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CT/MRI head, clinical profile, laboratory investigations Table 1: Causes of seizure
and exclusion of other causes were the basis of NCC Total Male Female P
diagnosis. Fundus examination was done in all patients n (%) n (%) n (%)
to rule out ocular NCC. Out of 21 NCC patients, Alcohal withdrawal 61 (46.5) 58 (59.8) 3 (8.8) < 0.001 b
MRI Brain was available for 2 patients and CT head syndrome 23 (17.5) 8 (8.2) 15 (44.1) < 0.001 b
Idiopathic
plain, and contrast were performed on the remaining generalized seizure
patients (19). Serum, anticysticercal antibodies test, NCC 21 (16.0) 15 (15.5) 6 (17.6) 0.765
1.0
was carried out in 2 patients, and serum titer (> 1:160) Encephalitis 4 (3.0) 3 (3.1) 1 (2.9) 0.053
4 (3.0)
1 (1.0)
Brain abscess
3 (8.8)
was positive in one of them. NCC was diagnosed Stroke
according to Del Brutto revised diagnostic criteria Hemorrhagic 3 (2.3) 1 (1.0) 2 (5.9) 0.165
[9]
Ischemic
0
a
for NCC. These include absolute, major, minor and Tuberculoma 2 (1.5) 3 (3.1) 2 (5.9) 0.604
5 (3.8)
2 (5.9)
epidemiological criteria, and the degrees of diagnostic Others 8 (6.1) 5 (5.1) 3 (8.8) 0.427
certainty can be further classified under definitive and Total 131 97 34
b
a
probable diagnosis. Reports of electroencephalography, Data are shown as n (%) or mean ± SD. P value not applicable; P < 0.001.
complete blood count, chest X-ray, Mantoux test, SD: standard deviation; NCC: neurocysticercosis
sputum for acid fast bacilli, renal and liver function test,
abdominal ultrasonography and electrocardiography Table 2: Characteristics of NCC lesions
were collected from each patient. The institution Total n (%) Male n (%) Female n (%) P
ethical board approved the study protocol. Age (years) 33.9 ± 16.4 33.0 ± 16.6 36.3 ± 17.1 0.685
Lesion
Single 13 (61.9) 9 (60.0) 4 (66.7) 1.0
Patients with an intracranial malignancy, head injury, Multiple 8 (38.1) 6 (40.0) 2 (33.3)
stroke, metabolic disturbance, tuberculosis, brain Seizure 18 (85.7) 14 (93.3) 4 (66.7) 0.184
GTCS
abscess and HIV were excluded. Patients of pediatric Partial 3 (14.3) 1 (6.7) 2 (33.3)
age, that is, below 15 years were not included in our CT/MRI stage
study. Details of patient’s personal data, socioeconomic Multiple 3 (14.3) 2 (13.3) 1 (16.7) 1.0
0
a
I
0
0
status, clinical profile, drug history and response were II 5 (23.8) 4 (26.7) 1 (16.7) 1.0
recorded. III 1 (4.8) 1 (6.7) 0 a
IV 12 (57.1) 8 (53.3) 4 (66.7) 0.659
a
Data storage and statistical analysis were performed by IBM Data are shown as n (%) or mean ± SD. P value not applicable. GTCS: generalized
tonic clonic seizure; CT: computer tomography; MRI: magnetic resonance imaging;
SPSS Statistics Version 20 for Mac (IBM Corporation, New SD: standard deviation; NCC: neurocysticercosis
York, United States). Chi-square and Student’s t-test were
used for comparison of variables; a two-tailed P < 0.05 most common seizure type in NCC patients (18 patients;
was considered statistically significant. 85.7%), two of whom had status epilepticus during
presentation in an emergency department. Three
RESULTS patients (14.3%) had focal seizure, one of them had
epilepsia partialis continua. Headache and vomiting
Out of 131 seizure patients, 46.5% were diagnosed with were observed in 7 (33.3%) and 5 (23.8%) patients,
alcohol withdrawal seizure, followed by idiopathic respectively [Figure 1]. Calcified stage of NCC was the
generalized seizure (17.5%), NCC (16.0%) and others most frequent CT/MRI findings (12 patients; 57.1%).
20%. NCC was the most common cause of secondary
epilepsy, followed by brain tuberculoma (3.8%), Seven patients (33.3%) had sought traditional healers
stroke (3.8%), encephalitis (3.0%), and brain before they were referred to our center. Eight patients
abscess (3.0%) [Table 1]. (38.1%) were found to be treated with antiepileptics
in local health-post without neuroimaging studies
Neurocysticercosis was diagnosed in 21 patients (16.0%) done. Phenytoin was preferred both by physicians and
with mean age of 33.9 ± 16.4 and male:female patients due to its low cost (12 patients; 57.1%). Valproic
ratio was 15:6 [Table 2]. According to of the NCC acid (5 patients; 23.8%) and carbamazepine (4 patients,
criteria described by Del Brutto, 10 patients were 19.04%) were other common first generation
[9]
classified under definitive diagnosis (1 absolute or antiepileptic drugs (AEDs) reported in our study.
combination or major, minor and epidemiologic Multiple AEDs were administered during treatment
criteria) and 11 patients were diagnosed as probable of 2 patients.
NCC (combination of major, minor and epidemiologic
criteria). About 30% of our NCC patients were local DISCUSSION
people of Kathmandu. Neuroimaging showed multiple
NCC lesions in 8 (38.1%) and a single NCC lesion in Neurocysticercosis is an endemic disease and a health
13 (61.9%). Generalized tonic clonic seizure was the burden in Nepal. In our study, it is the most common

168 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 169