Abstracts

Rationale: A 25 year old patient presented to our hospital for evaluation of neurocysticercosis and developed refractory and disabling epilepsy despite maximal medical therapy. He had multiple cerebral lesions consistent with calcified cysts from Tenia solium granulomata with perilesional edema that waxed and waned among multiple degenerating cysts. One lesion was resected after failed medical interventions could not eradicate edema and control seizures and another set of lesions are presently controlled with standard medical therapy. This article reviews the clinicopathologic features of the case. Since in general there is a limited surgical role for surgery with intracerebral parenchymal cysticercosis given the effectiveness of medical therapies that exist, this report highlights the clinical decision making leading to the successful control of intractable epilepsy using both surgical and medical approaches within the same patient.Methods: In a suburban Epilepsy center this patient with intractable seizures underwent clinical decision making over an approximately 9 year period and had multiple clinical evaluations with our neurology, infectious disease, and neurosurgery departments. This article describes the relevant clinical factors and evaluations and highlights the clinical decision making that yielded a successful outcome.Results: This patient gained control of intractable epilepsy only after both surgical and medical therapies. Resection of the culprit surgically treatable lesion in this case which was due to a degenerating granulomatous cysticercosis lesion with associated perilesional edema was performed. Surgery was successful after verifying ictal onsets utilizing MRI neuroimaging and electroencephalography(EEG) and analysis using a multidisciplinary approach. This patient also gained control of additional seizures by medically controlling the perilesional edema of a separate contralateral lesion.Conclusions: Our case report delineates the clinical and pathological features of a patient with neurocysticercosis and intractable seizures requiring both medical and surgical treatment. This article suggests there may be a role for both medical and surgical treatment of seizures secondary to degenerating or unstable Tenia solium granulomata and that clinical decision making must be individualized for optimal outcomes.