Epilepsy and cysticercosis in Northwest Cameroon: a serological study.

PURPOSE: The prevalence of epilepsy in Cameroon is higher than that of the industrialized world and other developing countries. Neurocysticercosis due to Taenia solium infestation has been reported as a major cause of epilepsy in some parts of Cameroon although there are some conflicting data. The prevalence of epilepsy is especially high in the Momo division of the North-West Province of Cameroon. We hypothesized that individuals with epilepsy in this region have a higher percentage of seropositivity to T. solium than matched controls. METHODS: We conducted a case-control study in the Momo subdivision of Ngie. Individuals with epilepsy were recruited from the health centers in Ngie. Control subjects were selected from 19 Ngie villages. Potential cases of people with epilepsy (PWE) were identified through a questionnaire applied by trained field workers, using history of epileptic seizures as a key indicator. Blood samples were taken from all consenting individuals by finger prick, stored in StabilZyme Select, and assayed for antibodies to T. solium in an Atlanta based reference laboratory. RESULTS: We accrued 249 patients with epilepsy, of whom 237 met the inclusion criteria, and 245 age-matched controls. There was no significant difference in seropositivity to T. solium between those individuals with epilepsy (5%) and controls (4.9%). CONCLUSIONS: Our data do not support the hypothesis that epilepsy is associated with seropositivity to T. solium. It is highly unlikely that cysticercosis plays a causative role in the high prevalence of epilepsy in this region of Cameroon.

Taeniasis/cysticercosis in a Tibetan population in Sichuan Province, China.

The results of a preliminary survey of taeniasis/cysticercosis in Yajiang County, Ganze Tibetan Prefecture in southwest Sichuan Province, China, indicated a very high prevalence of taeniasis (22.5%), with Taenia saginata as the dominant species. There was also a significant occurrence of late-onset epilepsy (8.5% prevalence and 16.4% seropositive for Taenia solium antibodies) attributable in large part to probable neurocysticercosis caused by T. solium. The poor sanitation and hygiene in this Tibetan community likely contributed to a high risk of human cysticercosis despite a low level of T. solium taeniasis (actually no T. solium carriers were detected amongst the 21 proven Taenia carriers). In addition, three taeniasis cases were confirmed by DNA genotyping as Taenia asiatica, which is the first report of this tapeworm in Tibetans, the first report for Sichuan Province and only the third report for mainland China.

Epidemiology of neurocysticercosis in Houston, Texas.

We identified 114 patients with neurocysticercosis admitted to Ben Taub General Hospital in Houston, Texas between January 1994 and June 1997. Most of these patients were born in Mexico (78%) or Central America (16%), but 6% were born in the United States. Review of neurology clinic records identified 54 patients diagnosed with neurocysticercosis, representing 2% of all neurology clinic patients and 16% of all Hispanics diagnosed with seizures. Forty-one patients were interviewed and all reported significant risk factors for infection, including ingestion of undercooked pork, pig husbandry, immigration from and frequent travel to villages in disease-endemic areas, or personal/family history of taeniasis. Among Mexican immigrants, most were born in rural areas in Central (31%) or north central Mexico (38%). Significantly fewer of the patients were from the border states (15%). The median period from immigration to diagnosis was 58 months, but it was 28 months for the 13 patients who had not left the United States after immigration. Although neurocysticercosis is being diagnosed with increasing frequency in the United States, acquisition of infection is still strongly associated with pig husbandry in rural Latin America, with little evidence of local transmission. Even among urban immigrants to the United States and United States-born cases, there is close ongoing contact with disease-endemic villages.

[Diagnostic image (174). A Nicaraguan man with an epileptic seizure. Neurocysticercosis]. / Diagnose in beeld (174). Een Nicaraguaanse man met een epileptische aanval. Neurocysticercose.

A 56-year-old Nicaraguan man was referred because of a generalised seizure. CT revealed neurocysticercosis.

Cefalea en un paciente joven. Neurocisticercosis / Migraine in a young patient. Neurocysticercosis

La cisticercosis cerebral es una forma de presentación de parasitosis cerebral causada por Tenia Soleum. A pesar de la escasa prevalencia lejos de las zonas endémicas, el incremento de los movimientos migratorios obliga a un mayor estado de alerta por parte del médico ante síntomas frecuentes como es una cefalea, sobre todo en pacientes con factores de riesgo epidemiológicos. El diagnóstico debe ser precoz y el tratamiento instaurarse lo antes posible, de lo contrario las consecuencias pueden ser fatales para el enfermo (AU)

[Neurocysticercosis in Spain. Apropos 4 cases seen in immigrant patients from endemic countries]. / Neurocisticercosis en España. A propósito de 4 casos observados en pacientes inmigrados de países endémicos.

Neurocysticercosis is a helminthiasis of the central nervous system produced by the encysted larvae of the pork tapeworm Taenia solium. We report 4 cases of neurocysticercosis observed in immigrants from endemic areas (India and Latin America). Three of the patients were diagnosed because of new onset of seizures, all of the no received anthelmintic therapy with favourable outcome. The fourth case was a form known as racemose cysticercosis. She was admitted because of CNS sensorial symptoms with later development of severe intracranial hypertension that required surgical treatment. All the cases had a positive result in the ELISA test for cysticercosis. In only one patient chronic epilepsy persisted thus needing long-term anticonvulsant therapy as a sequelae. Our report helps to familiarize clinicians with the characteristic radiological findings from cysticercosis and em s the fact that epidemiological suspicion and serological data are usually enough to get the diagnosis and avoid unnecessary probes.

Neurocisticercosis en España. A propósito de 4 casos observados en pacientes inmigrados de países endémicos / Neurocystercosis: report of 4 cases observed in inmigrants from endemic areas

La neurocisticercosis es una helmintiasis del sistema nervioso central causada por la larva enquistada de Taenia solium. Presentamos 4 casos de neurocisticercosis observados en inmigrantes procedentes de areas endémicas. Tres de ellos debutaron en forma de epilepsia y presentaron una respuesta favorable al tratamiento antihelmíntico. El cuarto caso fue una forma especial de cisticercosis conocida como racemosa que debutó en forma de focalidad sensitiva con posterior desarrollo de un cuadro de hipertensión endocraneal severa que requirió tratamiento quirúrgico. En todos los casos se obtuvo un test de ELISA positivo para cisticercosis. Solo en un caso persistieron secuelas crónicas en forma de epilepsia. Con la descripción de estos casos pretendemos familiarizar al clínico con las imágenes radiológicas características de esta entidad y recordar que la sospecha epidemiológica y el estudio serológico permiten habitualmente el diagnóstico y evitan exploraciones innecesarias para el paciente (AU)