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The research from Dr Ramirez-Bermudez is outstanding. It contributes
to a subject with such scarce publications in the literature. The high
number of patients evaluated and the care in performing correlations
between cognitive alterations due to neurocysticercosis (NCC), cerebral
spinal fluid and neuroimaging studies are remarkable. However, some topics
should be pointed out:
First, there was...
First, there was a great difference between the groups with and
without dementia concerning some basic epidemiological characteristics:
the dementia group showed a median of 63 years of age, 2 years of
education and a prevalence of epilepsy of 85%, while the non-dementia
group had a median of 33 years of age, 2 years of education, and a much
lower prevalence of epilepsy (58%). Age and years of education are well-
known variables interfering with cognitive testing(1) and could be
responsible for part of the results found in the study. Epilepsy is also
related to cognitive changes and the difference in its prevalence might
have some effect on the results of this study.
Second, there was an absence of information on the anti-epileptic
drugs taken by the patients. This is an important issue, since 85% of the
dementia group patients were found to have this disorder. Neither the
number of patients actually taking anti-epileptic drugs, nor its type or
dosing were provided. Also, seizure control was not assessed, which could
have greatly contributed to the discussion on whether or not interictal
seizure activity plays a role on the cognitive deficits of these
patients(2). Another point missing is the presence of alcohol abuse, which
is known to be strongly associated to lower socio-economic and educational
status (commonly found in patients with NCC) and which plays a crucial
whole on cognitive performance.
Lastly, the authors did not provide information on the prevalence of
active NCC disease in the group that had dementia and showed cognitive
improvement on the second evaluation. This could also enrich the
discussion on the role of active disease being the sole agent causing
cognitive deficit(3). For instance, if there were some patients with
inactive disease who were classified as having dementia on the first
evaluation and improved on the second assessment, it could suggest that
active disease is not the only agent causing cognitive decline in this
population, as it is probably true.
1. Forlenza OV, Filho AHGV, Nobrega JPS, et al. Psychiatric manifestations of neurocysticercosis: a study of 38 patients from a neurology clinic in Brazil. J Neurol Neurosurg Psychiatry 1997;62:612–16.
2. Caramelli P, Castro LHM. Dementia associated with
epilepsy. Intenational Psychogeriatrics 2005;17: 195-206.
3. VC Terra-Bustamarte, et al. Cognitive performance of patients with mesial temporal lobe epilepsy and incidental calcified neurocysticercosis. J Neurol Neurosurg Psychiatry 2005;76: 1080-83.