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Lauro Wichert-Ana, MD; Tonicarlo Rodrigues Velasco, MD; Vera Cristina Terra-Bustamante, MD; Veriano Alexandre, Jr, MD; Roger Walz, MD, PhD; Marino M. Bianchin, MD, PhD; João Pereira Leite, MD, PhD; João Alberto Assirati, MD; Carlos Gilberto Carlotti, MD, PhD; David Araújo, MD, PhD; Antonio Carlos Santos, MD, PhD; Osvaldo Massaiti Takayanagui, MD, PhD; Américo Ceiki Sakamoto, MD, PhD

Arch Neurol. 2004;61:1117-1119.

Background  Neurocysticercosis (NCC) is the most common parasitic disease of the human central nervous system and a major health problem for most developing countries. The most common clinical manifestations of NCC are epileptic seizures. Whenever epilepsy and NCC coexist in the same patient, an uncertainty may rise about a causal relationship between them.

Observation  We described a female patient with disseminated calcified NCC lesions and intractable epilepsy. Her medical history included cysticercotic meningoencephalitis and status epilepticus caused by active NCC. Fundoscopy showed the ocular presence of parasite; computed tomography of the brain showed evidence of cystic lesions with the scolex and calcified lesions; enzyme-linked immunosorbent assay of the cerebrospinal fluid was positive for cysticercosis. Epileptic seizures started after an 8-year silent period. Magnetic resonance imaging showed left hippocampal sclerosis. Plain x-ray film showed calcifications in muscles and subcutaneous tissue. Video-electroencephalography and ictal and interictal single-photon emission computed tomography disclosed left mesial temporal lobe epilepsy. The patient underwent left temporal lobectomy and has been seizure free since surgery, for a follow-up of 4 years.

Conclusion  This case report highlights and supports surgical therapy in patients with epileptic seizures and calcified NCC, even when there are several calcifications, provided that clear localization of epilepsy has been determined by means of a presurgical workup.

From the Departments of Neurology, Psychiatry, and Psychology (Drs Wichert-Ana, Velasco, Terra-Bustamante, Alexandre, Walz, Bianchin, Leite, Araújo, Takayanagui, and Sakamoto), Neurosurgery (Drs Assirati and Carlotti), and Radiology (Drs Santos and Araujo), Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil; the Faculdade de Medicina, Centro de Ciências da Saúde, Universidade do Vale do Itajaí, Univali, Itajaí, Brazil (Dr Walz); Centro de Cirurgia de Epilepsia do Hospital Governador Celso Ramos, Florianópolis, Brazil (Dr Walz); and the Departamento de Clinica Médica, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil (Dr Walz). The authors have no relevant financial interest in this article.

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