Brain Tissue Swelling and Seizure Activity in Inactive Cysticercosis

This study will examine what causes seizures in patients with cysticercosis (pork tapeworm infection). A better understanding of this could lead to improved methods of controlling or preventing seizures. In humans, the pork tapeworm (Taenia solium) lives in the small intestine. The parasite's microscopic eggs travel around the body-including to the brain-where they develop into cysts. Usually, the cysts don't cause symptoms until they die. Then, they provoke an inflammatory reaction that irritates the brain, causing seizures and other symptoms. The inflammation eventually goes away, but the dead cysts remain. Calcium deposits often form where the cysts are. Some of the calcified cysts develop swelling around them that seem to be associated with the development of seizures. This study will explore how and why these dead, calcified cysts continue to cause seizures. In so doing, it will try to determine: 1) the best diagnostic imaging method for detecting swelling around the cysts; 2) how often swelling occurs; and 3) what makes some cysts prone to swelling and related seizure activity, while others are not. Patients with cysticercosis who have had seizures or who have known or possible swelling around calcified cysts will be studied with various tests, including magnetic resonance imaging (MRI), computed tomography (CT) scans, electroencephalography (EEG), blood tests, and possibly lumbar puncture. Patients will be studied for two cycles of seizures (during active and quiet periods) or a maximum 4 years.

Sex

All

Minimum age

18 Years

* INCLUSION CRITERIA:

  18 years of age or older. If children are evaluated they can be seen under the general protocol and they may be entered into the present protocol under an exception.

Likely diagnosis of inactive cysticercosis and present or past seizure activity. Requires "a" and "b" plus any one of the remaining criteria:

1. History of seizures or present seizure activity;
2. Previously treated or has inactive disease and declines treatment;
3. Single calcified lesions and positive serology;
4. Multiple calcified lesions;
5. Multiple small enhancing nodular lesions;
6. History of cystic lesions responding to specific chemotherapy.

If female, not pregnant and using effective birth control methods.

EXCLUSION CRITERIA:

Less than 18 years of age.

Pregnant or unwilling to use effective birth control measures.

Refuse blood tests.

Unwilling or unable to undergo testing according to the schedule.

Unable to undergo MRI or CT examinations.

Patients who require anesthesia to undergo imaging studies.

• BACKGROUNDWhite AC Jr. Neurocysticercosis: a major cause of neurological disease worldwide. Clin Infect Dis. 1997 Feb;24(2):101-13; quiz 114-5. doi: 10.1093/clinids/24.2.101. No abstract available. PMID 9114131
• BACKGROUNDRajshekhar V, Chacko G, Haran RP, Chandy MJ, Chandi SM. Clinicoradiological and pathological correlations in patients with solitary cysticercus granuloma and epilepsy: focus on presence of the parasite and oedema formation. J Neurol Neurosurg Psychiatry. 1995 Sep;59(3):284-6. doi: 10.1136/jnnp.59.3.284. PMID 7673957
• BACKGROUNDNash TE, Neva FA. Recent advances in the diagnosis and treatment of cerebral cysticercosis. N Engl J Med. 1984 Dec 6;311(23):1492-6. doi: 10.1056/NEJM198412063112307. No abstract available. PMID 6390196