Epilepsy and neurocysticercosis in rural Tanzania—An imaging study

Purpose:   In developing countries, neurocysticercosis (NCC) is a common cause of epilepsy. Most of the work on NCC and epilepsy has been compiled in Latin America. To date, comprehensive neuroimaging studies are missing in sub-Saharan Africa.
Methods:   In our study, we interviewed 212 people with epilepsy (PWE) and performed cerebral computed tomography (CT) at the Haydom Lutheran Hospital in northern Tanzania. Control cerebral CT scans were selected from 198 consecutive individuals without epilepsy. Sera of PWE with lesions indicating NCC (n = 20), PWE without NCC lesions (n = 20), and healthy individuals (n = 20), as well as cerebrospinal fluid (CSF) samples of PWE with NCC lesions (n = 11) were investigated for anticysticercal antibodies.
Results:   Definite NCC lesions were present in five (2.4%), lesions highly suggestive of NCC in 24 (11.3%), and lesions compatible with NCC in nine (4.2%) PWE. This compares to two (1.0%) people with definite NCC lesions, two (1.0%) with lesions highly suggestive of, and six (2.9%) with lesions compatible with NCC in the control group. NCC lesions were significantly more frequent in PWE compared to controls (p < 0.0001). CT results, and serum and CSF analysis taken together, we diagnosed 22 (10.4%) individuals with probable and 7 (3.3%) with definitive NCC in our cohort of PWE.
Conclusion:   For the first time in sub-Saharan Africa, we give evidence within a large-scale neuroimaging study that NCC, a so far neglected infectious disease, represents a major cause of epilepsy.     

脑囊虫病继发癫痫231例临床特点分析

目的 总结脑囊虫病患者癫痫的发生率及其特点.方法 对1982～1994年在我院住院确诊的脑囊虫病231例进行回顾性分析.结果 癫痫发生率为59.7%,其特点是发生率高、起病晚、男性多、常合并皮下结节和高颅压等.结论癫痫是脑囊虫病最常见的临床表现,常常合并皮下结节及高颅压等特点,值得临床医生注意.     

A Case of Extensive Spinal Cysticercosis Involving the Whole Spinal Canal in a Patient with a History of Cerebral Cysticercosis

Although cysticercosis is the most common parasitic disease affecting the central nervous system, spinal cysticercosis is rare. A rare form of spinal cysticercosis involving the whole spinal canal is presented. A 45-year-old Korean male had a history of intracranial cysticercosis and showed progressive paraparesis. Spinal magnetic resonance scan showed multiple cysts compressing the spinal cord from C1 to L1. Three different levels (C1-2, T1-3, and T11-L1) required operation. Histopathological examination confirmed cysticercosis. The patient improved markedly after surgery.     

An Incidental Diagnosis of Neurocysticercosis in a Dental Patient

Tenia solium, a parasite causes cysticercous cellulose when affecting the central nervous system, the manifestation is called neurocysticercosis. The most common symptom in neurocysticercosis is seizure. Generally, oral diagnosticians come across cases of oral cysticercosis and it is rare to find a case of neurocysticercosis in the dental office, as it goes undetected. Sometimes, when patients experience seizure in the dental office and subsequent evaluation is performed, rarity such as this can be detected. One case of neurocysticercosis in a 27 year old unmarried female patient detected due to its presentation in the dental office is being reported here.     

7例脑囊虫病病例临床资料分析

采用描述性流行病学方法对7例脑囊虫病患者临床资料进行了回顾性分析。7例患者中3例有绦虫病史,均有头晕、头痛症状。其他症状表现为:癫痫、肢体麻木、发作性眩晕、视物模糊、记忆力下降等,其中4例患者脑脊液压力增高。7例患者血清特异性囊虫抗体均阳性。头颅CT和MRI对于诊断脑囊虫病具有重要的价值。脑囊虫病的治疗应首选阿苯达唑。     

Taeniasis/cysticercosis in a Tibetan population in Sichuan Province, China

The results of a preliminary survey of taeniasis/cysticercosis in Yajiang County, Ganze Tibetan Prefecture in southwest Sichuan Province, China, indicated a very high prevalence of taeniasis (22.5%), with Taenia saginata as the dominant species. There was also a significant occurrence of late-onset epilepsy (8.5% prevalence and 16.4% seropositive for Taenia solium antibodies) attributable in large part to probable neurocysticercosis caused by T. solium. The poor sanitation and hygiene in this Tibetan community likely contributed to a high risk of human cysticercosis despite a low level of T. solium taeniasis (actually no T. solium carriers were detected amongst the 21 proven Taenia carriers). In addition, three taeniasis cases were confirmed by DNA genotyping as Taenia asiatica, which is the first report of this tapeworm in Tibetans, the first report for Sichuan Province and only the third report for mainland China.     

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.     

Short course of prednisolone in Indian patients with solitary cysticercus granuloma and new-onset seizures

PURPOSE: To evaluate the role of a short course of oral corticosteroids in Indian patients with solitary cysticercus granuloma with seizures. METHODS: In this open-label, randomized, prospective follow-up study, 97 patients with new-onset seizures and a single enhancing computed tomography (CT)-detected lesion of cysticercosis were randomly divided in two groups to receive either antiepileptic monotherapy alone (n = 48) or antiepileptic monotherapy with prednisolone (n = 49). The patients in the latter group received prednisolone, 1 mg/kg/day for 10 days, followed by tapering over next 4 days. The patients were followed up for 6 months. Repeated CT scans were performed after 1 and 6 months. RESULTS: The majority of patients were young. Simple partial seizure, with or without secondary generalization, was the commonest seizure type encountered. Follow-up CT scans at 1 and 6 months demonstrated a significantly better response for prednisolone as far as complete resolution of CT lesion was concerned. Kaplan-Meier analysis suggested significantly less probability of seizure recurrence for prednisolone-treated patients. At 6 months, Kaplan-Meier estimated risk of seizure after first seizure was 2% in prednisolone-treated patients in comparison to 13% for those who were not given prednisolone. CONCLUSIONS: Short-term prednisolone therapy helps in rapid resolution of solitary cysticercus granuloma in Indian patients with new-onset seizures. Resolution of lesions is associated with improved seizure-related prognosis.