Abstracts

Rationale: Neurocysticercosis (NCC) is among the most common acquired causes of epilepsy worldwide. In NCC, cognitive impairment is the most common symptom and an important contributor to morbidity in this population. Limited studies have investigated cognitive function and its association with NCC in people with epilepsy (PWE). In the present study, cognitive screening was conducted within a large population-based cohort of PWE in an area highly endemic for Taenia solium, the pathogen responsible for NCC.

Methods: Participants with epilepsy in Northern Peru were enrolled in a clinical cohort from 2007 to 2020. Cognitive performance was cross-sectionally assessed by Mini-Mental State Examination (MMSE) at time of enrollment. Demographic data, clinical and treatment history of epilepsy, neurologic examination, and diagnostic testing results (EEG, neuroimaging, and serologies for NCC) were also collected. Logistic and linear regression models were used to assess differences in cognition stratified by NCC status, adjusted for possible confounding variables including age, sex, education level, as well as characteristics of epilepsy and NCC infection, such as duration of epilepsy, antiseizure medication use, and stage of NCC infection.


Results: The MMSE was completed on 764 PWE, of which 295 (38.6%) had probable or definite NCC by the Del Brutto criteria. The mean MMSE score across the entire cohort was 26.3 [SD: 4.2], with 6.6% [95% CI: 4.8%, 8.4%] of the cohort meeting criteria for mild or major cognitive impairment. MMSE scores did not differ when stratified by NCC status. Increased age, lower educational attainment, and higher number of prescribed antiseizure medications were associated with lower MMSE scores. Pre-enrollment duration of epilepsy, active epilepsy, and stage of NCC infection were not associated with differences in MMSE scores.

Conclusions: Cross sectional surveys conducted in high income nations have estimated- a similar prevalence of mild or major cognitive impairment, approximately 6%, as found in this cohort of PWE. In the present study, MMSE scores did not differ by NCC status, suggesting that cognitive dysfunction is no worse in epilepsy participants with a history of NCC as compared to their non-infected counterparts. Of covariates evaluated, only the number of prescribed antiseizure medications (ASM) at time of enrollment was associated with lower MMSE scores. While ASM use could represent a proxy for severity of disease, which was not otherwise assessed at baseline, it does compel a closer look at the relationship between ASM usage and cognitive dysfunction in this population.

Funding: Partial support was provided by the Bill and Melinda Gates Foundation (Grant 23981, US), the NIH National Institute of Allergy and Infectious Diseases (R01AI141554), and the Fogarty International Center (D43TW001140).