RESUMO
Purpose: Neurocysticercosis [NCC] is considered to be rare in Kerala state, India, although it is an important cause of epilepsy in many other parts of India. Our objective was to test this notion by determining the seroprevalence of cysticercosis [CC] in an unselected sample of persons with epilepsy and comparing it to that of persons without epilepsy living in Kerala
Methods: Individuals with active epilepsy [AE] who had never resided outside Kerala state for more than one month and were attending our center for epilepsy care constituted the cases. Sex-matched persons without epilepsy who had never resided outside Kerala state for more than one month constituted the controls. The demographic details, occupation, and food habits [for the cases and controls], as well as clinical characteristics and imaging [for cases only] were recorded. Sera separated from blood drawn by venipuncture from the cases and controls were assayed for cysticercal antibodies by enzyme-linked immunoelectrotransfer blot [EITB]
Results: Of the 80 persons with AE, 12 were seropositive for cysticercus antibodies [15%; 95% CI: 8.8-24.4]; among the 68 controls, 7 were seropositive [10.3%; 95% CI: 5.1-19.8]. The odds ratio [OR] for seropositivity in the epilepsy group [1.54] was not statistically significant [95% CI: 0.6-4.2]. Among the 69 patients who had a brain computed tomography [CT] scan or magnetic resonance imaging [MRI], none had features diagnostic of NCC. Gender, diet [vegetarian vs non-vegetarian, consumption of raw vegetables], drinking water status [clean vs unclean], residence [rural vs urban], exposure to manure, and animal rearing including pigs did not have any association with seropositivity
Conclusion: Among the residents of Kerala, most epilepsy is not related to cysticercosis
RESUMO
BACKGROUND: Subacute sclerosing panencephalitis (SSPE) is a delayed and fatal manifestation of measles infection. Fulminant SSPE is a rare presentation in which the disease progresses to death over a period of 6 months. The clinical features are atypical and can be misleading. CASE REPORT: We report herein a teenage boy who presented with acute-onset gait ataxia followed by right hemiparesis that evolved over 1 month, with left-hemispheric, delta-range slowing on the electroencephalogram (EEG). Magnetic resonance imaging disclosed multiple white-matter hyperintensities, suggesting a diagnosis of acute disseminated encephalomyelitis. He received intravenous steroids, and within 4 days of hospital admission he developed unilateral slow myoclonic jerks. Repeat EEG revealed Rademecker complexes, pathognomonic of SSPE, and an elevated titer of IgG antimeasles antibodies was detected in his cerebrospinal fluid. The disease progressed rapidly and the patient succumbed within 15 days of hospitalization. The diagnosis of SSPE was confirmed by autopsy. CONCLUSIONS: This case illustrates the difficulty of recognizing fulminant SSPE when it manifests with asymmetric clinical and EEG abnormalities.