Cognitive Changes and Quality of Life in Neurocysticercosis: A Longitudinal Study

Neurocysticercosis (NCC) is one of the most common parasitic infections of the central nervous system. Cognitive changes have been frequently reported with this disease but have not been well studied. Our study team recruited a group of new onset NCC cases and a matched set of healthy neighborhood controls and new onset epilepsy controls in Lima, Peru for this study. A neuropsychological battery was administered at baseline and at 6 months to all groups. Brain MRI studies were also obtained on NCC cases at baseline and at 6 months. Newly diagnosed patients with NCC had mild cognitive deficits and more marked decreases in quality of life at baseline compared with controls. Improvements were found in both cognitive status and quality of life in patients with NCC after treatment. This study is the first to assess cognitive status and quality of life longitudinally in patients with NCC and provides new data on an important clinical morbidity outcome

Calcificaciones cerebrales y edema perilesional

Brain calcifications, most frequently due to residual cysticercosis, are very common in developing countries. Recent reports have shown that residual brain lesions may be enhanced after contrast and present edema after an episode of neurological symptoms. We report three cases showing this phenomenon and how it can complicate the diagnosis, increasing hospital stay, and sometimes requiring invasive diagnostic procedures. Calcifications with surrounding edema must be considered in the differential diagnosis of enhancing brain lesions.Las calcificaciones del parénquima cerebral, mayormente atribuidas a neurocisticercosis residual, son comunes en países en vías de desarrollo. Recientemente se ha reportado que aún las lesiones calcificadas residuales pueden presentar captación de contraste y edema, detectables al tiempo de una manifestación neurológica. Presentamos tres casos que demuestran como este fenómeno puede innecesariamente complicar el diagnósltico, incrementando el tiempo de hospitalización y en algunas veces hasta practicar procedimientos invasivos para confirmar el diagnóstico. Las calcificaciones con edema perilesional deben ser consideradas en el diagnóstico diferencial de las lesiones granulomas intracerebrales

A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis.

BACKGROUND: Neurocysticercosis is the main cause of adult-onset seizures in the developing world. Whether therapy with antiparasitic agents results in improved seizure control has been questioned because of the lack of adequate, controlled studies. METHODS: We conducted a double-blind, placebo-controlled trial in which 120 patients who had living cysticerci in the brain and seizures treated with antiepileptic drugs were randomly assigned to receive either 800 mg of albendazole per day and 6 mg of dexamethasone per day for 10 days (60 patients) or two placebos (60 patients). The patients were followed for 30 months or until they had been seizure-free for 6 months after the doses of the antiepileptic drugs had been tapered. The efficacy of treatment was measured as the decrease in the number of seizures after treatment. RESULTS: In the albendazole group, there was a 46 percent reduction in the number of seizures (95 percent confidence interval, -74 to 83 percent) during months 2 to 30 after treatment. This reduction, which was not statistically significant, was composed of a nonsignificant reduction of 41 percent in the number of partial seizures (95 percent confidence interval, -124 to 84 percent) and a significant 67 percent reduction in the number of seizures with generalization (95 percent confidence interval, 20 to 86 percent). Most of the difference in the number of partial seizures was attributable to a few patients who had many seizures during follow-up. The proportions of patients who had partial seizures during follow-up were similar in the two groups (19 of 57 in the albendazole group and 16 of 59 in the placebo group), but the patients in the placebo group had a greater tendency to have seizures with generalization (22 of 59, vs. 13 of 57 in the albendazole group; risk ratio, 1.63; 95 percent confidence interval, 0.91 to 2.92). More of the intracranial cystic lesions resolved in the albendazole group than in the placebo group. With the sole exception of abdominal pain, side effects did not differ significantly between the two groups. CONCLUSIONS: In patients with seizures due to viable parenchymal cysts, antiparasitic therapy decreases the burden of parasites and is safe and effective, at least in reducing the number of seizures with generalization

Parasite antigen in serum predicts the presence of viable brain parasites in patients with apparently calcified cysticercosis only

Background. Computed tomography (CT) remains the standard neuroimaging screening exam for neurocysticercosis, and residual brain calcifications are the commonest finding. Magnetic resonance imaging (MRI) is more sensitive than CT but is rarely available in endemic regions. Enzyme-linked immunoelectrotransfer blot (EITB) assay uses antibody detection for diagnosis confirmation; by contrast, enzyme-linked immunosorbent assay (ELISA) antigen detection (Ag-ELISA) detects circulating parasite antigen. This study evaluated whether these assays predict undetected viable cysts in patients with only calcified lesions on brain CT. Methods. Serum samples from 39 patients with calcified neurocysticercosis and no viable parasites on CT were processed by Ag-ELISA and EITB. MRI was performed for each patient within 2 months of serologic testing. Conservatively high ELISA and EITB cutoffs were used to predict the finding of viable brain cysts on MRI. Results. Using receiver operating characteristic-optimized cutoffs, 7 patients were Ag-ELISA positive, and 8 had strong antibody reactions on EITB. MRI showed viable brain cysts in 7 (18.0%) patients. Patients with positive Ag-ELISA were more likely to have viable cysts than Ag-ELISA negatives (6/7 vs 1/32; odds ratio, 186 [95% confidence interval, 1-34 470.0], P < .001; sensitivity 85.7%, specificity 96.9%, positive likelihood ratio of 27 to detect viable cysts). Similar but weaker associations were also found between a strong antibody reaction on EITB and undetected viable brain cysts. Conclusions. Antigen detection, and in a lesser degree strong antibody reactions, can predict viable neurocysticercosis. Serological diagnostic methods could identify viable lesions missed by CT in patients with apparently only calcified cysticercosis and could be considered for diagnosis workup and further therapy

Individual cognitive test scores within the processing speed composite at baseline and 6-month follow-up.

#<p>Significant difference within groups longitudinally (p≤0.05). Standard error follows mean test scores in brackets.</p

SF-36 transformed scale scores for major quality-of-life outcomes at baseline and 6-month follow-up.

<p>*Difference vs. Neighborhood Controls cross-sectionally (p≤0.07);</p><p>**Significant Difference vs. Neighborhood Controls cross-sectionally (p≤0.05);</p>#<p>Significant difference within groups longitudinally (p≤0.05). Standard error follows transformed test scores in brackets.</p

Neuropsychological testing battery.

<p>*Attention composite tests;</p>#<p>Processing speed composite tests;</p>¶<p>Learning composite tests;</p>§<p>Memory composite tests (see <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001493#pntd-0001493-t003" target="_blank">Table 3</a>).</p><p>Abbreviations: WAIS: Wechsler Adult Intelligence Scale, WMS: Wechsler Memory Scale, RAVT: Raven's Progressive Matrices and Vocabulary Scales, SF-36: Short Form-36.</p

Composite age and education-adjusted test scores for major cognitive domains at baseline and 6-month follow-up.

<p>**Significant difference between NCC and Epilepsy groups cross-sectionally (p≤0.05). Standard deviation follows test scores in brackets.</p