A prospective cohort study to assess the frequency and risk factors for calcification in single lesion parenchymal neurocysticercosis. (December 2020) - Suthar, Renu
Highlights: Calcified neurocysticercosis was previously thought as terminal and a dead end. Presence of calcified NCC lesions predisposes to seizure recurrence. In our cohort, 32.5 % of the parenchymal NCC lesions were calcified at one year follow up. Presence of calcification in SWAN-MRI images and >10 mm size of the lesion at baseline MRI were predictors of calcification. Abstract: Background: Calcified neurocysticercosis (NCC) predisposes patients to an enduring state of epilepsy. The predictors for calcification in parenchymal neurocysticercosis are not well defined. Method: In this prospective cohort study, consecutive children with single-lesion parenchymal NCC were enrolled and followed up for one year. All patients were investigated with brain 3 T-MRI and electroimmunotransfer blot (EITB). Clinical follow-ups were performed every 3 months. Radiology was repeated at the 6-month and one-year follow-ups. The proportion of calcified lesions at one year and the predictors of calcification were studied. Result: During the study period from June 2013 to December 2015, 93 children with single lesion parenchymal NCC were enrolled. At presentation, 90 % of the lesions were in the colloidal stage, and 71 % of the lesions had moderate to severe perilesional oedema. All children had 6 months of follow-up, and 86 (92.5 %) had one year of follow-up. Seizure recurrence was present in 13 (14 %) children. Follow-up radiology at one year showed lesion resolution in 51 (59 %) lesions and calcification in 28 (32.5 %) lesions. Children with calcified lesions during follow-up had a higher odds of seizure recurrences {OR, 95 % CI 3.6(2.3–5.6)}. The presence at baseline of diffusion restriction {OR, 95% CI 2.9 (1.01–8.8)}, scolex or wall calcification in the T2 Star weighted angiography MRI images {OR, 95% CI 3.7 (1.7–8.2)} and >10 mm size of the lesion {OR, 95 % CI 2.4 (1.2–5.01)} predicted lesion calcification. Conclusion: Children with calcification of the parenchymal NCC lesions have a higher risk for seizure recurrence during follow-up. The presence of diffusion restriction, calcified nidus in the colloidal nodular stage, and >10 mm size of the lesion at baseline predicted calcification of the lesion during follow-up.