Neuropsychiatric manifestations and epidemiology of neurocysticercosis / Manifestações neuropsiquiátricas e epidemiologia de neurocisticercose

Neurocysticercosis (NCC) is the brain infection caused by larval stages of the helminth Taenia solium. The embryos of Taenia travel through the bloodstream and can reach the brain, muscles, eyes, and various organs. In the brain, the psychiatric manifestations are mood disorders, depression and anxiety, which are commonly associated with epilepsy and sensory-motor deficits. Neurocysticercosis is a frequent parasitic disease in the world population; it is endemic in Central and South America, Asia and Sub-Saharan Africa. In the present review, we report the major symptoms and signals of neurocysticercosis common to neurological and psychiatric illnesses. We briefly present Epidemiology of those manifestations and analyze the relationship between pathological changes and NCC symptomatology. OBJECTIVES AND METHODOLOGY: A literature review was conducted to characterize epidemiological, neurological and psychiatric manifestations of NCC. The final 90 papers were selected of a set of 937 publications from 2010 to 2016. RESULTS: NCC is a major cause of epilepsy in endemic areas; further- more, leads to a diversity of motor and sensitive deficits, manifestations vary from headache to severe intracranial hypertension. Potentially fatal conditions include arteritis, encephalitis and hydrocephalus. Depression and cognitive decline remain among the most important psychiatric manifestations. Neuropsychiatric manifestations, Epidemiology, and neuroimaging provide diagnostic criteria. Brain scans may reveal one or diverse cysts filled with fluid within a scolex (parasite's head). CONCLUSION: NCC's diversity of presentations encourage health professionals to consider it in diagnoses, especially in endemic countries, and also in non-endemic areas because migrants and travelers are subject to contagious. Treatment consists in use of antiparasitic drugs (albendazol, praziquantel) and drugs to treat associated conditions (anticonvulsants, corticosteroids). Surgery is reserved to extirpate the parasite from particular locations (eyes, spinal cord, cerebral ventricles) or to differentiate NCC from tumors, tuberculosis, mycosis, etc. Prevention includes treatment of intestinal helminthiasis, sanitation in animal farming, food preparing hygiene, quality control of water and food.

Neurocisticercose é a infecção cerebral causada pelos estágios lar- vais do helminto Taenia solium. Os embriões da Taenia deslocam-se através da corrente sanguínea e podem atingir o cérebro, músculos, olhos e vários órgãos. No cérebro, as manifestações psiquiátricas são transtornos de humor, depressão e ansiedade, as quais estão comumente associados com epilepsia e deficiências sensório-motoras. Neurocisticercose é uma parasitose frequente na população mundial, é endêmica na América Central e do Sul, Ásia e África subsaariana. Na presente revisão, relatamos os principais sintomas e sinais de neurocisticercose pertinentes a doenças neurológicas e psiquiátricas. Nós brevemente apresentamos a Epidemiologia dessas manifestações, e analisamos a relação entre alterações patológicas e sintomatologia da NCC. OBJETIVOS E METODOLOGIA: Uma revisão da literatura foi conduzida para caracterizar a epidemiologia, as manifestações neurológicas e psiquiátricas de NCC. Os 90 artigos finais foram selecionados de um conjunto de 937 publicações entre 2010 a 2016. RESULTADOS: NCC é uma importante etiologia de epilepsia em áreas endêmicas, além disso causa uma diversidade de deficiências motoras e sensoriais, as manifestações variam de cefaleia a severa hipertensão intracraniana. Condições potencialmente fatais incluem arterites, encefalites e hidrocefalia. Depressão e declíneo cognitive permanecem entre as mais importantes manifestações psiquiátricas. Manifestações neuropsiquiátricas, epidemiologia e neuroimagem provêm os critérios de diagnóstico. As imagens cerebrais podem revelar um ou diversos cistos preenchidos com líquido e o escólex (cabeça) do parasito. CONCLUSÕES: A diversidade de apresentações da NCC encoraja os profissionais de saúde a considerá-la dentre os diagnósticos, especialmente em países endêmicos; e também em áreas não-endêmicas, pois migrantes e viajantes estão sujeitos ao contágio. O tratamento consiste no uso de antiparasíticos (albendazol, praziquantel) e medicamentos para tratar condições associadas (anticonvulsivantes, corticosteróides). Cirurgia é reservada para remoção do parasito de locais particulares (olhos, medula espinhal, ventrículos cerebrais) ou para diferenciar NCC de tumores, tuberculose, micose, etc. Prevenção inclui o tratamento de helmintíases intestinais, sanidade animal, higiene ao preparar alimentos, controle da qualidade da água e alimentos.

Neurocysticercosis in asplenic patient, case report / Neurocisticercose em paciente asplênico, relato do caso

Neurocysticercosis is an important cause of neurologic and psychiatric disorders; it is a frequent etiology for acquired epilepsy worldwide. The parasitic infection of Taenia solium (including larval dissemination to the nervous system) can be avoided by effective means of prevention. Nonetheless, this disease remains endemic in many regions of the world. To demonstrate the importance of prophylaxis this paper reports the case of a patient without spleen, who was treated for neurocysticercosis manifested by epilepsy. In twenty years of follow up, the patient did not experience a repeat occurrence of neurocysticercosis, despite of immunological impairment (absence of spleen) and environmental exposure (living in an endemic area). Prevention was guided by a regular use of anthelmintic (Albendazole) and health education.

Neurocisticercose é uma importante causa de doenças neurológicas e psiquiátricas, é uma frequente etiologia de epilepsia adquirida, no mundo. A infecção parasitária da Taenia solium (incluindo a disseminação das larvas para o sistema nervoso) pode ser evitada por meios eficazes de prevenção; no entanto, esta enfermidade ainda é endêmica em muitas regiões do mundo. Para demonstrar a importância da profilaxia relata-se o caso de um paciente sem baço, o qual foi tratado para a neurocisticercose manifestada por epilepsia. Em vinte anos de seguimento, o paciente não repetiu a ocorrência de neurocisticercose, apesar de dano imunológico (ausência de baço) e exposição ambiental (habitação em área endêmica). A prevenção foi guiada pelo uso regular de anti-helmíntico (Albendazole) e medidas educativas em saúde.

fMRI investigation of response inhibition, emotion, impulsivity, and clinical high-risk behavior in adolescents.

High-risk behavior in adolescents is associated with injury, mental health problems, and poor outcomes in later life. Improved understanding of the neurobiology of high-risk behavior and impulsivity shows promise for informing clinical treatment and prevention as well as policy to better address high-risk behavior. We recruited 21 adolescents (age 14-17) with a wide range of high-risk behavior tendencies, including medically high-risk participants recruited from psychiatric clinics. Risk tendencies were assessed using the Adolescent Risk Behavior Screen (ARBS). ARBS risk scores correlated highly (0.78) with impulsivity scores from the Barratt Impulsivity scale (BIS). Participants underwent 4.7 Tesla functional magnetic resonance imaging (fMRI) while performing an emotional Go/NoGo task. This task presented an aversive or neutral distractor image simultaneously with each Go or NoGo stimulus. Risk behavior and impulsivity tendencies exhibited similar but not identical associations with fMRI activation patterns in prefrontal brain regions. We interpret these results as reflecting differences in response inhibition, emotional stimulus processing, and emotion regulation in relation to participant risk behavior tendencies and impulsivity levels. The results are consistent with high impulsivity playing an important role in determining high risk tendencies in this sample containing clinically high-risk adolescents.

Neural correlates of high-risk behavior tendencies and impulsivity in an emotional Go/NoGo fMRI task.

Improved neuroscientific understanding of high-risk behaviors such as alcohol binging, drug use, and unsafe sex will lead to therapeutic advances for high-risk groups. High-risk behavior often occurs in an emotionally-charged context, and behavioral inhibition and emotion regulation play important roles in risk-related decision making. High impulsivity is an important potential contributor to high-risk behavior tendencies. We explored the relationships between high-risk behavior tendencies, impulsivity, and fMRI brain activations in an emotional Go/NoGo task. This task presented emotional distractor pictures (aversive vs. neutral) simultaneously with Go/NoGo stimuli (square vs. circle) that required a button press or withholding of the press, respectively. Participants' risk behavior tendencies were assessed with the Cognitive Appraisal of Risky Events (CARE) scale. The Barratt Impulsivity Scale 11 (BIS) was used to assess participant impulsivity. Individuals with higher CARE risk scores exhibited reduced activation related to response inhibition (NoGo-Go) in right orbital frontal cortex (OFC) and ventromedial prefrontal cortex. These regions did not show a significant relationship with impulsivity scores. Conversely, more impulsive individuals showed reduced emotion-related activity (aversive-neutral distractors) in dorsomedial prefrontal cortex, perigenual anterior cingulate cortex, and right posterior OFC. There were distinct neural correlates of high-risk behavior tendency and impulsivity in terms of brain activity in the emotional Go/NoGo task. This dissociation supports the conception of high-risk behavior tendency as a distinct construct from that of impulsivity. Our results suggest that treatment for high-risk behavior may be more effective with a nuanced approach that does not conflate high impulsivity necessarily with high-risk behavior tendencies.