Neurocysticercosis in patients with active epilepsy in the tea garden community of Assam, Northeast India.

Neurocysticercosis is a significant cause of epilepsy in the tropics. The present cross-sectional survey was conducted in the socioeconomically backward tea garden community of Assam to gauge the prevalence of neurocysticercosis in patients with active epilepsy and to determine the associated risk factors. In a door to door survey, a total of 1028 individuals from every fifth household of the study Teagarden were enrolled to identify self-reported seizure cases, followed by a neurological examination to confirm the diagnosis of active epilepsy. Patients with active epilepsy underwent clinical, epidemiological, neuroimaging (contrast-enhanced computerized tomography) and immunological evaluations to establish the diagnosis of neurocysticercosis. Clinically confirmed 53 (5.16%) active epilepsy were identified; 45 agreed to further assessment for neurocysticercosis and 19 (42.2%) cases fulfilled either definitive or probable diagnostic criteria for neurocysticercosis. Patients with epilepsy due to neurocysticercosis were more likely to suffer from taeniasis (20.0% vs 0.0%), rear pigs (57.9% vs 15.4%) or have pigs in their neighbourhood (78.9% vs 53.8%) relative to epileptic patients without neurocysticercosis. Rearing pigs (aOR 14.35, 95% CI: 3.98-51.75) or having pigs in the neighbourhood (aOR 12.34, 95% CI: 2.53-60.31) were independent risk factors of neurocysticercosis. In this community, the prevalence of taeniasis (adult worm infection) was 6.6% based on microscopy. The study reports a high prevalence of active epilepsy in the tea garden community of Assam and neurocysticercosis as its primary cause. The high prevalence of taeniasis is also a significant concern.

Assessment of impediments affecting health systems response to neurocysticercosis in two districts (Gulu and Amuru) of Northern Uganda: A cross sectional study

Northern Uganda is recovering from the effects of prolonged war which devastated most of the health systems in the region. The aim of the study was to identify health sector impediments affecting health systems response to Neurocysticercosis in the districts of Gulu and Amuru. A cross sectional study was conducted on two hospitals and 10 health centers. Two hundred and three (n=203) respondents were involved. Questionnaires were used to collect the data. One hundred and forty two (70.0%) of the respondents are permanently employed (P=0.01). Seventy three point nine percent (73.9%) of respondents are residents from Gulu districts (P=0.024). One hundred and nine (53.4%) of respondents reported they received training on infectious diseases (P=0.507). One hundred and forty three (70%) reported their health facilities have polices (P=0.04). One hundred and forty seven (72.4%) reported in-charges reside at health facilities (P=0.01). One hundred and twenty four (61%) of the respondents reported Government is the primary source of funding (P=0.02). One hundred and seventeen (57.6%) of the respondents reported funding are irregular (P=0.23). Eighty seven percent (87%) reported inadequate physical infrastructure (P=0.04). Seventy three point six have limited knowledge on the diagnosis of Neurocysticercosis (P=0.01) and many prescribe anti-helminthic drugs to patients (P=0.27). Despite improvement in the healthcare services in the health sectors, health systems response to Neurocysticercosis in Gulu and Amuru, Northern Uganda is weak with most health facilities operating minimally. There is need for holistic approach to improvement of health systems in the region through increased Government funding and advocacy

Giant cerebral cysticercosis in an infant confused with a thalamic glioma.

Neurocysticercosis is a common parasitic infection of the central nervous system. Intraparenchymal giant cysticercosis has been described in literature, but this is a rare report of a thalamic giant cysticercosis in a young child where the diagnosis could be made on follow-up. A 1½-year-old male child presented with seizures, hemiparesis, and features of raised intracranial pressure. Initial neuroimaging findings of thalamic swelling with minimal edema and contrast enhancement with choline peak on magnetic resonance spectroscopy were attributed to thalamic glioma. Subsequent imaging revealed a ring enhancing lesion with an eccentric nodule suggestive of neurocysticercosis. It later resolved with residual gliosis. The presence of a pathognomic scolex and the resolution of size and symptoms without definitive treatment helped in making the diagnosis. This report reinforces the importance of considering cysticercosis in diagnosis of acute presentations of large cerebral masses in infants, particularly in prevalent regions, and emphasizes the follow-up of these patients.

Neurocysticercosis presenting as a vertical one-and-a-half syndrome with associated contralesional horizontal gaze paresis.

We describe a patient presenting with vertical one-and-a-half syndrome and concomitant contralesional horizontal gaze paresis as the result of a solitary neurocysticercosis (NCC) lesion in the right midbrain extending into the thalamomesencephalic junction. The patient received an albendazole-dexamethasone course which resulted in resolution of his symptoms. The neuro-ophthalmological complications of NCC are reviewed and the clinical topography of the neuro-ophthalmological findings of this unusual observation are discussed.

Investigação em material de autópsias sobre a hipótese de associação entre obesidade e neurocisticercose / Investigation in autopsy material on the hypothesis of the association between obesity and neurocysticercosis

Introdução: A Neurocisticercose (NCC) é uma infecção no sistema nervoso central que pode ser associada à obesidade quando o cisticerco afeta os centros hipotalâmicos relacionados ao controle da fome e da saciedade. Objetivo: Comparar o Índice de Massa Corporal (IMC) dos pacientesautopsiados com NCC (exceto hipotalâmica) com um grupo sem cisticercose. Métodos: Foram revistos 2.629 protocolos de autópsias realizadas no período de 1970 a 2004, avaliando-se as seguintes variáveis: índice de massa corporal, diagnóstico e localização da NCC. Resultados: A ocorrência de NCC foi de 2,7por cento e a mediana do IMC do grupo com NCC (19,06 kg/m2) foi significativamente menor (p igual 0,001) que a do grupo sem cisticercose (20,76 kg/m2). Conclusão: A NCC, por si só, não está relacionada à obesidade, exceto quando o cisticerco apresenta localização hipotalâmica.

Introduction: Neurocysticercosis (NCC) is an infection of the Central NervousSystem that may be associated with obesity when the cysticercus affectshypothalamic centers associated to the appetite and satiety. Aim: to compare the Body Mass Index (BMI) of autopsied patients with NCC (except hypothalamic) with an autopsied group without cysticercosis. Methods: 2,629 protocols from autopsies from 1970 until 2004 were revised and the following variables evaluated: BMI, positive diagnosis, and localization of neurocysticercosis. NCC was found in71 autopsies (2.7%). The median BMI of the group with NCC, which was 19.06kg/m2, was significantly lower (p=0.001) in comparison with the group without cysticercosis with a BMI of 20.76 kg/m2. Conclusion: NCC itself is not related to obesity, except when the cysticercus has hypothalamic localization.

Neurocisticercosis y enfermedad de Chagas / Neurocysticercosis and Chagas disease

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Epilepsy in Nepal.

This is a review of epilepsy in Nepal. Nepal is a predominantly rural country with a population of 21 million. A community-based survey in Morang district showed that the prevalence of epilepsy was 7.3 per 1,000 population. A cohort of 300 cases in Shree Birendra Military Hospital showed that neurocysticercosis was the most important etiological cause. There are seven neurologists, 10 CT scanners, three MRIs, and four EEG machines in the country. The practice of anticonvulsant use varied according to different geographical locations. The treatment gap may be in excess of 70%. The epidemiology study in Morang district showed that the proportion seeking modern treatment was higher among those with more frequent seizure. None of the patients were able to attribute their illness to brain disease. Various forms of traditional treatment are widely practiced in all casts among Hindus as well as Buddhists.

Intracranial cysticercosis: an effective treatment with alternative medicines.

The purpose of this study was to demonstrate the cysticidal activities of Ruta graveolens and calcium phosphate in fractional dilutions as a completely new approach for the treatment of neurocysticercosis in humans. These two homeopathic medicines when given to patients with neurocysticercosis have cured the infection in 25 subjects (69.4%) from a total of 36 patients. Our preliminary results indicate that Ruta graveolens in combination with calcium phosphate must be considered to be a potent cysticidal agent with very little or no side effects.