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