Authors :
Presenting Author: Karen Karol VASQUEZ QUICAÑO, MD – Hospital Nacional Daniel Alcides Carrión - Callao
Marina Koutsondontis Alvim, PhD – University od Campinas, São Paulo, Brazil
Enrico Ghizoni, PhD – University od Campinas, São Paulo, Brazil
Fabio Rogerio, PhD – University od Campinas, São Paulo, Brazil
Clarissa Lin Yasuda, PhD – University od Campinas, São Paulo, Brazil
Fernando Cendes, PhD – University od Campinas, São Paulo, Brazil
Rationale:
Calcified neurocysticercosis (cNCC) is considered a frequent etiology of epilepsy in developing countries. Objective: To evaluate if co-existent cNCC affects surgical outcomes in mesial temporal lobe epilepsy with unilateral HS (MTLE-HS). Methods:
We analyzed 82 patients with MTLE-HS operated between 1997 and 2020 at the University of Campinas, Brazil. All patients had ictal semiology indicating MTLE and EEG findings concordant with the side of HS diagnosed with high-resolution 3T-MRI epilepsy protocol. We determined the presence of cNCC with CT scans or SWI MRIs. We analyzed the postoperative outcomes according to the Engel classification. We used Fisher´s exact test to analyze differences in proportions. Results:
The median age was 42.15 years, and 54.87% were women. Thirty-three (40.2%) had multiple cNCC lesions in addition to HS, and 49 (59.8%) did not. Fewer patients with cNCC reported a history of febrile seizures compared to those without cNCC (2 [6.1%] vs. 7 [14.3%]), but without statistical significance (p=0.3). The mean postoperative follow-up was 12.5 years for those with cNCC and 5.5 years for those without. Overall, 58/82 (70.72%) achieved Engel IA. At the last follow-up, 27/33 patients (81.8%) with cNCC were categorized as Engel IA compared to 31/49 (63.3%) in those without cNCC; however, this difference was not significant (p=0.086). Conclusions:
Our results confirm previous studies showing that in patients with refractory unilateral MTLE-HS with concordant ictal semiology and EEG findings, cNCC does not change the probability of excellent postoperative seizure control and does not contraindicate surgery. These findings also indicate that the real cause of ongoing seizures in these patients who became seizure-free after surgery was not the cNCC but the HS. Therefore, the finding of cNCC on CT or MRI does not necessarily indicate the etiology of epilepsy, and perhaps neurocysticercosis acts as a precipitating insult in some patients with MTLE-HS.
Funding: Hospital Nacional Daniel Alcides Carrion