Detection of specific cysticercus antigen in the urine for diagnosis of neurocysticercosis

Neurocysticercosis (NCC) is an important zoonotic infection, and a significant cause of morbidity and mortality in India. Immunodiagnosis plays an important role in the early, rapid, and specific diagnosis of the condition. The aim of the present study was to detect specific cysticercal antigen excreted in the urine for the diagnosis of NCC. The objective was to develop and evaluate staphylococcal Co-agglutination (Co-A) test for the detection of urinary cysticercal antigen. In the present study, urine samples were collected from 9 cases of clinically suspected NCC, 8 cases of CT/MRI proven cases of NCC, 11 of non-cysticercal CNS infection controls, and 25 healthy control subjects. Polyclonal antisera raised in rabbits against porcine complete cysticercus homogenate antigen, was used in the Co-A test to detect cysticercal antigen. The Co-A detected excreted cysticercal antigen in the urine of five of nine (55.5%) clinically diagnosed NCC and in five of eight (62.5%), CT/MRI proven cases of NCC. A false positive reaction was observed with 1 of 11 (9%) of control urine specimens from non-cysticercal CNS infection controls. No false positivity was demonstrated with 25 urine samples collected from healthy controls. Results of the present study shows that the Co-A test can be employed as a moderately sensitive and specific test for detection of urinary antigen in the diagnosis of NCC in poorly equipped laboratories.     

Co-agglutination test for cysticercus antigen detection in the serum for the diagnosis of cysticercosis

The objective of the study was to develop the co-agglutination (Co-A) test, a rapid slide agglutination test for the diagnosis of cysticercosis. The present study included 21 cases of cysticercosis, which comprised seven cases of clinico-radiologically definite cases of neurocysticercosis (NCC) proven with either computed tomography (CT) scan or magnetic resonance imaging (MRI), eight cases of clinically strong NCC, six cases of extraneural cysticercosis in muscle and eye; 40 non-cysticercal parasitic infection controls; and 20 healthy controls. Hyperimmune cysticercus antiserum was raised in rabbits and was used to coat Staphylococcus aureus (Cowan strain-I) bearing protein A (SAPA) cells, and the Co-A was standardized to detect cysticercal antigen in the serum. Serum samples from 12 out of 21 (57%) cases of cysticercosis were positive for cysticercal antigen by the Co-A test. Of the 12 positive samples, eight were from cases of neurocysticercosis and four from cases of extra-neural cysticercosis. Serum samples from seven out of 40 non-cysticercal parasitic infection controls and serum samples from one out of 20 (5%) healthy controls showed a false-positive reaction for the antigen by the Co-A test. There was a statistically significant difference between the antigen detection rates among cysticercosis patients on one hand, and the patients with other parasitic diseases (P = 0.0014), and healthy controls (P=0.0003) on the other. The Co-A test appears to be a moderately sensitive and specific test for the diagnosis of cysticercosis.     

Seizure Control in Patients with Epilepsy during the COVID-19 Pandemic: A Systematic Review and Meta-analysis

Objective To investigate seizure control in patients with epilepsy during the coronavirus disease 2019 (COVID-19) pandemic. Method A systematic review and meta-analysis was conducted, and the MEDLINE, EMBASE, CENTRAL, and ClinicalTrials.gov databases were comprehensively searched for relevant studies. Studies that reported seizure control in patients with epilepsy during the COVID-19 pandemic were included. Pooled proportions with 95% confidence intervals (CIs) of patients with epilepsy who experienced seizure worsening during the COVID-19 pandemic were assessed using a random-effects model. The quality of the assessment for each study, heterogeneity between the studies, and publication bias were also evaluated. Subgroup analyses were performed, excluding studies with reports of seizures worsening from caregivers. Results A total of 24 studies with 6,492 patients/caregivers were included in the meta-analysis. The pooled proportion of seizure worsening was 18.5% (95% CI: 13.9-23.6; I²=96%; p<0.01). The pooled proportion of seizure worsening in the subgroup analysis was 18.9% (95% CI: 13.5-25.0; I²=96%; p<0.01). Conclusion Although the heterogeneity was high, our results showed a relatively high incidence of seizure worsening during the COVID-19 pandemic. During the COVID-19 pandemic, physicians should be aware of the likelihood of worsening seizures in patients with epilepsy.     

Seizure management at Auckland City Hospital Emergency Department between July and December 2009: time for a change?

Aims: To assess the management of epileptic seizures and status epilepticus in adult patients at Auckland City Hospital emergency department. This information will form the basis of future seizure management protocols and further research on the management of status epilepticus. Methods: The prehospital and acute hospital management of all adult seizure patients seen between 1 July 2009 and 31 December 2009 was reviewed with respect to seizure type, presence of first seizure, pre‐existing epilepsy diagnosis and disposition from the emergency department. Results: Two hundred and fifty‐five seizure events were identified in 227 patients. Nineteen patients presented twice during the study period and three patients presented three or more times. Generalised seizures were much more common than focal seizures. There were 75 presentations with first seizure (29.4%). Thirty‐seven patients (49.3%) with a first seizure received treatment with an anti‐epileptic drug. Status epilepticus occurred on 12 occasions (4.7%) with only three patients receiving lorazepam as treatment. The majority of seizure patients were managed by emergency department staff (58.4%) while general medicine (17.6%) and neurology (11.8%) teams managed fewer patients. Phenytoin was used in 56 patients (22%) with the majority (n= 43) receiving intravenous phenytoin. Many of the patients who received intravenous phenytoin were not subsequently discharged on that medication (46%). Conclusions: More patients than would be expected received treatment after their first seizure. Phenytoin was a widely used anti‐epileptic drug. There was a wide variability in the management of status epilepticus, and intravenous lorazepam was underutilised.     

Demographic characteristics and risk factors of first febrile seizures: a Jordanian experience

A prospective study of 203 children admitted with a first febrile seizure was carried out over 18 months. Aseptic meningitis was diagnosed in nine children (4%). The mean age of the children was 19.9 months and the peak age incidence (88%) was between 6 months and 3 years. Complex seizures were seen in 16 cases (8%). There was a history of perinatal asphyxia in 16 patients (8%), positive family history of epilepsy in 3%, of first degree relatives and a history of febrile seizures in siblings in 13%. Upper respiratory tract infection was the commonest triggering factor, diagnosed in 53% of cases. The third child was the most commonly affected (22%) in the family. There was a lower incidence of both complex febrile seizures and history of seizures in siblings compared to other studies. Lumbar puncture should be considered for all children below the age of 2 years, presenting with a first febrile seizure.     

Network dynamics of the brain and influence of the epileptic seizure onset zone

The human brain is a dynamic networked system. Patients with partial epileptic seizures have focal regions that periodically diverge from normal brain network dynamics during seizures. We studied the evolution of brain connectivity before, during, and after seizures with graph-theoretic techniques on continuous electrocorticographic (ECoG) recordings (5.4 ± 1.7 d per patient, mean ± SD) from 12 patients with temporal, occipital, or frontal lobe partial onset seizures. Each electrode was considered a node in a graph, and edges between pairs of nodes were weighted by their coherence within a frequency band. The leading eigenvector of the connectivity matrix, which captures network structure, was tracked over time and clustered to uncover a finite set of brain network states. Across patients, we found that (i) the network connectivity is structured and defines a finite set of brain states, (ii) seizures are characterized by a consistent sequence of states, (iii) a subset of nodes is isolated from the network at seizure onset and becomes more connected with the network toward seizure termination, and (iv) the isolated nodes may identify the seizure onset zone with high specificity and sensitivity. To localize a seizure, clinicians visually inspect seizures recorded from multiple intracranial electrode contacts, a time-consuming process that may not always result in definitive localization. We show that network metrics computed from all ECoG channels capture the dynamics of the seizure onset zone as it diverges from normal overall network structure. This suggests that a state space model can be used to help localize the seizure onset zone in ECoG recordings.Epilepsy affects over 60 million people worldwide, and approximately 40% of patients have drug-resistant epilepsy (DRE) with recurrent seizures that are not controlled by available medications (1–3). It is now routine to consider drug-resistant partial epilepsy patients, who represent the largest cohort of patients with uncontrolled seizures, for possible resective seizure surgery (4). Successful seizure surgery is predicated upon the ability to localize the seizure onset zone. Although some patients (e.g., those with mesial temporal sclerosis or lesional epilepsy) can proceed to surgery following scalp recordings of seizures delineating a seizure onset zone (5), a significant number of patients have seizures that are challenging to localize with scalp ictal (i.e., seizure) recordings. In this case, ictal recordings using intracranial electrodes (e.g., subdural strips, grids, or depth electrode arrays) are necessary. The purpose of these intracranial recording arrays is to provide information about seizure onset and propagation, representing spatiotemporal changes in cerebral function.Using intracranial electrocorticographic (ECoG) recordings taken over several days to capture ictal events, clinicians visually inspect the ECoG recordings at the onset of the seizures and look for signatures on individual channels (e.g., rhythmic spiking, low-voltage fast activity, etc.) that might be characteristic of the seizure onset zone (6). With the large numbers of implanted electrodes (typically more than 100 contacts), this can be time-consuming even for epileptologists who are quick and experienced. Moreover, the activity on individual channels is affected by functional networks that may involve many channels in the surrounding regions, and this is not always easily detected through visual inspection. Hence, seizure onset zone localization can be challenging in a significant number of patients (e.g., nonlesional) (7, 8).In particular, it is unknown whether or not a consistent structure emerges over time in brain functional networks during interictal and ictal periods. To date, brain connectivity has been studied by using intracranial ECoG recordings from brief temporal intervals only (tens to a few hundreds of seconds) in either interictal periods or ictal periods (9–19), or neuronal ensembles have been studied in vitro (20–22). Only a handful of studies have examined the role of the clinically annotated focus (i.e., the region that is clinically identified as the seizure onset zone and subsequently surgically resected) in brain networks over time (23–28).To further investigate the spatiotemporal mechanisms of cerebral function and to investigate whether a consistent structure emerges over time in brain functional networks, we used a network-based analysis and ECoG recordings from subdural and depth electrodes in 12 patients with DRE undergoing presurgical evaluations. We measured brain connectivity continuously (i.e., every second) during interictal, periictal, and ictal periods spanning several days (5.4 ± 1.7 d per patient, mean ± SD), and, for each patient, we used unsupervised clustering to group all of the networks computed over time into a finite set of distinct networks. Finally, if a robust set of clusters emerged, we examined how the brain transitions between these network clusters (brain states).Across all patients, we found that the interictal activity enters only a small set of distinct states (two to five), whereas there are 2–11 states during seizures. We also found that, during seizures, the brain transitions through a finite set of network states in a reproducible manner, i.e., the pattern is the same across different seizures in the same patient, with characteristic onset and termination. These findings suggest that the brain connectivity may be described in a low-dimensional state space.Moreover, the uncovered brain states allowed us to characterize the activity in the seizure onset zone before, during, and after ictal events, which may help understand the role of the zone in network connectivity dynamics. In particular, for each brain state revealed by our analysis, we studied the connectivity of the clinically annotated seizure onset zone to the remaining brain network and we found that there is a specific state during seizures that consistently occurs shortly after the seizure begins (especially in patients with successful surgeries that likely had adequate electrode coverage of the seizure onset zone). In this state, the seizure onset zone is significantly isolated from the rest of the network.In Discussion, we describe how the isolated state of the seizure onset zone may be used to assist in the development of a method to localize the seizure onset zone from intracranial ECoG recordings. Characterization and localization of the seizure onset zone are of utmost importance to guide subsequent surgical resection, which is still the best therapeutic alternative for patients with DRE (4). However, failure to optimally identify the seizure onset zone can occur even with intracranial ECoG recordings, particularly in patients with nonlesional epilepsy, and this can result in suboptimal surgical outcomes and a high chance (∼40%) of seizure recurrence within one year postsurgery (7, 8). Preliminary results of this study were presented in (29).     

Evaluation of ELISA and dot blots for the serodiagnosis of neurocysticercosis, in children found to have single or multiple enhancing lesions in computerized tomographic scans of the brain

Although human neurocysticercosis (NCC) is being increasingly recognized in children, diagnosis of the disease can be difficult, and the 'gold standard' criteria that indicate an unambiguous case have still to be established. In the present study, the performances of an ELISA and dot-blot assay, for the detection of antibodies against antigens from larval Taenia solium, were investigated and compared, using sera, from children aged 5-12 years, that were diluted to at least 1:400. Eighty of the subjects (20 aged 5-<8 years and 60 older children) each had the signs and symptoms of NCC, including one brain lesion (N=69) or multiple brain lesions (N=11) that were visible by computed tomography. Another 100 sera, from children who had tubercular meningitis (N=20) or a parasitic disease other than taeniasis/cysticercosis (N=20) or, apart from a minor respiratory-tract infection, appeared healthy (N=60), were also investigated. Most (86%) of the cases of NCC had presented with focal seizures.Analysis of antibody response indicated that the optimum threshold titres for seropositivity were 1:800 for the ELISA and 1:6400 for the dot-blot assays. When used with these thresholds, the ELISA gave a sensitivity, specificity, positive and negative predictive values and diagnostic efficacy of 89%, 81%, 79%, 90%, 85%, respectively. The corresponding values for the dot-blot assay were similar, at 89%, 73%, 72.5%, 89%, 82%, respectively. Both assays were more sensitive, in the detection of the specific antibody response, when used among the paediatric cases of NCC who had multiple brain lesions (100%) than when used among the single-lesion cases (87%). As the ELISA gave higher specificity and diagnostic efficacy than the dot-blot assay, it should be considered the better method for the serological confirmation of NCC in children.     

Neurocysticercosis in a 14-year-old boy in Italy: An unexpected case

Neurocysticercosis (NCC) is a parasitic infection of the central nervous system caused by larvae of Taenia solium. It represents the most common cause of neurological disease in children living in developing countries. In recent years, NCC is increasingly being diagnosed also in high-socioeconomic countries, mainly due to the high rate of immigration. We describe a case of a 14-year-old Ecuadorian boy living in Italy, who experienced a generalized tonic-clonic seizure and was diagnosed with NCC. The boy was successfully managed with anticonvulsant, anticysticercal and anti-inflammatory treatment. With the present case we would like to emphasize the importance of considering NCC as a possible cause of non febrile seizures in children living in developed countries, particularly in those immigrated from an endemic region or had a long-term stay in an area of high prevalence.     

Neurocysticercosis in a north Indian hospital

In endemic regions, neurocysticercosis (NCC) is the most commonly diagnosed parasitic disease of the central nervous system, and the most common cause of convulsions and hydrocephalus in adults. During January 2000-December 2006, serum samples collected from patients presenting with various manifestations with a clinical diagnosis of cysticercosis and/or relevant computed tomography findings were subjected to an enzyme-linked immunosorbent assay test for NCC. Anti-cysticercus antibodies were detected in 155 of the 1096 (14.1%) cases. Generalized seizure (33.9%) was the most common presenting symptom. Solitary lesion (74.2%) was the most common radiological finding. This study provides an assessment of the epidemiology of NCC in Delhi and stresses the need for its prevention.     

Etiologies of Acute Undifferentiated Fever and Clinical Prediction of Scrub Typhus in a Non-Tropical Endemic Area

Scrub typhus usually presents as acute undifferentiated fever. This cross-sectional study included adult patients presenting with acute undifferentiated fever defined as any febrile illness for ≤ 14 days without evidence of localized infection. Scrub typhus cases were defined by an antibody titer of a ≥ fourfold increase in paired sera, a ≥ 1:160 in a single serum using indirect immunofluorescence assay, or a positive result of the immunochromatographic test. Multiple regression analysis identified predictors associated with scrub typhus to develop a prediction rule. Of 250 cases with known etiology of acute undifferentiated fever, influenza (28.0%), hepatitis A (25.2%), and scrub typhus (16.4%) were major causes. A prediction rule for identifying suspected cases of scrub typhus consisted of age ≥ 65 years (two points), recent fieldwork/outdoor activities (one point), onset of illness during an outbreak period (two points), myalgia (one point), and eschar (two points). The c statistic was 0.977 (95% confidence interval = 0.960–0.994). At a cutoff value ≥ 4, the sensitivity and specificity were 92.7% (79.0–98.1%) and 90.9% (86.0–94.3%), respectively. Scrub typhus, the third leading cause of acute undifferentiated fever in our region, can be identified early using the prediction rule.     

Case Report: Calcified Neurocysticercus,Perilesional Edema,and Histologic Inflammation

Here, we present the second report of the histopathology of a Taenia solium calcification giving rise to perilesional edema. This has important implications, because if perilesional edema lesions are inflammatory in character, immunosuppressive or anti-inflammatory medications, not just antiepileptic drugs alone, may be useful to prevent or treat recurring episodes in such patients.Calcified Taenia solium cysts are the most common radiological finding in neurocysticercosis (NCC), with between 10% and 20% of the population in endemic populations exhibiting this feature on head computed tomography (CT).¹ Although most individuals with calcified cysts never experience seizures, they are commonly foci of seizure activity. The most persuasive evidence is the intermittent appearance of perilesional edema around a small subset of calcifications in persons presenting with seizures.^1–11 Reports have documented the phenomenon in many endemic regions. Of 110 persons followed prospectively in Lima, Peru who had a history of seizures, only calcifications as defined by imaging, and a positive cysticercosis serology, 50% of those with recurring seizures showed perilesional edema.⁵ In most endemic regions, relatively few persons with epilepsy show viable degenerating cysts leaving calcified cysts as the most common radiological finding associated with epilepsy caused by NCC,¹ amounting to about 29% of all epilepsies in affected areas.¹²The pathophysiology of perilesional edema is unclear mostly because of the paucity of direct examination of calcifications involved. The most favored hypothesis is that perilesional edema is caused by inflammation, perhaps as a result of intermittent release and/or recognition of enmeshed parasite antigen.¹³ However, others hypothesize perilesional edema is a result of seizure activity or release of ionic calcium.¹³ This is an important distinction, as therapies could differ, with immunosuppressive medications or antiepileptic drugs alone, respectively.To our knowledge there is only one full report of the histopathology of a T. solium calcification giving rise to perilesional edema¹⁴; the calcified lesion showed considerable inflammation associated with a degenerated cysticercus, which favored an inflammatory pathophysiology as the cause of perilesional edema. Here, we report the histopathology of a second case of an excised calcified cyst associated with perilesional edema.     

From the Cover: GalR2-positive allosteric modulator exhibits anticonvulsant effects in animal models

Galanin receptors type 1 (GalR1) and/or type 2 (GalR2) represent unique pharmacological targets for treatment of seizures and epilepsy. Previous studies have shown that the endogenous peptide ligand galanin exerts powerful anticonvulsant effect through activation of these two G protein-coupled receptors, which are highly expressed in the temporal lobe of rodent brain. Here we report the characterization of a putative GalR2-positive allosteric modulator CYM2503. CYM2503 potentiated the galanin-stimulated IP1 accumulation in HEK293 cells stably expressing GalR2 receptor, whereas it exhibited no detectable affinity for the ¹²⁵I galanin–binding site of GalR2 receptor, an effect consistent with that of a positive allosteric modulator. In the rat Li-pilocarpine status epilepticus model, CYM2503, injected intraperitoneally, increased the latency to first electrographic seizure and the latency to first stage 3 behavioral seizure, decreased the latency to the establishment of status epilepticus, and dramatically decreased the mortality. In a Li-pilocarpine seizure model in mice, CYM2503 increased the latency to first electrographic seizure and decreased the total time in seizure. CYM2503 also attenuated electroshock-induced seizures in mice. Thus, CYM2503 provides a starting point for the development of anticonvulsant therapy using the galanin R2 receptor as target.     

Microglial activation and TNFalpha production mediate altered CNS excitability following peripheral inflammation

Peripheral inflammation leads to a number of centrally mediated physiological and behavioral changes. The underlying mechanisms and the signaling pathways involved in these phenomena are not yet well understood. We hypothesized that peripheral inflammation leads to increased neuronal excitability arising from a CNS immune response. We induced inflammation in the gut by intracolonic administration of 2,4,6-trinitrobenzene sulfonic acid (TNBS) to adult male rats. To examine the excitability of the brain in vivo, we administered pentylenetetrazole (PTZ; a GABAergic antagonist) intravenously to evoke clonic seizures. Rats treated with TNBS showed increased susceptibility to PTZ seizures that was strongly correlated with the severity and progression of intestinal inflammation. In vitro hippocampal slices from inflamed, TNBS-treated rats showed increased spontaneous interictal burst firing following application of 4-aminopyridine, indicating increased intrinsic excitability. The TNBS-treated rats exhibited a marked, reversible inflammatory response within the hippocampus, characterized by microglial activation and increases in tumor necrosis factor α (TNFα) levels. Central antagonism of TNFα using a monoclonal antibody or inhibition of microglial activation by i.c.v. injection of minocycline prevented the increase in seizure susceptibility. Moreover, i.c.v. infusion of TNFα in untreated rats for 4 days also increased seizure susceptibility and thus mimicked the changes in seizure threshold observed with intestinal inflammation. Our finding of a microglia-dependent TNFα-mediated increase in CNS excitability provides insight into potential mechanisms underlying the disparate neurological and behavioral changes associated with chronic inflammation.     

Unexpected adrenal pheochromocytoma associated with a generalized tonic-clonic seizure in a prepubertal boy: A case report

Rationale:Pheochromocytoma (PHEO) is a rare neuroendocrine tumor arising from chromaffin cells of the adrenal medulla. Most pediatric PHEOs are functional tumors, and clinical manifestations are related to catecholamine hypersecretion and/or tumor mass effects.Patient concerns:We report here a case of a 10-year-old boy with a highly functional adrenal PHEO detected after the evaluation of a generalized tonic-clonic seizure in the patient. His vital signs at admission were: blood pressure up to 220/135 mm Hg; pulse, 112 beats/min; temperature, 37.4°C; respiratory rate, 22 breaths/min.Diagnosis:A 24-hour urine collection for catecholamines test showed a marked increase in Vanillylmandelic acid levels (338.9 μmol/L). An abdominal magnetic resonance imaging revealed a well-defined left adrenal gland mass measuring ∼5 cm in its largest dimension.Interventions:The mass was surgically removed, and histopathological examination revealed PHEO with low malignant potential (Adrenal Gland Scaled Score/PASS/ < 4).Outcomes:The patient was discharged on the 10th postoperative day in good condition. At 24-month follow-up, the patient was doing well without complications such as tumor recurrence, elevated blood pressure, and seizure.Lessons:PHEO should be considered in the differential diagnosis of children with seizures presenting in the emergency department. A multidisciplinary approach to the evaluation and treatment of PHEO is also crucial for a successful outcome.     

Cardiac troponin I (CTnI) level among children with epileptic seizures

Epilepsy is a common chronic neurological disorder in pediatric age characterized by recurrent, unprovoked seizures; these seizures are transient signs of abnormal excessive or hyper synchronous neuronal activity in the brain. Complicated epilepsy is associated with high seizure frequency, prolonged seizures and may lead to some sort of cardiac ischemia, myocardial injury and elevated serum CTnI.AimA possible importance of Cardiac troponin I (CTnI) level in epileptic children.Patients and methodsThe study was carried out upon 90 children, classified into three groups: Group I: 30 with uncomplicated epilepsy. Group II: 30 with complicated epilepsy. Group III (control): 30 apparently clinically healthy children with similar age and sex. All groups were subjected to the following: full history taking – thorough clinical examination – EEG – assessment of serum cardiac troponin I- and CT only for groups I and II.ResultsOur research revealed a significant statistical increase in the cardiac troponin level (CTnI) maximum in group II followed by group I then lastly group III and revealed a direct correlation between cardiac troponin I and presence of prenatal problem, mental retardation, EEG abnormality and abnormal C T or MRI. There was an indirect correlation between cardiac troponin I and age of seizure onset. Also there was one between cardiac troponin I and etiology of epilepsy.ConclusionCardiac troponin I is a perfect tool for early detection of cases with myocardial dysfunction in epileptic patients – cardiac troponin I is significantly increased in children with epilepsy especially the complicated epilepsy. Cardiac injury in epileptic children is more common in patients with early onset epilepsy, positive prenatal problem, idiopathic epilepsy, abnormal imaging and EEG – elevated TnI levels may be of value in assessing the severity and eventual outcome and mortality risk of the disease in children with epilepsy.     

Dot-ELISA for the diagnosis of neurocysticercosis

The aim of the present study was to standardize and evaluate dot-Enzyme linked immunosorbent assay (Dot-ELISA), a simple and rapid test for the detection of cysticercus antibodies in the serum for the diagnosis of neurocysticercosis (NCC). The antigen used in the study was a complete homogenate of Cysticercus cellulosae cysts obtained from infected pigs and dotted on to nitrocellulose membrane. Test sera were collected from the patients of NCC, and control sera from patients with other diseases and healthy students and blood donors of the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Hospital, Pondicherry, during a study period from 2001 to 2003. Dot-ELISA detected antibodies in 14 of 25 (56%) in clinically suspected cases of NCC, 13 of 23 (56.5%) in CT/MRI proven cases of NCC and 2 of 25 (8%) each in non-cysticercal CNS infection controls and healthy controls. The test showed a sensitivity of 56.25%, specificity of 92%, positive predictive value of 87.09%, and negative predictive value of 70.76%. Results of the present study shows that the Dot-ELISA as a simple test can be used in the field or poorly equipped laboratories for diagnosis of NCC .     

Outcome in Subjects with Alcohol-Provoked Seizures

The outcome in 165 subjects with either an unknown (n = 93) or an alcohol-related (n = 72) seizure etiology, admitted to the emergency room of a general hospital in 1977-1978, was assessed after 10 years on the basis of subsequent hospital records and death-certificate-based mortality data. Alcohol and/or drug poisoning was the most frequent cause of death in the group with alcohol-related seizures. Sixty-four percent of the deaths in this group were directly related to alcohol abuse. The crude mortality was 45.8 (expected 8.6)/100 persons/10 years in the group with alcohol-related seizures and 15.1 (expected 6.0)/100 persons/10 years in the other group, the odds ratio between the groups being 4.8. Twenty percent of those with an unknown seizure etiology were found to show alcohol-related seizures, while the seizure etiology remained unknown in 59%, and a specific etiology other than alcohol abuse was revealed in 21% during the follow-up period. We conclude that alcohol abuse is an important, though often undetected, seizure etiology carrying a poor prognosis. The difference in mortality between the groups was due more to alcoholism than to seizures. There was no difference in mortality between those with a first alcohol-related seizure and those with previous alcohol-related seizures.     

Evaluation of an IgG-ELISA strategy using Taenia solium metacestode somatic and excretory-secretory antigens for diagnosis of neurocysticercosis revealing biological stage of the larvae

Diagnosis of neurocysticercosis (NCC) is complicated because of the variability in clinical presentations and course of the disease where viability of parasite is a major determinant. The present study describes evaluation of ELISAs using Taenia solium metacestode somatic and excretory-secretory (ES) antigens for detection of anti-T. solium metacestode IgG antibodies in serum and cerebrospinal fluid (CSF). And results of the ELISAs in cases with a definitive diagnosis of NCC are correlated with the biological stages of the parasite such as live vesicular or degenerated stage. The sensitivity of the IgG-ELISA using ES antigen is observed to be much higher in serum (88.2%) than in CSF (64.28%) although it is only marginally higher in serum (76.4%) than in CSF (75%) when somatic antigen is used in the ELISA. Whereas, the specificities of the ELISA using either somatic or ES antigen for detection of IgG antibodies in serum (97.97%; 96.96%) and CSF (96.42%; 97.61%) are comparable. A strong association is observed between live stage of the parasite and detection of antibodies in sera and CSF from more number of NCC patients by ELISA using ES antigens. Similarly, detection of antibodies by ELISA using somatic antigens could be associated with the dead or degenerated stage of the parasite in brain. The IgG-ELISA strategy developed in the present study opens up an avenue for diagnosis of NCC in hospitals or in population prevalence studies. The use of crude extracts of ES proteins might improve the serodiagnosis of the cases of NCC carrying live vesicular stage of the parasite larvae.     

颞叶癫痫中的过度运动性发作(附2例报告)

目的过度运动性发作常见于额叶癫痫,总结我中心病例,探讨颞叶癫痫表现为过度运动性发作时的临床决策。方法回顾2007～2009年进行手术治疗的颞叶癫痫患者,对所有患者的术前评估资料包括病史、MRI、头皮视频脑电图、PET和颅内脑电记录进行回顾性分析。根据Luders的描述对过度运动性发作进行识别。结果 102例患者中有2例表现为典型的过度运动性发作,尽管症状学提示额叶起源,但是头皮脑电图均提示颞叶为发作起始区,1例进行颅内电极监测,另1例因为MRI的阳性发现而直接进行手术切除。2例患者进行了前颞叶切除术,术后2 a以上无发作。结论过度运动性发作发作偶尔可见于颞叶癫痫,如果其头皮EEG结果与影像学检查一致,则手术治疗效果比较理想。     

Influenza-associated central nervous system dysfunction: a literature review

CONTEXT: Influenza is a viral pathogen that imposes an under-recognized burden of central nervous system (CNS) disease. OBJECTIVE: To describe the epidemiology, clinical features and etiology of the CNS disease entities associated with influenza. DATA SOURCES: English-language publications from MEDLINE. DATA EXTRACTION: Articles were identified using "influenza, human"[Mesh] AND "nervous system diseases"[Mesh] and screened for inclusion based on relevance and scientific rigor. RESULTS: Febrile seizure is the most frequently encountered influenza-associated CNS complication, with one in five children hospitalized with influenza experiencing one or more events. In most instances, symptoms resolve without neurological sequelae, although the risk for subsequent afebrile seizure may be increased. Influenza-associated encephalitis/encephalopathy is a less common but potentially more serious complication that is widely reported in Japanese populations, although cases from other East Asian countries, North America, and Europe have been described. Clinical manifestations are diverse, and typically involve febrile seizures and abnormal behaviors in mild cases, with rapid evolution through decreased consciousness to coma in severe forms. In cases of serious disease, the prognosis is often poor, with outcomes including death or severe neurological sequelae. Influenza is also a known trigger for a number of rarely encountered, yet often serious, CNS diseases, including the encephalopathic condition of Reye's syndrome, the peripheral neuropathy known as Guillain-Barré syndrome, and the lesser known complaints of Kleine-Levin syndrome and post-encephalitic Parkinson's disease. CONCLUSIONS: Influenza imposes a sizeable burden of CNS disease. Increased awareness and monitoring of CNS function is indicated, especially in infants and young children.