Singh Alok Kumar, Garg Ravindra Kumar, Rizvi Imran, Malhotra Hardeep Singh, Kumar Neeraj, Gupta Rakesh Kumar
Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India.
Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India.
Epilepsy Res. 2017 Nov;137:78-83. doi: 10.1016/j.eplepsyres.2017.09.010. Epub 2017 Sep 20.
Solitary calcified neurocysticercosis is a common cause of seizures in the developing countries. Factors responsible for seizure recurrence in patients with solitary calcified neurocysticercosis are not known. We evaluated the clinical, neuroimaging and biochemical predictors of seizure recurrence.
This was a prospective observational study. Patients with new-onset seizures and a solitary calcified neurocysticercosis were included. Patients were evaluated clinically; baseline electroencephalography and magnetic resonance imaging of brain were done for all patients.. The patients were followed for 1year. Seizure recurrence was defined as the recurrence of an episode of seizure at least 1 week after the initiation of the anti-epileptic drugs.
Fifty-four patients with a mean age of 20.43±7.34years were included. Thirteen patients developed seizure recurrence during the follow-up period. On univariate analysis, status epilepticus at presentation (p=0.025), size of the lesion >10mm (p=0.015), presence of perilesional edema (p<0.001) and scolex (p=0.033) were significantly associated with seizure recurrence. On multivariate analysis, only presence of perilesional edema (p=0.018, odds ratio=12.122, 95% confidence interval 1.521-96.639) was an independent predictor of seizure recurrence.
Status epilepticus at presentation is associated with an increased risk of seizure recurrence. Neuroimaging features like presence of perilesional edema and scolex can similarly predict seizure recurrence. These neuroimaging features can serve as potential surrogate markers to define therapy in these patients. The findings of our study might be helpful in stratifying patients with a higher risk of seizure recurrence, especially those who may require a more aggressive management.
孤立性钙化神经囊尾蚴病是发展中国家癫痫发作的常见原因。孤立性钙化神经囊尾蚴病患者癫痫复发的相关因素尚不清楚。我们评估了癫痫复发的临床、神经影像学和生化预测因素。
这是一项前瞻性观察研究。纳入新发癫痫且患有孤立性钙化神经囊尾蚴病的患者。对患者进行临床评估；所有患者均进行了基线脑电图和脑部磁共振成像检查。对患者随访1年。癫痫复发定义为在开始使用抗癫痫药物至少1周后癫痫发作事件的再次出现。
纳入54例平均年龄为20.43±7.34岁的患者。13例患者在随访期间出现癫痫复发。单因素分析显示，就诊时癫痫持续状态（p=0.025）、病灶大小>10mm（p=0.015）、病灶周围水肿的存在（p<0.001）和头节（p=0.033）与癫痫复发显著相关。多因素分析显示，仅病灶周围水肿的存在（p=0.018，比值比=12.122，95%置信区间1.521-96.639）是癫痫复发的独立预测因素。
就诊时癫痫持续状态与癫痫复发风险增加相关。病灶周围水肿和头节等神经影像学特征同样可预测癫痫复发。这些神经影像学特征可作为确定这些患者治疗方案的潜在替代标志物。我们研究的结果可能有助于对癫痫复发风险较高的患者进行分层，尤其是那些可能需要更积极治疗的患者。
