca, Ecuador.

Reactivation of neurocysticercosis: case report.

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