Clinical and neuroimaging predictors of seizure recurrence in solitary calcified neurocysticercosis: A prospective observational study

- Calcified neurocysticercosis is a major cause of seizures in India.
- In our study, approximately 24% of patients developed seizure recurrence despite of therapy.
- Presence of perilesional edema may be a predictor of seizure recurrence in these patients.

BackgroundSolitary calcified neurocysticercosis is a common cause of seizures in the developing countries. Factors responsible for seizure recurrence in patients with solitary calcified neurocysticercosis are not known. We evaluated the clinical, neuroimaging and biochemical predictors of seizure recurrence.MethodsThis was a prospective observational study. Patients with new-onset seizures and a solitary calcified neurocysticercosis were included. Patients were evaluated clinically; baseline electroencephalography and magnetic resonance imaging of brain were done for all patients.. The patients were followed for 1 year. Seizure recurrence was defined as the recurrence of an episode of seizure at least 1 week after the initiation of the anti-epileptic drugs.ResultsFifty-four patients with a mean age of 20.43 ± 7.34 years were included. Thirteen patients developed seizure recurrence during the follow-up period. On univariate analysis, status epilepticus at presentation (p = 0.025), size of the lesion >10 mm (p = 0.015), presence of perilesional edema (p < 0.001) and scolex (p = 0.033) were significantly associated with seizure recurrence. On multivariate analysis, only presence of perilesional edema (p = 0.018, odds ratio = 12.122, 95% confidence interval 1.521-96.639) was an independent predictor of seizure recurrence.ConclusionStatus epilepticus at presentation is associated with an increased risk of seizure recurrence. Neuroimaging features like presence of perilesional edema and scolex can similarly predict seizure recurrence. These neuroimaging features can serve as potential surrogate markers to define therapy in these patients. The findings of our study might be helpful in stratifying patients with a higher risk of seizure recurrence, especially those who may require a more aggressive management.