CYSTICERCOSIS AND EPILEPSY - A CRITICAL-REVIEW

Neurocysticercosis (NC) remains a major public health problem in devel oping and some developed countries. Currently, the best procedures for diagnosing NC are neuroimaging studies. Immunoserologic assays, such as enzyme-linked immunoelectrotransfer blot assay (EITB) or enzyme-lin ked immunosorbent assay (ELISA), detect antibodies against Taenia soli um, or cysticercus. Consequently, they are useful in idenfying a popul ation at risk of contact with the parasite but do not necessarily indi cate a systemic active infection. Most seropositive individuals are as ymptomatic. No data from prospective studies concern the proportion of these individuals that will develop seizures or other neurologic symp toms. Then is a discrepancy between the results of serologic assays an d neuroimaging studies: >50% of those individuals with NC diagnosed by computed tomography (CT) scan test EITB negative. Pathophysiologic cl assification of NC into active, transitional, and inactive forms permi ts a good correlation between clinical manifestations and neuroimaging procedures and facilitates medical and surgical management and resear ch. The most frequent clinical manifestations of NC are seizures. We a ssume that NC is the main cause of symptomatic epilepsy in developing countries; however, no case-control or cohort studies demonstrate this association. Most patients with NC with seizures have a good prognosi s; nevertheless, further studies analyzing factors related to recurren ce of seizures and possibilities of discontinuation of antiepileptic m edications (AEDs) are needed. Regarding treatment of NC with antihelmi nthic drugs, no controlled clinical trials exist that establish specif ic indications, definitive doses, and duration of treatment. The most effective approach to taeniasis/cysticercosis infection is prevention. This should be a primary public health focus for developing countries . We critically review the available information regarding the epidemi ology and diagnosis of human cysticercosis, the physiopathology and im aging correlation of the parasite in the central nervous system (CNS) of the host, the relation between seizures or epilepsy and NC, and the issues surrounding the treatment and prognosis of NC, including the u se of antihelminthic therapy.