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. 2016 Sep;110(9):517-526.
doi: 10.1093/trstmh/trw066.

Neurocysticercosis in Bhutan: a cross-sectional study in people with epilepsy

Kate Brizzi  1 , Sonam Pelden  2 , Tshokey Tshokey  2 , Damber K Nirola  3 , Megan B Diamond  1 , Joshua P Klein  4   5 , Lhab Tshering  3 , Sonam Deki  3 , Dechen Nidup  6 , Veronica Bruno  1 , Pierre Dorny  7 , Hector Hugo Garcia  8 , Farrah J Mateen  9   5 ; Bhutan Epilepsy Project
Affiliations

Neurocysticercosis in Bhutan: a cross-sectional study in people with epilepsy

Kate Brizzi et al. Trans R Soc Trop Med Hyg. 2016 Sep.

Abstract

Background: We sought to provide an assessment of the burden of neurocysticercosis among people with epilepsy (PWE) in Bhutan and evaluate the yield of various tests for Taenia solium.

Methods: PWE were enrolled at the National Referral Hospital in Thimphu (2014-2015). Serum was tested for anti-Taenia solium IgG using ELISA (Ab-ELISA), enzyme-linked immunoelectrotransfer blot (EITB), and parasite antigen. Results were compared to brain MRI. Participants were categorized as definite neurocysticercosis (MRI and EITB positive), probable neurocysticercosis (MRI or EITB positive), or without neurocysticercosis. Logistic regression models were constructed to explore clinicodemographic associations.

Results: There were 12/205 (6%, 95% CI 2%, 9%) definite and 40/205 (20%, 95% CI 14%, 25%) probable neurocysticercosis cases. 25/205 (12%) with positive EITB did not have neurocysticercosis on MRI, and 15/205 (7%) participants with positive MRI had negative EITB. Participants with neurocysticercosis-suggestive lesions on MRI had an average of 1.2 cysts (parenchymal 26/27; nodular/calcified stage 21/27). In a multivariable analysis, present age (OR 1.05, 95% CI 1.01,1.09, p=0.025) was positively associated with (combined probable or definite) neurocysticercosis while mesial temporal sclerosis on MRI (OR 0.294, 95% CI 0.144, 0.598, p=0.001) was negatively associated.

Conclusions: Neurocysticercosis was associated with 6-25% of epilepsy in a Bhutanese cohort. Combining EITB and MRI would aid the diagnosis of neurocysticercosis among PWE since no test identified all cases.

Keywords: Bhutan; Enzyme-linked immunoelectrotransfer blot; Epilepsy; Magnetic resonance imaging; Neurocysticercosis; Seizure.

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Conflict of interest statement

Conflicts of Interest: None declared

Figures

Figure 1
Figure 1
Schematic of testing
See this image and copyright information in PMC

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