HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

Correspondence to:

BRIEF COMMUNICATIONS: Vedantam Rajshekhar Rate of spontaneous resolution of a solitary cysticercus granuloma in patients with seizures Neurology 2001; 57: 2315-2317 [Abstract] [Full text] [PDF]

Correspondence: Submit a response to this article

Correspondence published:

Reply to Garg

Vedantam Rajshekhar   (8 January 2002)

Rate of spontaneous resolution of a solitary cysticercus granuloma in patients with seizures

Ravindra Kumar Garg   (2 January 2002)

Reply to Garg 8 January 2002
Vedantam Rajshekhar, neurosurgeon cmc hospital, vellore,india Send Correspondence to journal: Re: Reply to Garg rajshekhar{at}cmcvellore.ac.in Vedantam Rajshekhar	I thank Dr. Garg for his interest in my article. I reported the wide variation in the reported rate of spontaneous resolution of solitary cysticercus granuloma (SCG). All our patients in the study had their initial CT scan done within a month of their seizure. If patients who have had the initial scan done several months after the first seizure are included, then it is likely that follow up scans will indicate early resolution as the initial scan itself would have revealed a granuloma which is partly resolved. I speculated that one of the other possible reasons for the variation in the rate of resolution reported in different series could be due to a difference in the techniques used in performing the follow up CT scan (amount of contrast injection and slice thickness). Thirty-six percent of our patients had the persistent lesion seen on the follow up scan which measured 5 mm or less. If the follow up scan slice thickness is more than 5 mm, these lesions may be missed resulting in a higher estimate of the rate of resolution. Considering the fact that our patients had their initial scan soon after their initial ictus and that a uniform policy of thin slice CT examinations with adequate contrast injection was followed for their follow up imaging, I believe that our data reveals the true rate of spontaneous resolution of SCG. I agree with Dr. Garg's suggestion that early repeat CT examinations are not necessary in patients who are not recruiting new symptoms or signs but would still recommend at least one follow up scan 6 months or more after the initial scan. This will reveal any enlargement of the lesion even if the patient is asymptomatic and this might indicate a pathology other than a SCG. It will also facilitate early withdrawal of antiepileptic drugs if the granuloma has resovled. Finally, the issue of the duration of antiepileptic drug therapy for patients with SCG is unresolved and we are in the process of analyzing data with long term follow up of patients who have had early withdrawal of antiepileptic drugs soon after the resolution of the SCG was demonstrated on the CT.
Rate of spontaneous resolution of a solitary cysticercus granuloma in patients with seizures 2 January 2002
Ravindra Kumar Garg, Assistant professor Department of Neurology, King George's Medical College, Lucknow, India Send Correspondence to journal: Re: Rate of spontaneous resolution of a solitary cysticercus granuloma in patients with seizures garg50{at}satyam.net.in Ravindra Kumar Garg	In this article, the author evaluated the rate of spontaneous resolution of single enhancing CT lesions (author referred to them as solitary cysticercus granuloma) and observed that the proportion of granuloma that had resolved completely was 19% at 3 months. [1] We observed that approximately 73% of similar lesions spontaneously disappeared at 2 months. (2) With these conflicting results, what should be the ideal time for follow-up CT scan? In developing countries like India, CT scans are not affordable for many patients. Can we manage these patients without follow-up CT scans? Currently, there are no guidelines to suggest the need and timings for repeat CT scans. Sawhney et al [3] suggest that first follow-up CT scan should be done after 12 weeks if patient is symptom-free and neurological examination is normal. It may be done earlier if new symptoms or signs develop. A third scan may be done when the second scan has not shown any resolution of lesion, seizures are uncontrolled, progressive neurological deficit appears, or patient has been treated with albendazole or antituberculous drugs. Rajshekhar [1] suggests delaying the follow-up CT scans until 6 months after the initial diagnosis. He further suggests that all such patients should be frequently evaluated for symptoms and signs of progressive lesion. Histopathological studies of single enhancing CT lesions in patients with seizures suggest that cysticercosis and several other diseases (most frequently tuberculoma) could also produce similar CT lesions. [4] None of the several retrospective and prospective follow-up studies [1,2,5,6] indicate clinical and radiological progression of single enhancing CT lesions. Secondly, the issue of early withdrawal of antiepileptic drugs immediately after complete resolution of granuloma is also unclear and no prospective follow-up study is currently available.(4) Furthermore, we recently reported that antiepileptic therapy is effective in controlling seizures in the majority of patients and recurrences are infrequent. In a few patients, seizures recurred even after complete disappearance of CT lesions. (2) Until sufficient data are available, seizures in patients with single enhancing CT lesions should be treated for 2 to 3 years--like any other epileptic syndromes, regardless of complete resolution of the lesion in follow-up CT scans. Also, following CT lesions with repeated follow-up scans is more of an academic exercise and patients can be managed satisfactorily without second or third scans. References 1. Rajshekhar V. Rate of spontaneous resolution of a solitary cysticercus granuloma in patients with seizures. Neurology 2001: 57:2315-2317. 2. Singh MK, Garg RK, Nath G, Verma DN, Misra S. Single small enhancing computed tomographic (CT) lesions in Indian patients with new onset seizures. A prospective follow-up in 75 patients. Seizure, doi: 10.1053/Siez.2001.0558, available online at http//www.idealibrary.com. 3. Sawhney IMS, Thussu A, Chopra JS. Single small enhancing CT lesions in epilepsy. In: Chopra JS, Sawhney IMS (eds). Neurology in Tropics. BI Churchill Livingston, New Delhi, 1999:532-541. 4. Garg RK, Singh MK, Misra S. Single-enhancing CT lesions in Indian patients with seizures: a review. Epilepsy Res 2000:38:91-104. 5. Chopra JS, Sawhney IMS, Suresh N, Prabhakar S, Dhand UK, Suri S. Vanishing CT lesions in epilepsy. J Neurol Sci 1992; 107: 40-49. 6. Garg RK, Nag D. Single enhancing CT lesions in Indian patients with seizures: clinical and radiological evaluation and follow up. J Trop Pediatr 1998; 44: 204-210.