Abstracts

RATIONALE: Fifty million people are infected worldwide by Neurocysticercosis (NCS) and it is the most common cause of seizures in: Central America, China, India, Mexico and South America. It is increasingly becoming more common in large metropolitan areas of the US particularly in the southern regions. Epilepsy surgery is often not considered as treatment for recurrent seizures due to NCS. We evaluated the role of surgical intervention in patients with an isolated NCS lesion to assess if they may be rendered seizure free through surgical removal of the lesion.
METHODS: Surgical logbooks and computerized databases for all cases of NCS with intractable seizures that had undergone surgery for seizures at Mayo Clinic Scottsdale from 1998-2000 were reviewed. The following variables were assessed: Demographics, clinical data, EEG data, seizure type, imaging and use of antihelmenthics. The number and stage of cystic lesions and whether other organ systems were involved was noted. Seizure outcome was documented based on the last clinical follow-up visit.
RESULTS: Three patients who underwent surgery for intractable seizures secondary to NCS were identified. Two patients are male, one female, (ages 21, 37, and 43). Two presented with generalized seizures, one with a focal onset with secondary generalization. All of them had interictal EEG[ssquote]s that showed focal slowing consistent with the site of the lesion, and all had failed antiepileptic drug therapy. All patients had MRI[ssquote]s that showed a distinct single ring-enhanced lesion consistent with late stage NCS. The lesion locations are right frontal temporal, right parietal, and right temporal. All three reported having gastrointestinal complaints after pork ingestion, one to two years before seizure onset and had been tried on antihelmenthics for suspected tapeworm. One of the three patients had cystic lesions involving the renal system. The patients underwent surgery with ultrasonagraphic guidance for detection of other smaller cysts. Surgery involved resection of the suspected calcified neurocystic lesion. Pathology showed a necrotic organism with scolices consistent with cysticercus. Two of the three patients have been seizure free since removal of the single lesion. The outcome is pending for the third patient.
CONCLUSIONS: Many patients with neurocysticercosis have multiple lesions. Those with a single calcified neurocystic lesion may benefit from surgery for control of seizures similar to all epilepsy lesional cases. Prospective evaluations are needed to assess the timing of surgery in relation to the stage of the disease.