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Original Article

Neurocysticercosis in Nepal: a retrospective

clinical analysis

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Rajeev Ojha , Dinesh Bikram Shah , Amina Shrestha , Sunil Koirala , Apurba Dahal , Khem Adhikari ,
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Anjal Bisht , Pratik Wagle 1
1 Department of Medicine, Neurology Unit, National Academy of Medical Sciences, Bir Hospital, Mahaboudha, Kathmandu 44600, Nepal.
2 Department of Medicine, Om Hospital and Research Center, Chabahil, Kathmandu 44602, Nepal.
ABSTRA CT
Aim: The prevalence of epilepsy is higher in Nepal. This study was conducted to analyze the clinical manifestations of
neurocysticercosis (NCC) among seizure patients admitted to our center. Methods: We retrospectively studied all the NCC patients
admitted to Neurology Department, Bir Hospital, Kathmandu, Nepal from April 2012 to February 2014. Computer tomography/
magnetic resonance imaging (CT/MRI) head, clinical profile, lab investigations and exclusion of other causes were the basis of
the NCC diagnosis. Chi‑square and Student’s t‑test were used for comparison of variables. Results: Out of 131 seizure patients
admitted, 21 patients were diagnosed with NCC [mean age: 33.95 ± 16.41; male: 15 (71.4%), female: 6 (28.6%)]. Generalized tonic
clonic seizure was the most common seizure type in NCC patients (18 patients; 85.7%), two of them had status epilepticus during
presentation in Emergency Department. Three patients had focal seizure, one with epilepsia partialis continua. Neuroimaging showed
multiple NCC lesions in 8 (38.1%) and a single NCC lesion in 13 (61.9%) patients. Seven of them (33.3%) sought traditional healers
before being presented to our center. Eight patients (38.1%) were treated with antiepileptics in local health‑post without neuroimaging
studies done. Calcified stage of NCC was the most frequent CT/MRI findings (12 patients; 57.1%). Phenytoin was preferred both by
physicians and patients due to its low cost. Conclusion: NCC is a common finding among seizure patients in Nepal. Poor economic
status, illiteracy and underdeveloped rural society are the major challenges in prevention and treatment of NCC.

Key words: Cysticercosis, epilepsy, neurocysticercosis, Nepal, south Asia

INTRODUCTION headache. Diagnosis is often difficult even in developed
and non endemic areas, where NCC lesions are confused
Neurocysticercosis (NCC) is the most common parasitic with tuberculoma or metastatic lesions. [2,3] Due to
infection of the human brain. It is caused by the unavailability of laboratory tests and radioimaging
larval stage of Taenia solium, which enters the central tools, diagnosis of NCC is often challenging in
nervous system by ingestion of its eggs due to the use of developing countries. A large treatment gap has been
contaminated hand, water or food. Being a low-income reported from developing countries, 70% in Nepal,
[1]
[4]
country, the majority of Nepalese population is still 96% in Nigeria, 73% in Pakistan and 90% in India.
[6]
[5]
[7]
illiterate and deal with crops and animal farming. Due Among these, epidemiological studies reported higher
to lack of toilets in many Nepalese homes, open field prevalence of the treatment gap in rural areas in India
defecation is a common practice. Thus, poor sanitation and Pakistan. [6,7]
and improper management of food and meat products
are the major causes for higher NCC cases in Nepal. Since only a few NCC reports were conducted in Nepal,
this study aims at describing the clinical manifestations
Seizure is the most common clinical manifestation of NCC among seizure patients admitted to our center.
of NCC, followed by focal neurological deficits and
METHODS
Access this article online
Quick Response Code: We retrospectively analyzed all the available data
Website: of NCC patients who were admitted to Neurology
www.nnjournal.net
Department, Bir Hospital, Kathmandu, Nepal from
DOI: April 2012 to February 2014. Computer tomography
10.4103/2347-8659.160856 and magnetic resonance imaging (CT and MRI) head
[8]
were used to classify the various stages of NCC.
Corresponding Author: Dr. Rajeev Ojha, Department of Medicine, Neurology Unit, National Academy of Medical Sciences, Bir
Hospital, Mahaboudha, Kathmandu 44600, Nepal. E‑mail: rajeevnet@hotmail.com

PB Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 167