Surgical treatment for mesial temporal lobe epilepsy in the presence of massive calcified neurocysticercosis.
BACKGROUND
Neurocysticercosis (NCC) is the most common parasitic disease of the human central nervous system and a major health problem for most developing countries. The most common clinical manifestations of NCC are epileptic seizures. Whenever epilepsy and NCC coexist in the same patient, an uncertainty may rise about a causal relationship between them.


METHODS
We described a female patient with disseminated calcified NCC lesions and intractable epilepsy. Her medical history included cysticercotic meningoencephalitis and status epilepticus caused by active NCC. Fundoscopy showed the ocular presence of parasite; computed tomography of the brain showed evidence of cystic lesions with the scolex and calcified lesions; enzyme-linked immunosorbent assay of the cerebrospinal fluid was positive for cysticercosis. Epileptic seizures started after an 8-year silent period. Magnetic resonance imaging showed left hippocampal sclerosis. Plain x-ray film showed calcifications in muscles and subcutaneous tissue. Video-electroencephalography and ictal and interictal single-photon emission computed tomography disclosed left mesial temporal lobe epilepsy. The patient underwent left temporal lobectomy and has been seizure free since surgery, for a follow-up of 4 years.


CONCLUSIONS
This case report highlights and supports surgical therapy in patients with epileptic seizures and calcified NCC, even when there are several calcifications, provided that clear localization of epilepsy has been determined by means of a presurgical workup.
Wichert-Ana
Lauro
L
Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Av. Bandeirantes 3900, Campus Universitário, Monte Alegre, Ribeirão Preto, SpCEP 14.048-900, Brazil. lwichert@rnp.fmrp.usp.br
Velasco
Tonicarlo Rodrigues
TR
Terra-Bustamante
Vera Cristina
VC
Alexandre
Veriano
V
Walz
Roger
R
Bianchin
Marino M
MM
Leite
João Pereira
JP
Assirati
João Alberto
JA
Carlotti
Carlos Gilberto
CG
Araújo
David
D
Santos
Antonio Carlos
AC
Takayanagui
Osvaldo Massaiti
OM
Sakamoto
Américo Ceiki
AC
D000328:Adult; D002114:Calcinosis / Q000150:complications / Q000469:parasitology* / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000209:etiology / Q000469:parasitology* / Q000601:surgery*; D005260:Female; D006801:Humans; D020019:Neurocysticercosis / Q000150:complications / Q000601:surgery*