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On the relationship between calcified neurocysticercosis and epilepsy in an endemic village: A large‐scale, computed tomography–based population study in rural Ecuador
Author(s) -
Del Brutto Oscar H.,
Arroyo Gianfranco,
Del Brutto Victor J.,
Zambrano Mauricio,
García Héctor H.
Publication year - 2017
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13892
Subject(s) - neurocysticercosis , medicine , epilepsy , logistic regression , confidence interval , population , epidemiology , cysticercosis , pediatrics , pathology , psychiatry , environmental health
Summary Objective Using a large‐scale population‐based study, we aimed to assess prevalence and patterns of presentation of neurocysticercosis ( NCC ) and its relationship with epilepsy in community‐dwellers aged ≥20 years living in Atahualpa (rural Ecuador). Methods In a three‐phase epidemiological study, individuals with suspected seizures were identified during a door‐to‐door survey and an interview (phase I). Then, neurologists evaluated suspected cases and randomly selected negative persons to estimate epilepsy prevalence (phase II). In phase III, all participants were offered noncontrast computed tomography ( CT ) for identifying NCC cases. The independent association between NCC (exposure) and epilepsy (outcome) was assessed by the use of multivariate logistic regression models adjusted for age, sex, level of education, and alcohol intake. CT findings were subsequently compared to archived brain magnetic resonance imaging in a sizable subgroup of participants. Results Of 1,604 villagers aged ≥20 years, 1,462 (91%) were enrolled. Forty‐one persons with epilepsy ( PWE ) were identified, for a crude prevalence of epilepsy of 28 per 1,000 population (95% confidence interval [CI] = 20.7–38.2). A head CT was performed in 1,228 (84%) of 1,462 participants, including 39 of 41 PWE . CT showed lesions consistent with calcified parenchymal brain cysticerci in 118 (9.6%) cases (95% CI = 8.1–11.4%). No patient had other forms of NCC . Nine of 39 PWE , as opposed to 109 of 1,189 participants without epilepsy, had NCC (23.1% vs. 9.2%, p = 0.004). This difference persisted in the adjusted logistic regression model (odds ratio = 3.04, 95% CI = 1.35–6.81, p = 0.007). Significance This large CT ‐based study demonstrates that PWE had three times the odds of having NCC than those without epilepsy, providing robust epidemiological evidence favoring the relationship between NCC and epilepsy.