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Seizure outcome in patients with a solitary cerebral cysticercus granuloma

From the Departments of Neurological Sciences and Clinical Epidemiology, Christian Medical College Hospital, Vellore, India.

Address correspondence and reprint requests to Dr. V. Rajshekhar, Department of Neurologic Sciences, Christian Medical College Hospital, Vellore 632 004, India; e-mail: rajshekhar{at}cmcvellore.ac.in

Objective: To study the long-term seizure outcome and determine factors that predict recurrence of seizures following early withdrawal of antiepileptic drugs (AEDs) in patients with a solitary cerebral cysticercus granuloma (SCCG).

Methods: The authors prospectively studied 185 patients with SCCG and seizures in whom AEDs were withdrawn soon after (within 2 to 12 weeks) resolution of the SCCG was demonstrated on the CT scan. The follow-up of these patients ranged from 24 to 125 months (mean 65.8 months) or until seizure recurrence. Age, number of seizures, duration of AED therapy, occurrence of breakthrough seizures, administration of albendazole, and presence of a calcific residue of the SCCG on the CT scan were studied as prognostic factors to predict recurrence of seizures.

Results: One hundred fifty-seven patients (84.9%) were seizure-free, whereas 28 patients (15.1%) had recurrence of seizures after withdrawal of AEDs. The recurrences occurred at a mean duration of 18.8 months (range 0.5 to 78 months) after withdrawal of AEDs. Multivariate analysis showed that presence of calcific residue on the CT scan, occurrence of breakthrough seizures, and occurrence of more than two seizures were associated with a higher risk of recurrence of seizures. The other factors including administration of albendazole therapy did not affect seizure recurrence.

Conclusions: Nearly 85% of patients with a solitary cerebral cysticercus granuloma have a good seizure outcome following resolution of the lesion and early withdrawal of AEDs. However, recurrence of seizures can be expected in about 15% of patients. Patients with more than two seizures, those with breakthrough seizures, and those whose follow-up CT scan shows a calcific residue of the granuloma have a higher risk of recurrence and therefore need to be appropriately cautioned after withdrawal of AEDs. AED therapy might also have to be continued for longer periods in patients with these risk factors.

Received September 2, 2003. Accepted in final form February 23, 2004.

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