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Frequency and determinant factors for calcification in neurocysticercosis.
Clin Infect Dis. 2020 Jun 17 [Online ahead of print]CI

Abstract

BACKGROUND

Neurocysticercosis (NCC) is a major cause of acquired epilepsy in most of the world. Larval cysts in the human brain eventually resolve and either disappear or leave a calcified scar that is associated with seizures. This study assessed the proportion of residual calcification in parenchymal NCC, and defined risk factors associated with calcification.

METHODS

Data from 220 patients with parenchymal NCC from three randomized trials of antiparasitic treatment was assessed to determine what proportion of the cysts that resolved six months after antiparasitic treatment ended up in a residual calcification at one year. Also, we evaluated the risk factors associated with residual calcification. A multilevel Poisson regression model was used to estimate the risks of calcification.

RESULTS

The overall proportion of calcification was 38% (188/497 cysts, from 147 patients). Predictors for calcification at the cyst level were cysts larger than 14 mm (RR 1.34; 95% C.I. 1.02-1.75), and cysts with edema at baseline (RR 1.39; 95% C.I. 1.05-1.85). At the patient level, having had more than 24 months with seizures (RR: 1.25, 95% C.I. 1.08-1.46), mild antibody response (RR: 1.14; 95% C.I. 1.002-1.27), increased dose albendazole regime (RR: 1.26; 95% C.I. 1.14-1.39), lower doses of concomitant dexamethasone (RR: 1.36; 95% C.I. 1.02-1.81), not receiving early antiparasitic re-treatment (RR: 1.45; 1.08-1.93), or complete cure (RR: 1.48; 1.29-1.71).

CONCLUSIONS/SIGNIFICANCE

Approximately 38% of parenchymal cysts calcify after antiparasitic treatment. Some factors associated to calcification are modifiable and may be approached to decrease or avoid calcification, potentially decreasing the risk for seizure relapses.

Authors+Show Affiliations

Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú. Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú.Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú. Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú.Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú.Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú.Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú.Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú. Department of Neurology, Hospital Alberto Sabogal, Callao, Perú.Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America.Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú. School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon. United States of America.School of Medicine, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú.Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú. Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32556276

Citation

Bustos, Javier A., et al. "Frequency and Determinant Factors for Calcification in Neurocysticercosis." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 2020.
Bustos JA, Arroyo G, Gilman RH, et al. Frequency and determinant factors for calcification in neurocysticercosis. Clin Infect Dis. 2020.
Bustos, J. A., Arroyo, G., Gilman, R. H., Soto-Becerra, P., Gonzales, I., Saavedra, H., Pretell, E. J., Nash, T. E., O'Neal, S. E., Del Brutto, O. H., Gonzalez, A. E., & Garcia, H. H. (2020). Frequency and determinant factors for calcification in neurocysticercosis. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. https://doi.org/10.1093/cid/ciaa784
Bustos JA, et al. Frequency and Determinant Factors for Calcification in Neurocysticercosis. Clin Infect Dis. 2020 Jun 17; PubMed PMID: 32556276.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frequency and determinant factors for calcification in neurocysticercosis. AU - Bustos,Javier A, AU - Arroyo,Gianfranco, AU - Gilman,Robert H, AU - Soto-Becerra,Percy, AU - Gonzales,Isidro, AU - Saavedra,Herbert, AU - Pretell,E Javier, AU - Nash,Theodore E, AU - O'Neal,Seth E, AU - Del Brutto,Oscar H, AU - Gonzalez,Armando E, AU - Garcia,Hector H, AU - ,, Y1 - 2020/06/17/ PY - 2020/02/06/received PY - 2020/6/20/entrez KW - Taenia solium KW - Cysticercosis KW - Perú KW - calcification KW - risk factors JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. N2 - BACKGROUND: Neurocysticercosis (NCC) is a major cause of acquired epilepsy in most of the world. Larval cysts in the human brain eventually resolve and either disappear or leave a calcified scar that is associated with seizures. This study assessed the proportion of residual calcification in parenchymal NCC, and defined risk factors associated with calcification. METHODS: Data from 220 patients with parenchymal NCC from three randomized trials of antiparasitic treatment was assessed to determine what proportion of the cysts that resolved six months after antiparasitic treatment ended up in a residual calcification at one year. Also, we evaluated the risk factors associated with residual calcification. A multilevel Poisson regression model was used to estimate the risks of calcification. RESULTS: The overall proportion of calcification was 38% (188/497 cysts, from 147 patients). Predictors for calcification at the cyst level were cysts larger than 14 mm (RR 1.34; 95% C.I. 1.02-1.75), and cysts with edema at baseline (RR 1.39; 95% C.I. 1.05-1.85). At the patient level, having had more than 24 months with seizures (RR: 1.25, 95% C.I. 1.08-1.46), mild antibody response (RR: 1.14; 95% C.I. 1.002-1.27), increased dose albendazole regime (RR: 1.26; 95% C.I. 1.14-1.39), lower doses of concomitant dexamethasone (RR: 1.36; 95% C.I. 1.02-1.81), not receiving early antiparasitic re-treatment (RR: 1.45; 1.08-1.93), or complete cure (RR: 1.48; 1.29-1.71). CONCLUSIONS/SIGNIFICANCE: Approximately 38% of parenchymal cysts calcify after antiparasitic treatment. Some factors associated to calcification are modifiable and may be approached to decrease or avoid calcification, potentially decreasing the risk for seizure relapses. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/32556276/Frequency_and_determinant_factors_for_calcification_in_neurocysticercosis L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciaa784 DB - PRIME DP - Unbound Medicine ER -
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