Neurocysticercosis as a probable risk factor for hippocampal sclerosis

ABSTRACT Neurocysticercosis is one of the most common risk factors for epilepsy but its association with drug-resistant epilepsy remains uncertain. Conjectures of an association with drug-resistant epilepsy have been fueled by reports of an association between calcific neurocysticercosis lesions (CNL) and hippocampal sclerosis (HS) from specialized epilepsy centers in Taenia solium-endemic regions. The debate arising from these reports is whether the association is causal. Evidence for the association is not high quality but sufficiently persuasive to merit further investigation with longitudinal imaging studies in population-based samples from geographically-diverse regions. The other controversial point is the choice of a surgical approach for drug-resistant epilepsy associated with CNL-HS. Three approaches have been described: standard anteromesial temporal lobectomy, lesionectomy involving a CNL alone and lesionectomy with anteromesial temporal lobectomy (for dual pathology); reports of the latter two approaches are limited. Presurgical evaluation should consider possibilities of delineating the epileptogenic zone/s in accordance with all three approaches.

摘要：脑囊尾蚴病（Neurocysticercosis）是癫痫最常见的危险因素之一，但其与耐药性癫痫的关联仍不明确。有观点认为脑囊尾蚴病与耐药性癫痫存在关联，该推测因猪带绦虫流行区域的专科癫痫中心报道了钙化性脑囊尾蚴病灶（CNL）与海马硬化（HS）之间的关联而得到强化。此类报道引发的争议焦点在于，二者的关联是否具有因果性。目前支持该关联的证据质量欠佳，但已具备足够的说服力，值得在地理分布多元的人群样本中开展纵向影像学研究以深入探究。另一项颇具争议的议题是，针对合并CNL-HS的耐药性癫痫患者，应如何选择手术入路。目前已报道的手术入路共有三种：标准前内侧颞叶切除术、仅针对CNL的病灶切除术，以及联合前内侧颞叶切除术的病灶切除术（适用于双重病理病例）；而后两种术式的相关报道较为有限。术前评估需考虑依据上述三种术式分别明确致痫区（epileptogenic zone）的可能性。