title: New diagnostic criteria for neurocysticercosis: Reliability and validity.
abstract: OBJECTIVE
  The diagnosis of neurocysticercosis (NCC) remains problematic because of the heterogeneity of its clinical, immunological, and imaging characteristics. Our aim was to develop and assess a new set of diagnostic criteria for NCC, which might allow for the accurate detection of, and differentiation between, parenchymal and extraparenchymal disease.
  
  
  METHODS
  A group of Latin American NCC experts developed by consensus a new set of diagnostic criteria for NCC. A multicenter, retrospective study was then conducted to validate it. The reference standard for diagnosis of active NCC was the disappearance or reduction of cysts after anthelmintic treatment. In total, three pairs of independent neurologists blinded to the diagnosis evaluated 93 cases (with NCC) and 93 controls (without NCC) using the new diagnostic criteria. Mixed-effects logistic regression models were used to estimate sensitivity and specificity.
  
  
  RESULTS
  Inter-rater reliability (kappa) of diagnosis among evaluators was 0.60. For diagnosis of NCC versus no NCC, the new criteria had a sensitivity of 93.2% and specificity of 81.4%. For parenchymal NCC, the new criteria had a sensitivity of 89.8% and specificity of 80.7% and for extraparenchymal NCC, the new criteria had a sensitivity of 65.9% and specificity of 94.9%.
  
  
  CONCLUSIONS
  These criteria have acceptable reliability and validity and could be a new tool for clinicians and researchers. An advantage of the new criteria is that they consider parasite location (ie, parenchymal or extraparenchymal), which is an important factor determining the clinical, immunological, and radiological presentation of the disease, and importantly, its treatment and prognosis. Ann Neurol 2016;80:434-442.
authors.affiliation: Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca, Ecuador. afleury@biomedicas.unam.mx.|G.H. Sergievsky Center, Columbia University, New York, NY. afleury@biomedicas.unam.mx.
authors.forename: Arturo
authors.identifier: http://orcid.org/0000-0002-5821-6379
authors.initials: A
authors.lastname: Carpio
authors.affiliation: Instituto Nacional de Neurología y Neurocirugía, Secretaría de Salud, México, DF, México.|Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma, México, DF, México.
authors.forename: Agnès
authors.initials: A
authors.lastname: Fleury
authors.affiliation: Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca, Ecuador.|CUNY Graduate School of Public Health and Health Policy, New York, NY.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Romo
authors.affiliation: Universidade de Taubaté, São Paulo, SP, Brazil.
authors.forename: Ronaldo
authors.initials: R
authors.lastname: Abraham
authors.affiliation: Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas, FIRE, Cartagena, Colombia.
authors.forename: Jaime
authors.initials: J
authors.lastname: Fandiño
authors.affiliation: Hospital de Clínicas, Unidad de Neurología, La Paz, Bolivia.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Durán
authors.affiliation: Instituto Nacional de Neurología y Neurocirugía, Secretaría de Salud, México, DF, México.
authors.forename: Graciela
authors.initials: G
authors.lastname: Cárdenas
authors.affiliation: Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador.
authors.forename: Jorge
authors.initials: J
authors.lastname: Moncayo
authors.affiliation: Hospital Geral, Fortaleza, CE, Brazil.
authors.forename: Cleonísio
authors.initials: C
authors.lastname: Leite Rodrigues
authors.affiliation: Instituto Nacional de Neurología y Neurocirugía, Secretaría de Salud, México, DF, México.
authors.forename: Daniel
authors.initials: D
authors.lastname: San-Juan
authors.affiliation: Facultad de Medicina de la Pontificia Universidad Católica del Ecuador, Servicio de Neurología del Hospital Carlos Andrade Marin del Instituto Ecuatoriano de Seguridad Social (IESS), Quito, Ecuador.
authors.forename: Marcos
authors.initials: M
authors.lastname: Serrano-Dueñas
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Takayanagui
authors.affiliation: NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, United Kingdom.|Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
authors.forename: Josemir W
authors.identifier: http://orcid.org/0000-0001-6041-9661
authors.initials: JW
authors.lastname: Sander
mesh_terms: D000328:Adult; D032921:Consensus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020019:Neurocysticercosis / Q000175:diagnosis*; D017410:Practice Guidelines as Topic / Q000592:standards*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity