Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India.
Am J Trop Med Hyg. 2019 Oct;101(4):812-820. doi: 10.4269/ajtmh.19-0278.
Calcified neurocysticercosis (NCC), previously thought to be a dead end, is an important risk factor for seizure recurrences. We studied the pattern of seizure recurrences and associated radiological findings in children with calcified NCC. In this ambispective cohort study, we enrolled children (age 1-15 years) with calcified NCC attending the pediatric NCC clinic between January 2017 and December 2017. Retrospective data were collected from the hospital records, and all enrolled children were prospectively followed up till June 2018. The study group divided into two groups: 1) children first presenting with calcified granuloma and 2) children presented with ring-enhancing lesion (REL) and transformed into the calcified lesion during follow-up imaging. During the study period (January 2017-December 2017), 520 children with NCC were screened and 128 with calcified NCC were enrolled. The mean age was 10.8 ± 3.2 years, and 63% were boys. Among 128 children, 40 (31%) had calcified granuloma and 88 (69%) had REL transformed to calcified granuloma. Sixty-one (49%) children had seizure recurrence: 22 (58%) within calcified granuloma group and 39 (45%) within REL transformed to calcified granuloma group ( = 0.18). Seizure recurrence was associated with the presence of perilesional edema (PE) in 35 (57.4%) children on computed tomography scan. The median interval between two seizure recurrences was 30 (17-56) months, and the median antiepileptic drug-free interval was 17 (12-22) months. The total duration of continued seizures was 42 (26-58) months, slightly longer in children with REL transformed to calcified granuloma group (42, 95% CI: 18-66 months) in comparison to calcified granuloma group (35, 95% CI: 10-60 months, = 0.32). To conclude, children with calcified NCC have seizure recurrences over a prolonged period. Seizure recurrences are intermittent and may be interspersed with a prolonged period of quiescence in between. The presence of PE and contrast enhancement around the lesion during seizure recurrence suggests lesion reactivation.
钙化性神经囊尾蚴病（NCC）曾被认为是一种死胡同，但却是癫痫复发的一个重要危险因素。我们研究了伴有钙化性 NCC 的儿童癫痫复发的模式和相关的影像学发现。在这项前瞻性队列研究中，我们招募了 2017 年 1 月至 2017 年 12 月期间在儿科 NCC 诊所就诊的患有钙化性 NCC 的 1-15 岁儿童。从医院记录中收集回顾性数据，所有入组的儿童均进行前瞻性随访至 2018 年 6 月。研究组分为两组：1）首次表现为钙化性肉芽肿的儿童；2）表现为环形增强病变（REL）并在随访影像学中转变为钙化性病变的儿童。在研究期间（2017 年 1 月至 2017 年 12 月），共筛查了 520 名 NCC 患儿，其中 128 名患有钙化性 NCC。患儿的平均年龄为 10.8±3.2 岁，63%为男性。在 128 名儿童中，40 名（31%）患有钙化性肉芽肿，88 名（69%）患有 REL 转变为钙化性肉芽肿。61 名（49%）儿童出现癫痫复发：22 名（58%）在钙化性肉芽肿组，39 名（45%）在 REL 转变为钙化性肉芽肿组（ = 0.18）。35 名（57.4%）患儿在 CT 扫描上存在病变周围水肿（PE），与癫痫复发有关。两次癫痫复发之间的中位间隔时间为 30（17-56）个月，无抗癫痫药物的中位间隔时间为 17（12-22）个月。持续癫痫发作的总持续时间为 42（26-58）个月，在 REL 转变为钙化性肉芽肿组（42，95%CI：18-66 个月）中略长于钙化性肉芽肿组（35，95%CI：10-60 个月， = 0.32）。总之，患有钙化性 NCC 的儿童癫痫复发持续时间较长。癫痫复发是间歇性的，其间可能有一段较长的静止期。在癫痫复发期间，病变周围有 PE 和对比增强提示病变再激活。
