Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

Cysticercosis

 

Parenchymal brain calcified cysticercus and progression of hippocampal atrophy. Cisticerco calcificado en el parénquima cerebral y progresión de atrofia de hipocampos.

A seizure-free 74-year-old woman had a single calcified cysticercus (Figure 1), and normal hippocampi (Figure 2, upper panel). Neuroimaging exams were practiced for a study aimed to assess the association between neurocysticercosis and hippocampal atrophy (HA).1 Seven years later, a control MRI showed bilateral HA (Figure 2, lower panel). The patient remained seizure-free during the observation period.

The association between calcified cysticercus and HA in seizure-free individuals has been recognized.2 It has been postulated that repetitive episodes of inflammation from antigens released to the brain parenchyma from calcifications are responsible for remote HA. However, HA progression in these patients has not been reported. This case underscores the need of early treatment with bisphosphonates to reverse the calcification process in the brain, reducing the risk of progressive HA.3

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Palabras clave: atrofia de hipocampo, cisticerco calcificado, cisticercosis, neurocisticercosis,

Keywords: Calcified cysticerci, Cysticercosis, hippocampal atrophy, neurocysticercosis,

Cisticercos calcificados en el parénquima cerebral y daño de hipocampos. Calcified cysticerci in the brain parenchyma and hippocampal damage.

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Palabras clave: atrofia de hipocampo, calcificaciones cerebrales, cisticercosis, esclerosis de hipocampo, neurocisticercosis,

Keywords: brain calcifications, Cysticercosis, hippocampal atrophy, hippocampal sclerosis, neurocysticercosis,

Programas de control de cisticercosis y erradicación de epilepsia relacionada a neurocisticercosis, Cysticercosis control programs and neurocysticercosis-related epilepsy eradication

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Palabras clave: cisticercosis, Epilepsia, Erradicación, neurocisticercosis,

Keywords: Cysticercosis, Epilepsy, Eradication, neurocysticercosis,

Neurocisticercosis, Epilepsia y Uso de Drogas Antiparasitarias. Neurocysticercosis, Epilepsy And The Use Of Antiparasitic Drugs.

Cysticidal drugs have been used for more than three decades. However, its efficacy has been questioned on the assumption that cysts would die spontaneously, and thus, inflammatory reactions related to therapy are unnecessary. In addition, isolated reports have also questioned whether neurocysticercosis (NCC) causes epilepsy. A large body of evidence is currently available and little – if any – doubt exists on NCC as a cause of unprovoked seizures. NCC is consistently associated with seizures when suitable groups are compared, and in a sizable subset of patients, the semiology of seizures correlates with the anatomical location of parasites. Cyst degeneration and the subsequent inflammatory reaction related to therapy may transiently increase seizure expression, and this can be anticipated and managed with the additional use of corticosteroids. Several controlled trial support the concept that cysticidal drug efficacy, safety, and the impact of cyst destruction in decreasing seizures largely overcome the potential risks of therapy, and have provided evidence of the role of NCC as a cause of r ecurrent unprovoked seizures (epilepsy).

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Palabras clave: albendazol, cisticercosis, Epilepsia, neurocisticercosis, praz iquantel.,

Keywords: albendazole, Cysticercosis, Epilepsy, neurocysticercosis, praziquantel.,

Estudio Poblacional de Prevalencia de Cisticercosis Porcina en Atahualpa, Ecuador. Metodología y Definiciones Operacionales. Population-Based Study Of Porcine Cysticercosis Prevalence In Atahualpa, Ecuador. Methodology And Operational Definitions.

Objective: To assess sero-prevalence of porcine cysticercosis in Atahualpa, a rural Ecuadorian village endemic for human neurocysticercosis.

Design: We aim to collect at least 600 blood samples of local pigs, to quantify the number of positive bands in the EITB, and to estimate crude prevalence rates of porcine cysticercosis in the village. Sampling will only include pigs older than 2 months of age. Only healthy pigs will be sampled, to avoid risks inherent to manipulation of sick animals. There will be no risk for pigs as the result of the procedure. According to the estimated endemicity of human cysticercosis, we expect to find about 25% of infected pigs in this study. In the event of prevalence rates above or below the expected percentage, we will attempt to assess the causes of such discrepancies. All pig positive to 3 bands of more in the EITB will receive treatment with oxfendazole at a single dose of 30 mg/kg.

Comment: The importance of defining the prevalence of porcine cysticercosis in a village endemic for human neurocysticercosis is to confirm the existence of active transmission. If this is true, treatment of infected pigs will help to interrupt the life cycle of Taenia solium, thus reducing the prevalence of this disease in humans.

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Palabras clave: Atahualpa, cisticercosis, cisticercosis porcina, estudio poblacional, Inmunoblot, neurocisticercosis, Western Blot,

Keywords: Atahualpa, Cysticercosis, Immunoblot, neurocysticercosis, population-based study, Porcine cysticercosis, Western Blot,

“Brain Holes.” A Diagnostic Challenge In Cysticercosis-Endemic Areas.

The introduction of modern neuroimaging and immunologic techniques has increased the diagnostic accuracy for neurocysticercosis.
However, there are some conditions that mimic neurocysticercosis by the time of the initial evaluation of the patient. We present six patients with a single abnormally dilated perivascular Virchow-Robin space mimicking a cysticercus.
In such cases, administration of repeated trials of cysticidal drugs together with long-term follow-up observation, excluded the diagnosis of neurocysticercosis. Physicians working in cysticercosis-endemic areas must keep in mind the possible occurrence of a single dilated perivascular space, to avoid the practice of unnecessary invasive procedures in patients with “cysticerci-like” lesions that do not change after several courses of cysticidal drug therapy.

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Palabras clave: cisticercosis, neurocisticercosis, Virchow-Robin,

Keywords: Cysticercosis, neurocysticercosis, perivascular spaces, Virchow-Robin space,

Short course of albendazole therapy for neurocysticercosis: A prospective randomized trial comparing three days, eight days and the control group without albendazole

Antihelminthic therapy with albendazole for parenchymal cerebral cysticercosis, despite its widespread acceptance, is still the subject of controversy. In this prospective, randomized clinical trial, we compared the effectiveness of two regimens of albendazole therapy for neurocysticercosis against each other and against symptomatic therapy alone. A first group (27 patients) received albendazole for 3 days, a second group (27 patients) received albendazole for 8 days, and a third group (29 patients) received only symptomatic treatment. Effectiveness of albendazole was 85.8% with no difference between the 3 and 8-day groups of treatment. Improvement of the patients in the control group was 34.4%. Complete resolution of cysts was obtained in 77.7% of the patients who received albendazole. Two years after therapy, there was no difference in the number of patients free of seizures, when comparing the three groups of treatment. The ultra-short course of treatment with albendazole for 3 days was effective in our patients. Therapy with albendazole for 8 days did not provide additional benefits.

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Palabras clave: albendazol, cisticercosis, tratamiento antihelmíntico,

Keywords: albendazole, Antihelminthic therapy, Cysticercosis,
 
 
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