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Calcified cysticercotic lesions and intractable epilepsy: a cross sectional study of 512 patients

¹ CIREP, Centro de Cirurgia de Epilepsia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
² Departamento de Neurologia, Psiquiatria e Psicologia Médica, FMRP-USP, Ribeirão Preto, SP, Brazil
³ Departamento de Anatomia e Cirurgia, FMRP-USP, SP, Brazil

Correspondence to:
Correspondence to:
Tonicarlo R Velasco
CIREP 4° andar, Hospital das Clinicas de Ribeirão Preto, Universidade de São Paulo 14.048-900, SP, Brazil; tvelasco{at}rnp.fmrp.usp.br

Background: Neurocysticercosis is a major cause of epilepsy in developing countries and is endemic in Brazil. To test the hypothesis that the aetiological profile of patients with intractable epilepsy in Brazil includes neurocysticercosis, we conducted a cross sectional study investigating the aetiology of intractable epilepsy.

Methods: A total of 512 patients evaluated at the outpatient clinic for intractable epilepsy at the Ribeirão Preto School of Medicine were included in the survey. Medical intractability was determined on the basis of seizure incidence and severity, and response to appropriate epilepsy management. Neuroimaging included brain CT with non-contrasted and contrasted phases and high resolution MRI. Patients were divided into neurocysticercosis and non-neurocysticercosis groups according to previous diagnostic criteria.

Results: The most common epileptogenic lesions were mesial temporal sclerosis (MTS; 56.0%), malformations of cortical development (12.1%), and brain tumours (9.9%). Neuroimaging was normal in 8.7% of patients. Calcifications were found in 27% of patients and were significantly more common in patients with MTS than in those without MTS (p<0.001). Isolated neurocysticercosis was found in only eight patients (1.56%).

Conclusions: These data suggest that neurocysticercosis is an uncommon cause of intractable epilepsy, even in an endemic region such as Brazil, and that it may only represent a coexistent pathology. However, an analysis of our findings reveals that neurocysticercosis was more common in patients with MTS. This finding could suggest either that there is a cause-effect relationship between MTS and neurocysticercosis, or that MTS and neurocysticercosis co-vary with a missing variable, such as socio-economic status.

Abbreviations: FCD, focal cortical dysplasia; IPI, initial precipitating injury; MCD, malformations of cortical development; MTS, mesial temporal sclerosis

Keywords: hippocampal sclerosis; initial precipitating injury; intractable epilepsy; neurocysticercosis; neuroimaging