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Update on Cysticercosis Epileptogenesis: the Role of the Hippocampus

  • Infection (J Halperin, Section Editor)
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Abstract

Neurocysticercosis (NCC) is the most common helminthic infection of the nervous system and a frequent cause of reactive seizures and epilepsy worldwide. In many cases, multiple episodes of focal seizures related to an identifiable parenchymal brain cyst (and likely attributable to local damage) continue for years after the cyst resolves. However, cases where seizure semiology, interictal EEG abnormalities, and parasites location do not correlate raise concerns about the causal relationship between NCC and either reactive seizures or epilepsy, as well as the epileptogenic potential of parasites. Neurosurgical series of patients with intractable epilepsy and cross-sectional population-based studies have shown a robust association between NCC and hippocampal sclerosis (HS), which might contribute to the above-referred inconsistencies. Current information does not allow to define whether in patients with NCC, HS could result from recurrent seizure activity from a local or distant focus or from chronic recurrent inflammation. In either case, HS may become the pathological substrate of subsequent mesial temporal lobe epilepsy (MTLE). Longitudinal clinical- and population-based cohort studies are needed to evaluate the causal relationship between NCC and HS and to characterize this association with the occurrence of MTLE. If a cause-and-effect relationship between NCC and HS is demonstrated, NCC patients could be assessed to examine neuronal mechanisms of hippocampal epileptogenesis in comparison with animal models, to identify biomarkers of hippocampal epileptogenesis, and to develop novel interventions to prevent epilepsy in NCC and perhaps in other forms of acquired epilepsy.

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Correspondence to Oscar H. Del Brutto.

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Conflict of Interest

Oscar H. Del Brutto, Jerome Engel Jr., and Hector H. García declare that they have no conflict of interest.

Dawn S. Eliashiv has received consultancy fees, honoraria payments, and payment for development of educational presentations from Cyberonics, Sunovion, and UCB.

Funding

This study was partially supported by Universidad Espíritu Santo—Ecuador, Guayaquil, Ecuador. H.H. Garcia is supported by a Wellcome Trust International Senior Fellowship in Public Health and Tropical Medicine.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Del Brutto, O.H., Engel, J., Eliashiv, D.S. et al. Update on Cysticercosis Epileptogenesis: the Role of the Hippocampus. Curr Neurol Neurosci Rep 16, 1 (2016). https://doi.org/10.1007/s11910-015-0601-x

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