title: Cognitive and surgical outcome in mesial temporal lobe epilepsy associated with hippocampal sclerosis plus neurocysticercosis: a cohort study.
abstract: BACKGROUND
  Where neurocysticercosis (NCC) is endemic, chronic calcified neurocysticercosis (cNCC) can be observed in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS). Considering that both disorders cause recurrent seizures or cognitive impairment, we evaluated if temporal lobectomy is cognitively safe and effective for seizure control in MTLE-HS plus cNCC.
  
  
  METHODS
  Retrospective cohort study of neuropsychological profile and surgical outcome of 324 MTLE-HS patients submitted to temporal lobectomy, comparing the results according to the presence or absence of cNCC.
  
  
  RESULTS
  cNCC occurred in 126 (38.9%) of our MTLE-HS patients, a frequency higher than expected, more frequently in women than in men (O.R. = 1.66; 95% C.I. = 1.05-2.61; p = 0.03). Left-side (but not right side) surgery caused impairment in selected neuropsychological tests, but this impairment was not accentuated by the presence of cNCC. Ninety-four (74.6%) patients with MTLE-HS plus cNCC and 153 patients (77.3%) with MTLE-HS alone were Engel class I after surgery (O.R. = 1.16; 95% C.I. = 0.69-1.95; p = 0.58). However, the chances of Engel class IA were significantly lower in MTLE-HS plus cNCC than in patients with MTLE-HS alone (31.7% versus 48.5%; O.R. = 2.02; 95% C.I. = 1.27-3.23; p = 0.003). Patients with MTLE-HS plus cNCC showed higher rates of Engel class ID (15.1% versus 6.6%; O.R. = 2.50; 95% C.I. = 1.20-5.32; p = 0.012).
  
  
  CONCLUSIONS
  cNCC can be highly prevalent among MTLE-HS patients living in areas where neurocysticercosis is endemic, suggesting a cause-effect relationship between the two diseases. cNCC does not add further risk for cognitive decline after surgery in MTLE-HS patients. The rates of Engel class I outcome were very similar for the two groups; however, MTLE-HS plus cNCC patients achieved Engel IA status less frequently, and Engel ID status more frequently. Temporal lobectomy can be safely performed in most patients with MTLE-HS plus cNCC without affecting cognitive outcome. Long-term surgical seizure control in MTLE-HS plus cNCC is still satisfactory, as long as selected patients remain under medication.
authors.affiliation: Center for Epilepsy Surgery (CIREP), Hospital das Clínicas de Ribeirão Preto, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. mmbianchin@hotmail.com
authors.forename: Marino M
authors.initials: MM
authors.lastname: Bianchin
authors.forename: Tonicarlo R
authors.initials: TR
authors.lastname: Velasco
authors.forename: Erica R
authors.initials: ER
authors.lastname: Coimbra
authors.forename: Ana C
authors.initials: AC
authors.lastname: Gargaro
authors.forename: Sara R
authors.initials: SR
authors.lastname: Escorsi-Rosset
authors.forename: Lauro
authors.initials: L
authors.lastname: Wichert-Ana
authors.forename: Vera C
authors.initials: VC
authors.lastname: Terra
authors.forename: Veriano
authors.initials: V
authors.lastname: Alexandre
authors.forename: David
authors.initials: D
authors.lastname: Araujo
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: dos Santos
authors.forename: Regina M F
authors.initials: RM
authors.lastname: Fernandes
authors.forename: João A
authors.initials: JA
authors.lastname: Assirati
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Carlotti
authors.forename: João P
authors.initials: JP
authors.lastname: Leite
authors.forename: Osvaldo M
authors.initials: OM
authors.lastname: Takayanagui
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Markowitsch
authors.forename: Américo C
authors.initials: AC
authors.lastname: Sakamoto
mesh_terms: D000328:Adult; D002648:Child; D003071:Cognition; D015331:Cohort Studies; D003657:Decision Making; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008297:Male; D020019:Neurocysticercosis / Q000150:complications*; D012598:Sclerosis / Q000150:complications; D016896:Treatment Outcome