Clinical profile and follow-up of 51 pediatric neurocysticercosis cases: A study from Eastern India

Introduction:

Our present observational study attempted to evaluate the clinical profiles, diagnosis, treatment and follow-up results of 51 pediatric neurocysticercosis patients over a mean duration of five years (from January 2006 to December 2010).

Materials and Methods:

Diagnosis was mainly based on clinical features, computed tomography (CT)/magnetic resonance imaging scan and exclusion of other causes. Patients with active, transitional cysts and seizure were treated with albendazole for 28 days, steroids and anticonvulsants.

Results:

A total of 38 patients completed this study. Mean age of the presentation was 8.47 ± 3.19 years 52.6% of the patients were female. Overall patients presented with generalized seizure in 55.3%, focal in 31.6%, headache ± vomiting in 63.2%, focal neurodeficit in 10.5% and combination of symptoms in 60.5% cases. Contrast CT brain showed a solitary lesion in 27 (71.1%) and multiple in the rest. At presentation lesions were transitional in 58.2%, inactive in 20% and mixed in 14.6%. After a mean of 2 years, seizure persisted in 9 (23.7%) and headache in 8 (21.1%) of whom six had normal electroencephalography (EEG) while one each showed focal slowing, generalized slowing and epileptiform discharges. During the follow-up, CT scan brain 44.7% lesions calcified, 31.6% disappeared, 10.5% regressed and the rest persisted.

Conclusion:

Solitary ring enhancing lesions (transitional stage) involving the parietal lobe was the commonest CT picture at presentation. Generalized tonic-clonic seizure was the most common type of seizure. Number of lesions, persistence of lesion, number of seizures, EEG abnormality at presentation were not found to be prognostically significant (P > 0.05).Key Words: Brain, epilepsy, lesion, neurocysticercosis, parenchyma, solitary     

Insights into major facilitator superfamily domain-containing protein-2a (Mfsd2a) in physiology and pathophysiology. What do we know so far?

Major facilitator superfamily domain-containing protein-2a (Mfsd2a) which was considered as an orphan transporter has recently gained attention for its regulatory role in the maintenance of proper functioning of the blood–brain barrier. Besides the major role of Mfsd2a in maintaining the barrier function, increasing evidence has emerged with regard to the contributions of Mfsd2a to various biological processes such as transport, cell fusion, cell cycle, inflammation and regeneration, managing tumor growth, functioning of other organs with barrier functions or responses to injury. The purpose of this article is to review the different roles of Mfsd2a and its involvement in the physiological and pathophysiological processes primarily in the central nervous system and throughout the mammalian body under the lights of the current literature.     

Chemoprophylaxis use and the risk of malaria in travelers to Nepal

BACKGROUND: Malaria transmission in Nepal is focal and seasonal. Based on data in returning travelers the risk of malaria is low. Sources of advice give contradictory information regarding the need for chemoprophylaxis. As a result, a degree of confusion exists among visitors. The aim of this study was to describe chemoprophylactic practices among travelers to Nepal and to document differences in advice according to its source and the country in which it was given. METHODS: A questionnaire survey of tourists attending the CIWEC Clinic Travel Medicine Center, Kathmandu between June 2000 and May 2001. Resident expatriates and indigenous Nepalese were excluded. RESULTS: Completed questionnaires were obtained from 1,303 respondents. Two hundred and eighty-eight respondents were taking chemoprophylaxis specifically for their trip to Nepal (22%), whereas 958 were not. Travelers from the United Kingdom and Denmark were significantly more likely, and those from the United States and Germany significantly less likely, to be taking chemoprophylaxis. Most travelers sought pretravel advice (71%), and all sources were more likely to advise them not to take chemoprophylaxis than to take it. However, travelers advised by a family practitioner were significantly more likely to be taking chemoprophylaxis than those advised by a travel medicine specialist. Of those taking chemoprophylaxis, 53% were doing so for a visit to the Terai alone, 33% for all areas of Nepal, and 6% for the Kathmandu Valley. Nine different chemoprophylactic regimes were in use. Six hundred and forty respondents who were not taking chemoprophylaxis had been advised that it was not necessary; 276 had made the choice themselves; and 131 had been taking chemoprophylaxis but had stopped while in Nepal. Twenty-eight of these respondents had stopped because of side effects. The most common reason for choosing not to take chemoprophylaxis was either the occurrence of side effects or the fear of them (31%). CONCLUSIONS: The variable and ultimately low risk of contracting malaria in Nepal has resulted in a lack of consensus and a wide range of opinion regarding the need for chemoprophylaxis. There is a need for clarification and tighter definition of the malaria risk faced by travelers to Nepal to avoid unnecessary chemoprophylaxis use while protecting those at significant risk.     

Minocycline improves functional outcomes, memory deficits, and histopathology after endovascular perforation-induced subarachnoid hemorrhage in rats

Subarachnoid hemorrhage (SAH) results in significant long-lasting cognitive dysfunction. Therefore, evaluating acute and long-term outcomes after therapeutic intervention is important for clinical translation. The aim of this study was to use minocycline, a known neuroprotectant agent, to evaluate the long-term benefits in terms of neurobehavior and neuropathology after experimental SAH in rats, and to determine which neurobehavioral test would be effective for long-term evaluation. SAH was induced by endovascular perforation in adult male Sprague-Dawley rats (n=118). The animals were treated with intraperitoneal injection of minocycline (45?mg/kg or 135?mg/kg) or vehicle 1?h after SAH induction. In the short-term, animals were euthanized at 24 and 72?h for evaluation of neurobehavior, brain water content, and matrix metalloproteinase (MMP) activity. In the long-term, neurobehavior was evaluated at days 21-28 post-SAH, and histopathological analysis was done at day 28. High-dose but not low-dose minocycline reduced brain water content at 24?h, and therefore only the high-dose regimen was used for further evaluation, which reduced MMP-9 activity at 24?h. Further, high-dose minocycline improved spatial memory and attenuated neuronal loss in the hippocampus and cortex. The rotarod, T-maze, and water maze tests, but not the inclined plane test, detected neurobehavioral deficits in SAH rats at days 21-28. This study demonstrates that minocycline attenuates long-term functional and morphological outcomes after endovascular perforation-induced SAH. Long-term neurobehavioral assessments using the rotarod, T-maze, and water maze tests could be useful to evaluate the efficacy of therapeutic intervention after experimental SAH.     

Case Report of Lichen Planopilaris Occurring in a Pediatric Patient Receiving a Tumor Necrosis Factor α Inhibitor and a Review of the Literature

A 12‐year‐old girl with extended oligoarthritis treated with adalimumab presented with a short history of a progressive cutaneous eruption involving the legs and scalp. Physical examination and histologic results were consistent with lichen planopilaris. The adalimumab was discontinued. She received treatment with topical clobetasol propionate and the majority of the lesions resolved. Residual lesions and the extended oligoarthritis were then treated with sulfasalazine. Adalimumab is a tumor necrosis factor α (TNF‐α) inhibitor used for the treatment of a variety of immunologically mediated conditions, including lichen planus and lichen planopilaris. TNF‐α antagonists have been associated with paradoxical psoriasiform, lichenoid, eczematous, granulomatous, and acneiform eruptions. We detail this case and review the literature of lichenoid reactions secondary to TNF‐α inhibitors.