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From the School of Public Health and Administration (Dr. Montano) and Department of Microbiology (Drs. Villaran, Ylquimiche, Figueroa, Gilman, and Garcia), School of Sciences, Universidad Peruana Cayetano Heredia, US Naval Medical Research Center Detachment (Dr. Montano), Cysticercosis Unit (Dr. Garcia, S. Rodriguez), Instituto de Ciencias Neurologicas, and School of Veterinary Medicine (Dr. Gonzalez), Universidad Nacional Mayor de San Marcos, Lima, Peru; US Military HIV Research Program and Henry M. Jackson Foundation Inc. (C.T. Bautista), Rockville, MD, Department of International Health (Drs. Gonzalez, Gilman, and Garcia), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, and Immunology Branch (Dr. Tsang), Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA.
Address correspondence and reprint requests to Dr. H.H Garcia, Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Peru; e-mail: hgarcia{at}jhsph.edu
Background: Neurocysticercosis (NCC) is the commonest helminthic CNS infection and the main cause of adult-onset seizures in developing countries, also frequent in industrialized countries because of immigration from endemic zones. Although NCC is commonly seen in individuals with seizures in endemic areas, its role as a cause of epilepsy has been questioned on the basis of the poor methodology of published studies.
Objective: To determine, in a cysticercosis-endemic area of the northern Peruvian coast, the frequency of 1) epileptic seizures, 2) serum antibodies to Taenia solium, 3) NCC-compatible findings on brain CT, and 4) the associations between these variables.
Methods: A community-wide screening survey for possible seizure cases was performed using a validated questionnaire. Positive respondents were later examined in the field by neurologists. Seizure cases were categorized as single seizure, active epilepsy, or inactive epilepsy. Serology was performed for all consenting individuals using immunoblot. Noncontrast brain CT scans were performed in all individuals with seizures and two groups of control subjects without seizures (seropositive and seronegative).
Results: The screening survey was applied to 903 permanent residents. Most positive respondents (114/137 [83.2%]) were examined by neurologists. The overall prevalence of epilepsy was 32.1 per 1,000 and that of active epilepsy was 16.6 per 1,000. Seroprevalence was 24.2% (200/825). Seroprevalence was associated with seizures (odds ratio 2.14; p = 0.026). Brain CT abnormalities compatible with NCC were more frequent in individuals with seizures and in those seropositive.
Conclusion: In this hyperendemic area, an important proportion of seizure cases are associated with neurocysticercosis as demonstrated by serology or brain CT.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the July 26 issue to find the title link for this article.
Supported in part by research grant nos. P01 AI51976 and U01 AI35894 from the National Institute of Allergy and Infectious Diseases, NIH. Research grants from the Wellcome Trust (063109), the Food and Drug Administration (002309), and the Bill and Melinda Gates Foundation (23981) fund ongoing cysticercosis research by the authors.
The opinions and assertions expressed herein are those of the authors and do not necessarily reflect the official policy or position of the US Departments of the Navy or Army, the US Department of Defense, the US Government, or any other organization listed.
Received December 22, 2004. Accepted in final form April 14, 2005.
This work received the 2002 AAN Bruce Schoenberg Neuroepidemiology Award.
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