Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2020  |  Volume : 31  |  Issue : 4  |  Page : 881--882

Neurocysticercosis and Adult-Onset Epilepsy


Jamir Pitton Rissardo, Ana LetÍcia Fornari Caprara 
 Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil

Correspondence Address:
Jamir Pitton Rissardo
Department of Medicine, Federal University of Santa Maria, Santa Maria
Brazil




How to cite this article:
Rissardo JP, Fornari Caprara AL. Neurocysticercosis and Adult-Onset Epilepsy.Saudi J Kidney Dis Transpl 2020;31:881-882


How to cite this URL:
Rissardo JP, Fornari Caprara AL. Neurocysticercosis and Adult-Onset Epilepsy. Saudi J Kidney Dis Transpl [serial online] 2020 [cited 2020 Nov 25 ];31:881-882
Available from: https://www.sjkdt.org/text.asp?2020/31/4/881/292327


Full Text



To the Editor,

We read the published article entitled “Neurocysticercosis” with great interest. Siddiqua and Habeeb published a special article about neurocysticercosis (NCC) describing the life cycle, epidemiology, diagnosis, and management of this common pathology in underdeveloped countries.[1][Table 1]. Revised diagnostic criteria for neurocysticercosis (Del Brutto et al, 2017).{Table 1}

Here, we would like to highlight the importance of a common association of NCC and epilepsy, which we believe, along with the article of Siddiqua and Habeeb, could lead to a better comprehension of this relation.[1]

Del Brutto et al revised the diagnostic criteria and degrees of diagnostic certainty for NCC in 2017 [Table 1].[2]

NCC is an important cause of seizures and accounts for approximately 30% of all epilepsy cases in most developing countries.[3] It is worth mentioning that due to potential diagnostic limitations related to availability and financial issues, this condition is probably underdiag- nosed.[1] Interestingly, the central nervous system involvement of the tapeworm Taenia solium has the highest morbidity, while larval cysts elsewhere are usually destroyed, leading to asymptomatic disease.[2] The clinical manifes tations of NCC can range from asymptomatic brain lesions to any kind of neurological symptoms, in which the symptomatology depends on the location of the brain lesions.[3]

Caprara et al assessed the clinical predictors associated with drug-resistant adult-onset epilepsy in Brazil during a long-term follow-up. More than 300 patients were followed up for almost 10 years, 47 of them presented drug- resistant epilepsy. Structural epilepsy etiology was associated with an increased chance of relapse of 1.74 OR [confidence interval (CI) 1.66-1.89], but the infectious etiology (NCC) was positively associated with non-drug resistant epilepsy (OR 1.012, CI 1.001–1.215). Thus, it is possible that there is a correlation between seizure and seizure recurrence and the size of the lesions. In this way, individuals with NCC can have epilepsy although their epilepsy when compared to structural lesions is more easily controlled with a smaller number of anti- epileptic drugs.[4][Table 2]. Neurocysticercosis stages and clinical features.{Table 2}

The pathophysiological explanation of NCC leading to epilepsy is probably related to inflammation around the parasite in the cerebral brain parenchyma, which is necessary for the process of parasite death.[5] Thus, the increase of cytokines may play a role in the epileptogenic process driven by the misguided inflammatory response, blood-brain-barrier disruption, and increased expression of other reactive peptides. This hypothesis can easily explain the early stages of this disorder, but during the calcified stages, there probably occurs residual peri-lesional gliosis causing a chronic epileptogenic focus [Table 2].[5],[6]

References

1Siddiqua T, Habeeb A. Neurocysticercosis. Saudi J Kidney Dis Transpl 2020;31:254-8.
2Del Brutto O, Nash T, White A Jr., et al. Revised diagnostic criteria for neurocysti- cercosis. J NeurolSci2017;372:202-10.
3Lesh EJ, Brady MF. Tapeworm (Taenia Solium, Taenia Saginata, Diphyllobothrium, Cysticercosis, Neurocysticercosis). Treasure Island (FL): StatPearls Publishing; 2020 Jan.
4Caprara AL, Rissardo JP, Leite MT, et al. Course and prognosis of adult-onset epilepsy in Brazil: A cohort study. Epilepsy Behav 2020; 105:106969.
5Millogo A, Kongnyu Njamnshi A, Kabwa- Pierre Luabeya M. Neurocysticercosis and epilepsy in sub-Saharan Africa. Brain Res Bull 2019;145:30-8.
6deLange A, Mahanty S, Raimondo JV. Model systems for investigating disease processes in neurocysticercosis. Parasitology 2019;146:553- 62.