Article

Spectrum of cognitive impairment in neurocysticercosis: Differences according to disease phase

Departamento de Neurologia, Universidade de São Paulo, Brazil.
Neurology (Impact Factor: 8.29). 03/2012; 78(12):861-6. DOI: 10.1212/WNL.0b013e31824c46d1
Source: PubMed

ABSTRACT

Cognitive decline related to neurocysticercosis (NC) remains poorly characterized and underdiagnosed. In a cross-sectional study with a prospective phase, we evaluated cognitive decline in patients with strictly calcified form (C-NC), the epidemiologically largest subgroup of NC, and investigated whether there is a spectrum of cognitive abnormalities in the disease.
Forty treatment-naive patients with C-NC aged 37.6 ± 11.3 years and fulfilling criteria for definitive C-NC were submitted to a comprehensive cognitive and functional evaluation and were compared with 40 patients with active NC (A-NC) and 40 healthy controls (HC) matched for age and education. Patients with dementia were reassessed after 24 months.
Patients with C-NC presented 9.4 ± 3.1 altered test scores out of the 30 from the cognitive battery when compared to HC. No patient with C-NC had dementia and 10 patients (25%) presented cognitive impairment-no dementia (CIND). The A-NC group had 5 patients (12.5%) with dementia and 11 patients (27.5%) with CIND. On follow-up, 3 out of 5 patients with A-NC with dementia previously still presented cystic lesions with scolex on MRI and still had dementia. One patient died and the remaining patient no longer fulfilled criteria for either dementia or CIND, presenting exclusively calcified lesions on neuroimaging.
Independently of its phase, NC leads to a spectrum of cognitive abnormalities, ranging from impairment in a single domain, to CIND and, occasionally, to dementia. These findings are more conspicuous during active vesicular phase and less prominent in calcified stages.

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Available from: Lucas Massaroppe, Dec 27, 2013
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    • "In two studies (Forlenza et al. 1997 ; Carpio et al. 2008 ) which provided defi nitions of clinical manifestations, depression was reported in about 53 % and 15 % of the patients, respectively. A recent study reports a spectrum of cognitive abnormalities , including dementia (Rodrigues et al. 2012 ). "
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    ABSTRACT: Neurocysticercosis, the most common parasitic brain disease worldwide, is due to the larvae infestation of Taenia solium. It is an endemic, neglected disease in poor countries with deprived sanitation, and is increasingly being reported in wealthy countries due to migration. Humans are the only defi nitive host of T. solium , while pigs are the intermediate hosts. Humans may become intermediate host by ingesting food or water contaminated by T. solium eggs. Infection is associated with local and systemic immune-infl ammatory responses modulated by the developmental stage of the parasite in the host (vesicular, colloi-dal. granular-nodular, and calcifi ed stages) and by the central nervous system compartment where the parasites are located. Genetic diversity of cysticerci has been studied and the genome of T. solium is currently being sequenced. The clinical manifestations are heterogeneous and depend mainly on the local-ization of cysts and immune response to the host. Seizures, headache, focal defi cits and cognitive abnormalities are the most frequent manifestations. The prognosis is good; nevertheless, it may lead to long-term neurological sequels such as epilepsy and hydrocephalus. Diagnosis is made mainly by neuroimaging, which is useful in the detection of evolutionary stage, number and localization of cysts. Immunological testing can be helpful; nonetheless, a negative test does not rule out the diagnosis. 128 Treatment is complex and should be individualized, based on location and viability of the parasites. In most cases treatment is only symptomatic. Antihelminthic drugs are effective in approximately one-third of patients with parenchymal viable cysts. The most effective approach to Taeniasis/cysticercosis is prevention. This should be a primary public health focus for poor countries.
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    • "NCC has been reported to be associated with impairment of several cognitive functions that varies according to the brain areas involved, the number of cysticerci, and the differences in the inflammatory response of each individual [16]–[21]. However, our results show that the cognitive effects of cNCC are not so evident in MTLE-HS patients, perhaps masked by the impairment that patients with MTLE-HS already have due to pathology, seizures, and drug therapy. "
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    ABSTRACT: Where neurocysticercosis (NCC) is endemic, chronic calcified neurocysticercosis (cNCC) can be observed in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS). Considering that both disorders cause recurrent seizures or cognitive impairment, we evaluated if temporal lobectomy is cognitively safe and effective for seizure control in MTLE-HS plus cNCC. Retrospective cohort study of neuropsychological profile and surgical outcome of 324 MTLE-HS patients submitted to temporal lobectomy, comparing the results according to the presence or absence of cNCC. cNCC occurred in 126 (38.9%) of our MTLE-HS patients, a frequency higher than expected, more frequently in women than in men (O.R. = 1.66; 95% C.I. = 1.05-2.61; p = 0.03). Left-side (but not right side) surgery caused impairment in selected neuropsychological tests, but this impairment was not accentuated by the presence of cNCC. Ninety-four (74.6%) patients with MTLE-HS plus cNCC and 153 patients (77.3%) with MTLE-HS alone were Engel class I after surgery (O.R. = 1.16; 95% C.I. = 0.69-1.95; p = 0.58). However, the chances of Engel class IA were significantly lower in MTLE-HS plus cNCC than in patients with MTLE-HS alone (31.7% versus 48.5%; O.R. = 2.02; 95% C.I. = 1.27-3.23; p = 0.003). Patients with MTLE-HS plus cNCC showed higher rates of Engel class ID (15.1% versus 6.6%; O.R. = 2.50; 95% C.I. = 1.20-5.32; p = 0.012). cNCC can be highly prevalent among MTLE-HS patients living in areas where neurocysticercosis is endemic, suggesting a cause-effect relationship between the two diseases. cNCC does not add further risk for cognitive decline after surgery in MTLE-HS patients. The rates of Engel class I outcome were very similar for the two groups; however, MTLE-HS plus cNCC patients achieved Engel IA status less frequently, and Engel ID status more frequently. Temporal lobectomy can be safely performed in most patients with MTLE-HS plus cNCC without affecting cognitive outcome. Long-term surgical seizure control in MTLE-HS plus cNCC is still satisfactory, as long as selected patients remain under medication.
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