oa Neurocysticercosis in Qatar with particular emphasis on epilepsy-related neurocysticercosis

OBJECTIVE : Taenia solium neurocysticercosis (NCC) is the most common parasitic infection of the brain and is a leading cause of epilepsy in the developing world, especially Latin America,India,Africa,and China .It is increasingly being reported in patients suffering from epilepsy . However, its true prevalence and association with adult-onset seizures is largely unknown in the Middle East particularly in Qatar. Our study will demonstrate that NCC is also a major cause of first seizures in an increasingly young population in Qatar. BACKGROUND Awareness of NCC and associated seizures in the developing countries and the increased frequencies of hospital admissions of young Asian patients with first seizures and abnormal brain CT/MRI suggestive of NCC were the main reasons behind this study. METHODS : This is a retrospective and prospective study, based on hospital populations(2010 to present ) .All patients with seizure(s) seen at the emergency department at Hamad Medical Corporation (HMC) ,the largest single governement hospital in the state of Qatar with a capacity of 1600 beds , were reviewed. Among those patients, all individuals suspected of having NCC were admitted for further investigations and treatment. NCC was diagnosed on the basis of the following : CT or MRI (brain) showing cystic lesions with scolex or Lesions suggestive of NCC on CT/MRI and a compatible epidemiological and clinical history. The complementary examinations included an awake EEG, a CT SCAN or MRI of the brain and serum and CSF studies for some. The results of this study were compared to the most recent data reported in the literature. RESULTS: During this period, 120 patients with seizure(s) were seen at the emergency department .Among them , 55 patients (45,8%) were diagnosed as having NCC on the basis of the above criteria. 54 of the NCC patients (98,3%) were males ;Most of them,53 patients(96.5%), expatriate from the Indian Subcontinent.52 patients ( 94,6%) were older than 20years ; 53 patients(96,5%) presented with seizures with 45 patients (81,8%) having their first seizure. 33 patients ,(60%), had partial seizures, the rest secondary generalized or generalized seizures.17 patients presented with headache. Most of the patients(31) showed a viable cyst on CT/MRI .More than half of patients(29) had an abnormal EEG, however relationship between focal EEG changes and cyst location was only found in 13 patients. Most patients were treated with cysticidal therapy and corticosteroids except those patients with calcification lesions on CT/MRI and absence of edema .Non-neurological side effects included abdominal pain ,nausea, and diarrhea in 8 patients. Antiepileptic therapy (AEDs) was used in 50 patients from the onset and avoided in 5 patients with first seizures and tiny lesions on CT/MRI. During the study-period, AEDs were withdrawn in 6 patients.