Javier A Bustos1,2, Gianfranco Arroyo1,2, Robert H Gilman3, Percy Soto-Becerra2, Isidro Gonzales1, Herbert Saavedra1, E Javier Pretell1,4, Theodore E Nash5, Seth E O'Neal2,6, Oscar H Del Brutto7, Armando E Gonzalez2, Hector H Garcia1,2. 1. Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú. 2. Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú. 3. Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. 4. Department of Neurology, Hospital Alberto Sabogal, Callao, Perú. 5. Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA. 6. School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon, USA. 7. School of Medicine, Universidad Espíritu Santo-Ecuador, Samborondón, Ecuador.
Abstract
BACKGROUND: Neurocysticercosis is a major cause of acquired epilepsy. Larval cysts in the human brain eventually resolve and either disappear or leave a calcification that is associated with seizures. In this study, we assessed the proportion of calcification in parenchymal neurocysticercosis and risk factors associated with calcification. METHODS: Data for 220 patients with parenchymal NCC from 3 trials of antiparasitic treatment were assessed to determine what proportion of the cysts that resolved 6 months after treatment ended up in a residual calcification at 1 year. Also, we evaluated the risk factors associated with calcification. RESULTS: The overall proportion of calcification was 38% (188/497 cysts, from 147 patients). Predictors for calcification at the cyst level were cysts larger than 14 mm (risk ratio [RR], 1.34; 95% confidence interval [CI], 1.02-1.75) and cysts with edema at baseline (RR, 1.39; 95% CI, 1.05-1.85). At the patient level, having had more than 24 months with seizures (RR, 1.25; 95% CI, 1.08-1.46), mild antibody response (RR, 1.14; 95% CI, 1.002-1.27), increased dose albendazole regime (RR, 1.26; 95% CI, 1.14-1.39), lower doses of dexamethasone (RR, 1.36; 95% CI, 1.02-1.81), not receiving early antiparasitic retreatment (RR, 1.45; 95% CI, 1.08-1.93), or complete cure (RR, 1.48; 95% CI, 1.29-1.71) were associated with a increased risk of calcification. CONCLUSIONS: Approximately 38% of parenchymal cysts calcify after antiparasitic treatment. Some factors associated with calcification are modifiable and may be considered to decrease or avoid calcification, potentially decreasing the risk for seizure relapses.
BACKGROUND: Neurocysticercosis is a major cause of acquired epilepsy. Larval cysts in the human brain eventually resolve and either disappear or leave a calcification that is associated with seizures. In this study, we assessed the proportion of calcification in parenchymal neurocysticercosis and risk factors associated with calcification. METHODS: Data for 220 patients with parenchymal NCC from 3 trials of antiparasitic treatment were assessed to determine what proportion of the cysts that resolved 6 months after treatment ended up in a residual calcification at 1 year. Also, we evaluated the risk factors associated with calcification. RESULTS: The overall proportion of calcification was 38% (188/497 cysts, from 147 patients). Predictors for calcification at the cyst level were cysts larger than 14 mm (risk ratio [RR], 1.34; 95% confidence interval [CI], 1.02-1.75) and cysts with edema at baseline (RR, 1.39; 95% CI, 1.05-1.85). At the patient level, having had more than 24 months with seizures (RR, 1.25; 95% CI, 1.08-1.46), mild antibody response (RR, 1.14; 95% CI, 1.002-1.27), increased dose albendazole regime (RR, 1.26; 95% CI, 1.14-1.39), lower doses of dexamethasone (RR, 1.36; 95% CI, 1.02-1.81), not receiving early antiparasitic retreatment (RR, 1.45; 95% CI, 1.08-1.93), or complete cure (RR, 1.48; 95% CI, 1.29-1.71) were associated with a increased risk of calcification. CONCLUSIONS: Approximately 38% of parenchymal cysts calcify after antiparasitic treatment. Some factors associated with calcification are modifiable and may be considered to decrease or avoid calcification, potentially decreasing the risk for seizure relapses.
Authors: Oscar H Del Brutto; Perla Salgado; Julio Lama; Victor J Del Brutto; Xavier Campos; Mauricio Zambrano; Héctor H García Journal: Am J Trop Med Hyg Date: 2014-10-27 Impact factor: 2.345
Authors: Hector H Garcia; Isidro Gonzales; Andres G Lescano; Javier A Bustos; E Javier Pretell; Herbert Saavedra; Theodore E Nash Journal: Epilepsia Date: 2014-08-04 Impact factor: 5.864
Authors: Amit Prasad; Rakesh K Gupta; Sunil Pradhan; Mukesh Tripathi; Chandra M Pandey; Kashi N Prasad Journal: Parasitol Int Date: 2007-12-08 Impact factor: 2.230
Authors: T E Nash; O H Del Brutto; J A Butman; T Corona; A Delgado-Escueta; R M Duron; C A W Evans; R H Gilman; A E Gonzalez; J A Loeb; M T Medina; S Pietsch-Escueta; E J Pretell; O M Takayanagui; W Theodore; V C W Tsang; H H Garcia Journal: Neurology Date: 2004-06-08 Impact factor: 9.910
Authors: Jesus Abanto; Daniel Blanco; Herbert Saavedra; Isidro Gonzales; Diego Siu; E Javier Pretell; Javier A Bustos; Hector H Garcia Journal: Am J Trop Med Hyg Date: 2021-07-07 Impact factor: 3.707