Convulsive status epilepticus due to different evolutionary stages of neurocysticercosis - solitary cyticercus granuloma, low cyst load, and single calcific lesion in an endemic country: Clinical profile

Highlights

• Convulsive SE is extremely uncommon in NCC with low lesion burden.

• CSE due to NCC (low lesion load) responds well with first line medication.

• CSE due to NCC (low lesion load) is associated with excellent outcome.

Abstract

Purpose

The aims of the study were: (a) to evaluate the clinical profile of convulsive status epilepticus (CSE) due to different evolutionary stages of neurocysticercosis (NCC), solitary cysticercus granuloma, low cyst load and single calcific lesion in an endemic country; (b) to evaluate the response of CSE to antiepileptic drugs; and (c) to evaluate long-term outcomes

Methods

A retrospective review of case records of patients with CSE due to different evaluative stages of NCC seen over a period of 18 years.

Results

During 18 years period, 41 (24 males, mean age 25.3 years, range 8–65 years) patients with CSE due to different evolutionary stages of NCC were admitted to our Neurological Intensive Care Unit. There were 7 patients with 3–5 degenerative cyst load, 20 with solitary cysticercus granuloma (SCG), and 14 with single calcific (cNCC) lesion. Of the 41 patients, CSE was the initial presenting feature in 38 (93%) patients. The mean duration of CSE was 5.85 h (range 0.5–48 h). The mean duration of CSE due to single cNCC was significantly shorter when compared to the duration of CSE due to degenerative stages of NCC (1.96 + 1.39 h vs. 7.87+13.18; p < 0.026). Of the 41 patients, 39 (95%) responded to first-line treatment (intravenous (IV) benzodiazepine followed by IV phenytoin/ fosphenytoin or valproate), two patients required continuous IV midazolam. Both the patients developed aspiration pneumonia. There were no deaths, and all the 41 patients had Glasgow Outcome Score of 5 at 90-day follow-up and were back to their previous occupation.

Conclusions

This study suggests that CSE due to different evolutionary stages of NCC, SCG, low lesional load, and single calcific lesion is rare even in countries endemic to NCC and is associated with an excellent outcome.