Comparative Efficacy and Safety of Lacosamide and Oxcarbazepine for Seizure Control in Children with Newly Diagnosed Solitary Neurocysticercosis.

BACKGROUND: In newly diagnosed neurocysticercosis (NCC) with seizures, the choice of anti-seizure medication (ASM) seems to be arbitrary due to a lack of comparative studies. Although oxcarbazepine (OXC) is often considered efficacious for focal seizures in NCC, due to adverse effects, newer ASMs like levetiracetam (LCM) and lacosamide are also being explored. METHODS: This study was performed by case record review of children with newly diagnosed solitary viable parenchymal NCC aged 4-18years who received lacosamide and OXC at least for 12 weeks between August 2019 and April 2021, from a prospective registry of a tertiary care teaching hospital in north India. Seizure control, electroencephalographic abnormalities, resolution of inflammatory granulomas and adverse effects were compared between two arms at 12 and 24 weeks. RESULTS: Total 31 (8.3 ± 4.7 years, 19 boys) and 72 (8.6 ± 4.2 years, 43 boys) completed at least 12 weeks follow-up in LCM and OXC groups, out of which 2 and 51 completed at least 24 weeks follow-up in LCM and OXC groups, respectively. The occurrence of breakthrough seizure was comparable in both arms at 12 and 24 weeks (1/31 and 2/22 in lacosamide group vs. 2/72 and 4/51 in OXC group, p = 0.66 and 0.59, respectively). Patients receiving OXC had more frequent treatment-emergent adverse events (p = 0.0001) and four patients required discontinuation due to severe adverse events (SAEs), while none in the lacosamide group had SAEs. CONCLUSIONS: Lacosamide appears to be efficacious and safe for achieving seizure freedom in patients with solitary viable parenchymal neurocysticercosis.

Neurocysticercosis in asplenic patient, case report / Neurocisticercose em paciente asplênico, relato do caso

Neurocysticercosis is an important cause of neurologic and psychiatric disorders; it is a frequent etiology for acquired epilepsy worldwide. The parasitic infection of Taenia solium (including larval dissemination to the nervous system) can be avoided by effective means of prevention. Nonetheless, this disease remains endemic in many regions of the world. To demonstrate the importance of prophylaxis this paper reports the case of a patient without spleen, who was treated for neurocysticercosis manifested by epilepsy. In twenty years of follow up, the patient did not experience a repeat occurrence of neurocysticercosis, despite of immunological impairment (absence of spleen) and environmental exposure (living in an endemic area). Prevention was guided by a regular use of anthelmintic (Albendazole) and health education.

Neurocisticercose é uma importante causa de doenças neurológicas e psiquiátricas, é uma frequente etiologia de epilepsia adquirida, no mundo. A infecção parasitária da Taenia solium (incluindo a disseminação das larvas para o sistema nervoso) pode ser evitada por meios eficazes de prevenção; no entanto, esta enfermidade ainda é endêmica em muitas regiões do mundo. Para demonstrar a importância da profilaxia relata-se o caso de um paciente sem baço, o qual foi tratado para a neurocisticercose manifestada por epilepsia. Em vinte anos de seguimento, o paciente não repetiu a ocorrência de neurocisticercose, apesar de dano imunológico (ausência de baço) e exposição ambiental (habitação em área endêmica). A prevenção foi guiada pelo uso regular de anti-helmíntico (Albendazole) e medidas educativas em saúde.

[Wallenberg syndrome and neurocysticercosis: about one case in Ouagadougou, Burkina Faso]. / Syndrome de Wallenberg et neurocysticercose: a propos d'un cas a Ouagadougou, Burkina Faso.

Neurocysticercosis (NCC) frequently appears by seizures following parenchymatous location of encysted worms of Taenia solium. We report a case of NCC revealed by a Wallenberg's syndrome. A man of 44 years old, without any cardiovascular risk factor was admitted at the neurology department of Yalgado-Ouédraogo hospital in Ouagadougou for an abrupt onset of vertigos, recurrent falls on the right side, hiccough, and deglutition weakness. The clinical examination found a blood pressure at 130 mmHg/80 mmHg, a CMI at 24, a Wallenberg's syndrome. The CT scan showed a laterobulbar lacunar infarct with punctiform calcifications of cerebellum, third ventricle, frontal, right temporal, occipital and left parietal lobes. The CSF showed a raise of cells number at 23 lymphocytic elements, proteins rose to 1.5 g/l, glucose and chloride were normal. Cysticercosis blood and CSF serologies were positive. The blood cells count showed only an eosinophilia and the blood sedimentation rate reached 119 mm in the first hour. The accepted diagnosis was: laterobulbar lacunar infarct following a NCC angiitis. The course of the disease under albendazole at 15 mg/kg during two weeks combined with a short steroid therapy by prednisolone at 1 mg/kg during 5 days was favourable. NCC should be more and more regarded as a cerebrovascular risk factor in endemic area, especially in young people.