A Large Case Series of Neurocysticercosis in Kuwait, a Nonendemic Arabian Gulf Country in the Middle East Region

Colloidal/Calcified Neurocysticercosis at University Hospital of KSA: A Case Series

Background

Neurocysticercosis (NCC) is considered the most common central nervous system (CNS) helminthic infection. The prevalence of NCC cases in the Middle East has increased in recent years. Thirty-nine cases of NCC were reported between 2003-2011 in the Arabian Peninsula, among, five cases being from the kingdom Saudi Arabia (KSA). Most of the cases reported from the KSA were presented with seizures, and they belonged to expatriate workers or their related contacts. In this case series, we presented three cases of colloidal/calcified NCC.

Cases

Our patients were diagnosed with NCC based on epidemiologic exposure, clinical features, and typical radiological findings. Stool samples for ova and parasites were negative in all three cases. Among these cases, two patients were immigrants and belonged to endemic areas, and third case who is the youngest in this series was a Saudi, without any history of exposure to any source.

Results

The first and the third cases were treated with Albendazole and Dexamethasone. We did not offer any medication regarding NCC in the second case as he had asymptomatic NCC and the disease was inactive so did not mandate anti-helminth medication.

Conclusion

NCC in KSA, like in non-endemic countries, is not a rare or unusual infection anymore, presenting with seizures or incidental findings in an asymptomatic state. Vigilant diagnostic protocols with efficient diagnostic tools are required for detecting carriers of the adult form of the parasite. Timely detection of these carriers can avoid further spread and its related complications in the Saudi population.

Neurocysticercosis-related Seizures: Imaging Biomarkers

Neurocysticercosis (NCC)-a parasitic CNS infection endemic to developing nations-has been called the leading global cause of acquired epilepsy yet remains understudied. It is currently unknown why a large proportion of patients develop recurrent seizures, often following the presentation of acute seizures. Furthermore, the presentation of NCC is heterogenous and the features that predispose to the development of an epileptogenic state remain uncertain. Perilesional factors (such as oedema and gliosis) have been implicated in NCC-related ictogenesis, but the effects of cystic factors, including lesion load and location, seem not to play a role in the development of habitual epilepsy. In addition, the cytotoxic consequences of the cyst's degenerative stages are varied and the majority of research, relying on retrospective data, lacks the necessary specificity to distinguish between acute symptomatic and unprovoked seizures. Previous research has established that epileptogenesis can be the consequence of abnormal network connectivity, and some imaging studies have suggested that a causative link may exist between NCC and aberrant network organisation. In wider epilepsy research, network approaches have been widely adopted; studies benefiting predominantly from the rich, multimodal data provided by advanced MRI methods are at the forefront of the field. Quantitative MRI approaches have the potential to elucidate the lesser-understood epileptogenic mechanisms of NCC. This review will summarise the current understanding of the relationship between NCC and epilepsy, with a focus on MRI methodologies. In addition, network neuroscience approaches with putative value will be highlighted, drawing from current imaging trends in epilepsy research.

Neurocysticercosis in non-endemic regions: The experience of Qatar

Objective

To describe the occurrence and features of Neurocystircercosis (NCC) in Qatar.

Background

Qatar has a mixed population of natives and expats. NCC is not endemic to the region, but clinical practice suggests its occurrence in large numbers.

Design/ methods

A database was created to summarize information retrospectively collected on patients with NCC seen through the national health system (HMC) between 2013 and 2018. We identified demographic and disease related variables (clinical manifestations, investigative findings, treatment and outcome) for all patients.

Results

Out of 420 identified NCC patients, 393 (93.6%) were men, and 98.3% were immigrants from NCC endemic countries such as Nepal (63.8%) and India (29.5%). Eighty percent of patients presented with seizures, with the majority (69%) experiencing generalized tonic-clonic seizures. Five percent presented with status epilepticus. Headaches, the second most common complaint, were reported in 18% of subjects. On imaging, 50% had a single lesion while 63% included pathology at the calcified stage. The lesions were parenchymal in 99.5% of cases, predominantly in the frontal lobe (59%). Thirteen percent were diagnosed incidentally on imaging, mainly in the form of isolated calcified non enhancing lesions. Albendazole was received by 55% of patients, and phenytoin was the most prescribed anti-seizure drug (57%). When long term follow up was available, 70% of the patients presenting with seizures were completely seizure free.

Conclusion

NCC is prevalent in Qatar, mainly within the large Southeast Asian immigrant population. NCC is currently a significant contributor to the epilepsy burden in Qatar, often with a good outcome regarding seizure control. NCC with intraparenchymal single lesion shares a large proportion of our cohort.

Neurocysticercosis: an update on diagnosis, treatment, and prevention

Neurocysticercosis (NCC) is an important cause of neurological disease worldwide, including imported cases in nonendemic countries.

PURPOSE OF REVIEW

The purpose of this review is to update information on diagnosis, management, and prevention of neurocysticercosis.

RECENT FINDINGS

WHO and Infectious Diseases Society of America/American Society of Tropical Medicine and Hygiene guidelines emphasize the importance of corticosteroids and antiparasitic drugs for viable parenchymal disease and single enhancing lesions. Subarachnoid NCC is associated with a high fatality rate unless optimally treated. Advances in subarachnoid NCC include use of prolonged antiparasitic and anti-inflammatory courses and the increasing use of antigen-detection and quantitative PCR assays in diagnosis and follow-up. Emerging data support the safety and efficacy of minimally invasive surgery in ventricular cases. Calcified neurocysticercosis continues to be associated with a high burden of disease. Field studies are demonstrating the feasibility of eradication using a combination of mass chemotherapy for human tapeworms and vaccination/treatment of porcine cysticercosis.

SUMMARY

NCC remains an important and challenging cause of neurological disease with significant morbidity despite advances in treatment and prevention.