Abstracts

Rationale: To determine whether cysticercal calcifications (CCs), or an alternate epileptogenic lesion, was the cause of drug-resistant epilepsy in a cohort of immigrant Hispanic patients with evidence of neurocysticercosis (NCC).Methods: Diagnostic data were reviewed from immigrant Hispanic patients referred to our epilepsy monitoring unit for epilepsy surgical evaluation from Los Angeles Department of Health System tertiary care clinics between September 2007 and December 2011. Thirty-four patients who underwent comprehensive presurgical evaluation had characteristic cysticercal calcifications on computed tomography (CT) of the head. CT and magnetic resonance imaging (MRI) images were reviewed for lesion findings and categorized by hemisphere and lobe. Seizure localizations by continuous video-electroencephalography (VEM) were similarly categorized by location, and then compared for concordance with neuroimaging findings.Results: Thirty-three of 34 patients had alternate epileptogenic lesions on MRI besides NCC, including 27 patients (79%) with mesial temporal sclerosis (MTS). The alternative epileptogenic lesion co-localized with ictal onset via VEM significantly better than did CCs (91% v. 12%, p<0.001). CCs were concordant with ictal onset in only 4 cases, and in all 4 cases, there was an adjacent alternative epileptogenic lesion. Resective surgery was performed in 14 patients, of whom 12 have Engel class 1 outcomes and 2 have class 3 outcomes (mean follow-up 27.6 months, range 10-53).Conclusions: This first study of NCC patients who received comprehensive surgical evaluation in an urban U.S. epilepsy center showed that CCs were not a common cause of drug-resistant epilepsy. Cysticercal calcifications on initial head CT should not preclude patients with DRE from epilepsy surgery evaluation, as CCs may not be the cause, and surgical outcome may be as good as patients without evidence of NCC.