Abstracts

Rationale: To determine the frequency of mesial temporal lobe sclerosis (MTS) in patients with drug-resistant epilepsy (DRE) and neurocysticercosis (NCC) and to describe their clinical features in a tertiary hospital (NINN) in a developing country. Methods: We performed a descriptive, retrospective, analytical study. We included 172 patients with DRE as defined by the ILAE 2010 criteria in the period of 2006-2012; we found 26 patients (15.12%) with NCC and DRE, of which 15 had MTS. STATISTICAL ANALYSIS: Data were collected using SPSS software. Results: Of the 26 patients who had NCC and DRE, 15 (57.69%) also had MTS. 10 (66.7%) were female, aged between 23 and 55 (40.60±10.10). The onset of seizures was between 1 and 25 years (12.27±8). Past medical history was relevant for perinatal hypoxia in one (6.7%), 1 (6.7%) prolonged labor, 14 (93.33%) had normal psychomotor development, 4 (26.7%) febrile seizures, 7 (46.7%) head trauma. Family history for epilepsy was present in 6 (40%). Although none had a previous history of psychiatric illness, 7 (46.7%) had anxiety, depression or psychosis. fourteen (93.3%) had a normal physical examination, one (6.7%) had mild mental retardation. Mean seizure frequency was 13±22 (range 1 to 90 per month). Regarding seizure type one (6.7%) had partial motor seizures, 1 (6.7%) visual, 3 (20%) dizziness, 3 (20%) dysmnesics, 2 (13.3%) affective. Fourteen (93.3%) had partial seizures followed by secondarily generalization. No patient had absence seizures, myoclonic, atonic or tonic-clonic. Two (13.3%) had tonic seizures and 4 (26.7%) had catamenial epilepsy. In the evolution 3 (20%) had non-convulsive or convulsive status epilepticus (SE), 1 (6.7%) twice. On EEG 13 had abnormal findings (86.7%), six (40%) with focal activity, one (6.7%) diffuse alteration and one (6.7%) focal activity and diffuse abnormalities. In patients where epileptic activity was observed 9 (60%) had focal activity and 3 (20%) bilateral activity. On MRI studies right MTS was found in 4 (26.7%), left MTS in 8 (53.3%) and bilateral in 3 (20%). All patients had calcified granulomas that were located in the temporal lobe in 8 (53.33%) and 4 (26.7%) had multiple granulomas bilateral. All lesions were intraparenchymal. SPECT was performed in 8 (53.3%) and was abnormal in all the patients. PET scan was performed in 7 (46.7%) and only one had a normal result. Regarding antiepileptic drugs (AEDs) everyone used an average of 2 to 3 AEDs. AEDs used in polytherapy were VPA (73.3%), CBZ (66.7%), LTG (53.3%), PHT (46.7%), CLZ (33.3%), CLB (26.7%), OXC (13.3%), PMD (13.3%), LEV (13.3%), acetazolamide (13.3%), TPM (6.7%) and GBP (6.7%). Conclusions: NCC is a common cause of epilepsy in developing countries, but hasn't been commonly associated with DRE. In patients with NCC and DRE the possibility that the inflammatory reaction can trigger a dual pathology with mesial temporal lobe sclerosis has been raised, it should be determined if it is related to the location of the NCC, gliosis or the inflammatory reaction that occurs. In our series NCC was a rare cause of DRE.