title: Neurocysticercosis in Bhutan: a cross-sectional study in people with epilepsy.
abstract: We sought to provide an assessment of the burden of neurocysticercosis among people with epilepsy (PWE) in Bhutan and evaluate the yield of various tests for Taenia solium.
  
  
  
  PWE were enrolled at the National Referral Hospital in Thimphu (2014-2015). Serum was tested for anti-Taenia solium IgG using ELISA (Ab-ELISA), enzyme-linked immunoelectrotransfer blot (EITB), and parasite antigen. Results were compared to brain MRI. Participants were categorized as definite neurocysticercosis (MRI and EITB positive), probable neurocysticercosis (MRI or EITB positive), or without neurocysticercosis. Logistic regression models were constructed to explore clinicodemographic associations.
  
  
  
  There were 12/205 (6%, 95% CI 2%, 9%) definite and 40/205 (20%, 95% CI 14%, 25%) probable neurocysticercosis cases. 25/205 (12%) with positive EITB did not have neurocysticercosis on MRI, and 15/205 (7%) participants with positive MRI had negative EITB. Participants with neurocysticercosis-suggestive lesions on MRI had an average of 1.2 cysts (parenchymal 26/27; nodular/calcified stage 21/27). In a multivariable analysis, present age (OR 1.05, 95% CI 1.01,1.09, p=0.025) was positively associated with (combined probable or definite) neurocysticercosis while mesial temporal sclerosis on MRI (OR 0.294, 95% CI 0.144, 0.598, p=0.001) was negatively associated.
  
  
  
  Neurocysticercosis was associated with 6-25% of epilepsy in a Bhutanese cohort. Combining EITB and MRI would aid the diagnosis of neurocysticercosis among PWE since no test identified all cases.
authors: Massachusetts General Hospital, Boston, MA, USA.
authors: Kate
authors: K
authors: Brizzi
authors: Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Bhutan.
authors: Sonam
authors: S
authors: Pelden
authors: Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Bhutan.
authors: Tshokey
authors: T
authors: Tshokey
authors: Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Bhutan.
authors: Damber K
authors: DK
authors: Nirola
authors: Massachusetts General Hospital, Boston, MA, USA.
authors: Megan B
authors: MB
authors: Diamond
authors: Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors: Joshua P
authors: JP
authors: Klein
authors: Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Bhutan.
authors: Lhab
authors: L
authors: Tshering
authors: Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Bhutan.
authors: Sonam
authors: S
authors: Deki
authors: Department of Radiology, Jigme Dorji Wangchuck National Referral Hospital, Bhutan.
authors: Dechen
authors: D
authors: Nidup
authors: Massachusetts General Hospital, Boston, MA, USA.
authors: Veronica
authors: V
authors: Bruno
authors: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors: Pierre
authors: P
authors: Dorny
authors: Cysticercosis Unit, Instituto de Ciencias Neurologicas, Department of Microbiology, Universidad Peruana Cayetan Heredia, Lima, Peru.
authors: Hector Hugo
authors: HH
authors: Garcia
authors: Massachusetts General Hospital, Boston, MA, USA fmateen@partners.org.|Harvard Medical School, Boston, MA, USA.
authors: Farrah J
authors: FJ
authors: Mateen
mesh_terms: D000328:Adult; D000818:Animals; D000909:Antibodies, Helminth / Q000097:blood; D000947:Antigens, Helminth / Q000097:blood; D001631:Bhutan / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis / Q000209:etiology / Q000469:parasitology*; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015151:Immunoblotting / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D020019:Neurocysticercosis / Q000175:diagnosis* / Q000453:epidemiology / Q000469:parasitology*; D059906:Neuroimaging; D009790:Occupations; D012680:Sensitivity and Specificity; D041201:Taenia solium / Q000302:isolation & purification
chemical_list: D000909:Antibodies, Helminth; D000947:Antigens, Helminth
keywords: Bhutan; Enzyme-linked immunoelectrotransfer blot; Epilepsy; Magnetic resonance imaging; Neurocysticercosis; Seizure