Neurocysticercosis: An uncommon cause of drug-refractory epilepsy in North Indian population

ObjectiveBeing a common cause of epilepsy in endemic areas, neurocysticercosis (NCC) is expected to account for a sizable proportion of patients with drug-refractory epilepsy (DRE) as well. However, data regarding prevalence of DRE in NCC are sparse. This study aimed to determine the prevalence of DRE as well as identification of clinical and radiologic factors that lead to DRE in patients with NCC. MethodsThis study was conducted in a tertiary-care postgraduate teaching institute in Northern India from July 2011 to July 2013. Two hundred patients with epilepsy due to NCC (definite [n=59, 29.5%] or probable [n=141, 70.5%]) based on diagnostic criteria by Del Brutto etal. were enrolled in the study in both a prospective (n=51 [25.5%]) and a retrospective manner (n=149 [74.5%]), and were followed for a minimum period of 1year. ResultsThirteen patients with NCC were found to be refractory to drug therapy. Prevalence of DRE was found to be 65 of 1,000 NCC patients with epilepsy in the present study. The risk factors associated with high risk of DRE were male sex (p=0.035), older age (p=0.016), pig-raising practices (p=0.003), pork eating (p=0.04), and presence of multiple (>2) (p=0.0001) or mixed stage lesions (p=0.007) on neuroimaging. On multivariate analysis, it was found that residing in an area where pig raising is prevalent (p=0.01) and presence of multiple (>2) (p=0.004) lesions on neuroimaging are associated with increased risk of DRE. SignificanceNCC is only rarely associated with the development of DRE. The common risk factors associated with increased chance of DRE include pig-rearing practices and presence of multiple (>2) lesions on neuroimaging.