Cognitive and Surgical Outcome in Mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis Plus Neurocysticercosis: A Cohort Study

Bianchin MM, Velasco TR, Coimbra ER, Gargaro AC, Escorsi-Rosset SR, Wichert-Ana L, Terra VC, Alexandre V, J, Araujo D, J, dos Santos AC, Fernandes RMF, et al. (2013)
Plos One 8(4): e60949.

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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. Findings: 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). Interpretation: 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.
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Bianchin MM, Velasco TR, Coimbra ER, et al. Cognitive and Surgical Outcome in Mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis Plus Neurocysticercosis: A Cohort Study. Plos One. 2013;8(4):e60949.
Bianchin, M. M., Velasco, T. R., Coimbra, E. R., Gargaro, A. C., Escorsi-Rosset, S. R., Wichert-Ana, L., Terra, V. C., et al. (2013). Cognitive and Surgical Outcome in Mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis Plus Neurocysticercosis: A Cohort Study. Plos One, 8(4), e60949. doi:10.1371/journal.pone.0060949
Bianchin, M. M., Velasco, T. R., Coimbra, E. R., Gargaro, A. C., Escorsi-Rosset, S. R., Wichert-Ana, L., Terra, V. C., Alexandre, V. , J., Araujo, D. , J., dos Santos, A. C., et al. (2013). Cognitive and Surgical Outcome in Mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis Plus Neurocysticercosis: A Cohort Study. Plos One 8, e60949.
Bianchin, M.M., et al., 2013. Cognitive and Surgical Outcome in Mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis Plus Neurocysticercosis: A Cohort Study. Plos One, 8(4), p e60949.
M.M. Bianchin, et al., “Cognitive and Surgical Outcome in Mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis Plus Neurocysticercosis: A Cohort Study”, Plos One, vol. 8, 2013, pp. e60949.
Bianchin, M.M., Velasco, T.R., Coimbra, E.R., Gargaro, A.C., Escorsi-Rosset, S.R., Wichert-Ana, L., Terra, V.C., Alexandre, V., J., Araujo, D., J., dos Santos, A.C., Fernandes, R.M.F., Assirati, J.A., J., Carlotti, C.G., J., Leite, J.P., Takayanagui, O.M., Markowitsch, H.J., Sakamoto, A.C.: Cognitive and Surgical Outcome in Mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis Plus Neurocysticercosis: A Cohort Study. Plos One. 8, e60949 (2013).
Bianchin, Marino M., Velasco, Tonicarlo R., Coimbra, Erica R., Gargaro, Ana C., Escorsi-Rosset, Sara R., Wichert-Ana, Lauro, Terra, Vera C., Alexandre, Veriano, Jr., Araujo, David, Jr., dos Santos, Antonio Carlos, Fernandes, Regina M. F., Assirati, Joao A., Jr., Carlotti, Carlos G., Jr., Leite, Joao P., Takayanagui, Osvaldo M., Markowitsch, Hans J., and Sakamoto, Americo C. “Cognitive and Surgical Outcome in Mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis Plus Neurocysticercosis: A Cohort Study”. Plos One 8.4 (2013): e60949.
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