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Abstract

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.

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Published In

Neurology®
Volume 65Number 2July 26, 2005
Pages: 229-233
PubMed: 16043791

Publication History

Published online: July 25, 2005
Published in print: July 26, 2005

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Affiliations & Disclosures

S. M. Montano, MD, MPH
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.
M. V. Villaran, MD, DTMPH
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.
L. Ylquimiche, MDC
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.
J. J. Figueroa, MD
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.
S. Rodriguez, BS
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.
C. T. Bautista, MS
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.
A. E. Gonzalez, DVM, PhD
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.
V.C.W. Tsang, PhD
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.
R. H. Gilman, MD, DTMH
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.
H. H. Garcia, MD, PhD
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.
for the Cysticercosis Working Group in Peru
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.

Notes

Address correspondence and reprint requests to Dr. H.H Garcia, Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Peru; e-mail: [email protected]

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