EEG and Seizure Characteristics of Adults with Neurocysticercosis-associated Epilepsy at the University Teaching Hospital in Lusaka, Zambia
Melody Asukile1, Mashina Chomba2, Mulenga Chilando1, Frighton Mutete1, Chimuka Muleya2, Theresa Shankanga2, Diwell Mwansa2, Ndonji Chiwaya2, Deanna Saylor3
1University Teaching Hospital, 2University of Zambia, 3Johns Hopkins Hospital
Objective:
To describe the electroclinical features of Neurocysticercosis-associated epilepsy and identify seizure severity predictors.
Background:
Neurocysticercosis (NCC), caused by the parasite taenia solium, is a neglected tropical disease and a leading cause of focal epilepsy in sub-Saharan Africa. Biomarkers to guide treatment and diagnosis of NCC-associated epilepsy are sparse.
Design/Methods:
A cross-sectional study of adults with NCC at UTH in Lusaka, Zambia was conducted. Data collected between December 2021 and March 2023 were analyzed.
Results:
Of 73 participants, 57 (78%) were male with mean age of 39.5+13.6 years. Most were either unemployed 22/66 (33%) or self/informally employed 30/66 (45%), and 22.6% (12/63) were people living with HIV. Clinical presentations comprised seizures (88.9%, 56/63), headache (12.7%, 8/63), cranial neuropathy (3.2%, 2/63) and incidental findings on CT head (3.2, 2/63). Of those with seizures (n=53), majority reportedly had either generalized (45.3%) or focal unaware seizures (45.3%). EEG was abnormal in 33% (21/63), of which 57.1% (12/21) showed focal abnormalities, and 41.7% (5/12) were epileptiform, with 11/21 (52.4%) being in those without seizures. Of 60 participants with neuroimaging, 44 (73.3%) had <10 lesions, 9 (15%) had 10-20 and 7 (11.7%) had >20. Stages of NCC lesions were 51.7% (31/60) vesicular, 41.2% (25/60) colloidal, 15% (9/60) granular nodular, 31.2% (19/60) calcified. Multiple stages were present in 38.3% (23/60). Mean Liverpool Seizure Severity Score was 56.5+8.8 (possible range, 20-80). Higher lesion number was not associated with abnormal EEG (p=0.42) nor higher seizure severity score (p=0.84). No association was found between NCC stage and presence of an abnormal EEG (p>0.05).
Conclusions:
Disabling seizures were the commonest presentation of NCC. EEG and brain imaging findings were not predictive of seizure severity. Further investigation is needed into the association between NCC and abnormal EEG even in those without seizures, and the causes for male preponderance of NCC.