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Desai S, Abrahim N, Garg D, Yadav R, Iacono D, Ugawa Y, Lk P, Sankhla C, Cardoso F, Schneider SA, Pal PK. Definition, diagnosis and classification of infection-related movement disorders: Consensus proposal. Parkinsonism Relat Disord 2024:106988. [PMID: 38705765 DOI: 10.1016/j.parkreldis.2024.106988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/10/2024] [Accepted: 04/28/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Infection-related movement disorders (IRMD) present a complex diagnostic challenge due to the broad phenotypic spectrum, the variety of possible infectious aetiologies, and the complicated underlying mechanisms. Yet, a comprehensive framework for classifying IRMD is lacking. METHODS An international consensus panel under the directives of the Movement Disorders Society Infection-Related Movement Disorders Study Group developed a comprehensive definition and a consensus classification system. Case scenarios were used for validation. RESULTS A definition for IRMD and a two-axis-based classification system consisting of six descriptors are proposed, intended as tools for researchers and clinicians. Collected information on clinical characteristics, investigational findings, the infectious organism and presumed pathogenesis facilitate the evaluation of diagnostic certainty. CONCLUSION The proposed framework will serve for optimised diagnostic algorithms, systematic aggregation of informative datasets across studies, and ultimately improved care and outcome of patients with IRMDs.
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Affiliation(s)
- Soaham Desai
- Dept of Neurology, Shree Krishna Hospital Pramukhswami Medical College, Bhaikaka University, Gujarat, India.
| | - Norlinah Abrahim
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia.
| | - Divyani Garg
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Diego Iacono
- Departments of Neurology, Pathology, Neuroscience Program, F. Edward Hebert School of Medicine, Uniformed Services University (USU), Bethesda, MD, USA; DoD/USU Brain Tissue Repository and Neuropathology Program, Henry Jackson Foundation (HJF), Inc. Bethesda, MD, USA.
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Japan.
| | - Prashanth Lk
- Centre for Parkinson's Disease and Movement Disorders, Miller's Road, Bangalore, India.
| | | | - Fransisco Cardoso
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, The Federal University of Minas Gerais, UFMG, Brazil.
| | | | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, 560029, India.
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Milenković Z, Momčilović S, Ignjatovic A, Tasić-Otašević S. Is Antihelminthics Necessary in Postoperative Treatment of Intraventricular Neurocysticercosis? A Systematic Review. World Neurosurg 2024; 181:e533-e550. [PMID: 37879434 DOI: 10.1016/j.wneu.2023.10.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Patients with intraventricular neurocysticercosis (IVNCC) may require cerebrospinal fluid diversion surgery for late-onset hydrocephalus in the postsurgical period. Controversy exists regarding cysticidal treatment. Our main objective was to compare surgically treated cases of IVNCC that received postoperative anthelmintics with those that did not regard the incidence and treatment of late-onset hydrocephalus. METHODS We searched the Medline database and extracted the following data: age, gender, stage of development of cysticercosis, type of operation, frequency of delayed hydrocephalus, cerebrospinal fluid diversion surgery, outcome, and follow-up. RESULTS We analyzed 130 articles on intraventricular cysticercosis and identified 117 cases of isolated IVNCC and 314 patients in the case-control series who met inclusion criteria. There was no significant difference in postoperative delayed hydrocephalus between isolated IVNCC and case-control study groups. Children under the age of 16 received anthelmintic drugs more frequently during the postoperative period. Statistical relevance was observed in all patient groups regarding the application of steroids in favor of cysticidal therapy Endoscopy was a better option than craniotomy for cases of isolated IVNCC and case-control studies. Other variables were not relevant. CONCLUSIONS Patients who received antihelminths did not show a statistically significant reduction in delayed hydrocephalus compared to individuals who did not receive after surgical resection of the parasite. Corticosteroid therapy prevailed in people who have been treated with anthelmintics. Children under the age of 16 were administered anthelmintic drugs more frequently during the postoperative period. Endoscopy was the preferred method for all groups, but some patients with cysts in the fourth ventricle required a craniotomy.
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Affiliation(s)
- Zoran Milenković
- General Hospital "Sava Surgery", Kej 29 decembra 2, Niš, Serbia.
| | - Stefan Momčilović
- Plastic and Reconstructive Surgery Clinic, Clinical Center Niš, Niš, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Suzana Tasić-Otašević
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Niš, Serbia
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Xu WB, Fu JJ, Yuan XJ, Xian QJ, Zhang LJ, Song PP, You ZQ, Wang CT, Zhao QG, Pang F. Metagenomic next-generation sequencing in the diagnosis of neurocysticercosis: A case report. World J Clin Cases 2023; 11:4912-4919. [PMID: 37584000 PMCID: PMC10424049 DOI: 10.12998/wjcc.v11.i20.4912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/21/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND The clinical symptoms and imaging manifestations of neurocysticercosis (NCC) are very different, and the difficulty and delay of clinical diagnoses may lead to an increase in mortality and disability. Rapid and accurate pathogen identification is important for the treatment of these patients. Metagenomic next-generation sequencing (mNGS) is a powerful tool to identify pathogens, especially in infections that are difficult to identify by conventional methods. CASE SUMMARY A 43-year-old male patient was admitted due to a recurrent headache for a few months. Imaging examinations showed hydrocephalus and cystic lesions, which were considered to be a central nervous system infection, but no etiology was found by routine examination. mNGS of the cerebrospinal fluid revealed high Taenia solium reads, and the positive results of a cysticercosis antibody test confirmed the infection. Combined with the patient's clinical manifestations, the etiological evidence, and the imaging manifestation, the patient was finally diagnosed with NCC and he was prescribed dexamethasone, albendazole, neurotrophic drugs, and intracranial pressure reduction therapy. The headaches disappeared after anti-parasite treatment, and no associated symptoms recurred prior to the three- and six-month follow-up. CONCLUSION As an accurate and sensitivity detection method, mNGS can be a reliable approach for the diagnosis of NCC.
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Affiliation(s)
- Wen-Bin Xu
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Juan-Juan Fu
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Xiao-Ju Yuan
- Department of Gastroenterology, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Qing-Jie Xian
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Li-Jun Zhang
- Department of Neurology, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Ping-Ping Song
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Zhi-Qing You
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Cheng-Tan Wang
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Qi-Gang Zhao
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Feng Pang
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
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Castillo Y, Toribio LM, Guzman C, Arroyo G, Espinoza C, Saavedra H, Bustos JA, Dorny P, O’Neal SE, Garcia HH. Consistent Measurement of Parasite-Specific Antigen Levels in Sera of Patients with Neurocysticercosis Using Two Different Monoclonal Antibody (mAb)-Based Enzyme-Linked Immunosorbent Assays. Pathogens 2023; 12:566. [PMID: 37111451 PMCID: PMC10143799 DOI: 10.3390/pathogens12040566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Monoclonal antibody (mAb)-based enzyme-linked immunosorbent assay (ELISA) is a complementary diagnosis technique for neurocysticercosis (NCC), which detects circulating parasite antigen (Ag) indicative of viable infection and Ag levels that correlate well with the parasite burden. In this study, we compared the performance of two Ag-ELISA techniques for the detection of NCC. We assessed the agreement between our in-house TsW8/TsW5 Ag-ELISA and the widely used B158/B60 Ag-ELISA for measuring T. solium antigen levels in the sera from 113 patients with calcified, parenchymal, and subarachnoid NCC. Concordance was demonstrated evaluating the limits of agreement (LoAs) stratified by the type of NCC. Both ELISA's detected 47/48 (97.8%) subarachnoid NCC cases. In parenchymal and calcified NCC, the B158/B60 Ag-ELISA detected 19/24 (79.2%) and 18/41 (43.9%) cases, while the TsW8/TsW5 Ag-ELISA detected 21/24 (87.5%) and 13/41 (31.7%), respectively. Parenchymal and calcified NCC obtained a perfect agreement (100%), indicating that all sample results were within the predicted LoA, while for subarachnoid NCC, the agreement was 89.6%. The high concordance between the assays was confirmed by Lin's concordance coefficient (LCC = 0.97). Patients with viable parenchymal NCC (LCC = 0.95) obtained the highest concordance between assays, followed by subarachnoid NCC (LCC = 0.93) and calcified NCC (LCC = 0.92). The TsW8/TsW5 Ag-ELISA and B158/B60 Ag-ELISA showed high Ag measurement correlations across diverse types of NCC.
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Affiliation(s)
- Yesenia Castillo
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
| | - Luz M. Toribio
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima 15030, Peru
| | - Carolina Guzman
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima 15030, Peru
| | - Gianfranco Arroyo
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
| | - Cindy Espinoza
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
| | - Herbert Saavedra
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima 15030, Peru
| | - Javier A. Bustos
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima 15030, Peru
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2060 Antwerp, Belgium
| | - Seth E. O’Neal
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
- School of Public Health, Oregon Health & Sciences, Portland State University, Portland, OR 97207, USA
| | - Hector H. Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima 15030, Peru
- Department of International Health, Bloomberg School for Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Muacevic A, Adler JR, Hussaini H, Omar Z, Lakhra S, Mohamed KH, Abdefatah Ali M, Nguty Nkeng E, Garg T, Khan A. Cysticercal Encephalitis in a Young Female: A Rare Presentation of Neurocysticercosis. Cureus 2023; 15:e33931. [PMID: 36819416 PMCID: PMC9937515 DOI: 10.7759/cureus.33931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
One of the most frequent parasite infections of the central nervous system is neurocysticercosis. This neurologic condition is caused by Taenia solium (T. solium) larval infestation. Infected pork intake, poor hygiene practices, water tainted with T. solium, or asymptomatic carriers are the main ways of spread. We describe a case of neurocysticercosis in a young woman who presented with low-grade fever, headache, altered sensorium, and recurrent seizures. Computed tomography of the head revealed an inflammatory granuloma and a ring-increased attenuating lesion in the left temporal region. Additionally, a well-defined rounded discrete lesion was identified in the left parietal region on magnetic resonance imaging of the brain. Even if the symptoms do not initially suggest neurocysticercosis or if the patient lives in a region where the condition is uncommon, our case depicts adding neurocysticercosis to the differential diagnosis for encephalitis.
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Garcia HH, Verastegui MR, Arroyo G, Bustos JA, Gilman RH. New animal models of neurocysticercosis can help understand epileptogenesis in neuroinfection. Front Mol Neurosci 2022; 15:1039083. [PMID: 36466808 PMCID: PMC9708716 DOI: 10.3389/fnmol.2022.1039083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hector H. Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru,Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru,Asociación Benéfica PRISMA, Lima, Peru,*Correspondence: Hector H. Garcia
| | - Manuela R. Verastegui
- Alberto Cazorla School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gianfranco Arroyo
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru,Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Javier A. Bustos
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru,Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Human Neurocysticercosis: An Overview. Pathogens 2022; 11:pathogens11101212. [PMID: 36297269 PMCID: PMC9607454 DOI: 10.3390/pathogens11101212] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/20/2022] Open
Abstract
Human cysticercosis is caused by ingestion of T. solium eggs from taenia carriers. Neurocysticercosis (NCC), defined as the infection of the CNS and the meninges by the larval stage of Taenia solium, is the most common helminthic infection of the CNS worldwide. Parasites may lodge in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that account for the pleomorphism of this disease. Seizures/epilepsy are the most common clinical manifestation, but other patients present with headache, focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of NCC is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. However, neuroimaging studies are fundamental for diagnosis because immunological test and clinical manifestations only provide circumstantial evidence of NCC. The introduction of cysticidal drugs changed the prognosis of most NCC patients. These drugs have been shown to reduce the burden of infection and to improve the clinical course of the disease in many patients. Efforts should be directed to eradicate the disease through the implementation of control programs against all the steps in the life cycle of T. solium, including carriers of the adult tapeworm, infected pigs, and eggs in the environment.
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