Neurocysticercosis in Non-Endemic Areas: The Experience in Qatar
Areej Nauman1, Farah Wahbeh1, Yanal Shaheen1, Mohammed Abunaib2, Gayane Melikyan2, Boulenouar Mesraoua2, Dirk Deleu2, Hassan Jassim Al Hail3, Ahmed El Sotouhy2, Ziyad Mahfoud1, Naim Haddad1
1Weill Cornell Medicine-Qatar, 2Hamad Medical Corporation, 3HMC
Objective:

To characterize Neurocysticercosis (NCC) in Qatar with a large database of a multiethnic population.

Background:
Qatar is a nation in the Gulf region of the Middle East with a predominantly immigrant population, making it a unique area of study for the epidemiology of NCC. Historically, NCC is not endemic in the region.
Design/Methods:

We retrospectively studied instances of NCC (n=420) recorded in Qatar from 2013-2018 through the national healthcare system. We analyzed the data and stratified it based on several variables such as symptoms, treatment, and outcome, as well as radiological features. 

Results:

Out of the 420 patients, 93.6% were men, and 98.3% were immigrants from NCC endemic countries such as Nepal (63.8%) and India (29.5%). Eighty percent of patients presented with seizures, with the majority (69%) experiencing generalized tonic-clonic seizures. Five percent presented with status epilepticus. Headaches, the second most common complaint, were reported in 18% of subjects. On imaging, 50% had a single lesion while 63% were at the calcified stage. The lesions were parenchymal in 99.5% of cases, predominantly in the frontal lobe (59%). Thirteen percent were diagnosed incidentally on imaging, mainly in the form of isolated calcified non-enhancing lesions. Phenytoin was the most prescribed anti-seizure drug (57%), and albendazole was received by 55% of patients. When follow up information was available, clinical improvement was noted in 81% of patients.

Conclusions:

NCC is prevalent in Qatar and remains confined to the large proportion of Southeast Asian immigrants within the population. Given this, dissemination most likely occurred in their countries of origin where NCC is endemic. NCC is a significant contributor to the epilepsy burden in Qatar, often with a good outcome regarding seizure control. NCC with an intraparenchymal single lesion seems to be overrepresented in our cohort.

10.1212/WNL.0000000000201987