Journal of Dr. NTR University of Health Sciences

: 2022  |  Volume : 11  |  Issue : 2  |  Page : 159--160

Neuropsychiatric manifestations associated with neurocysticercosis

Jamir P Rissardo, Ana L Fornari Caprara 
 Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil

Correspondence Address:
Dr. Jamir P Rissardo
Av. Roraima, 1000 - Camobi, Santa Maria, RS 97105-900

How to cite this article:
Rissardo JP, Fornari Caprara AL. Neuropsychiatric manifestations associated with neurocysticercosis.J NTR Univ Health Sci 2022;11:159-160

How to cite this URL:
Rissardo JP, Fornari Caprara AL. Neuropsychiatric manifestations associated with neurocysticercosis. J NTR Univ Health Sci [serial online] 2022 [cited 2022 Oct 5 ];11:159-160
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Dear Editor,

We read the article entitled ''Intramedullary cysticercosis'' in the esteemed ''Journal of Dr. NTR University of Health Sciences'' with great interest. Suneeth et al.[1] reported a case of a 28-year-old male presenting with cervicalgia, difficulty in walking, and urinary incontinence. Cervical and spinal magnetic resonance imaging revealed a well-defined peripherally enhancing intramedullary cystic lesion. He had progressive neurological deficits and surgery was performed. The pathological examination demonstrated a cysticercus body cavity.

Neurocysticercosis (NCC) is endemic in most of the developing world due to poor sanitary conditions, poverty, and illiteracy. It is considered the most common human central nervous system helminthic infection. Also, NCC is one of the most common causes of acquired epilepsy in endemic areas. Nevertheless, NCC appears to be a protective factor in the development of drug-resistant epilepsy, when we compare it with other etiologies such as structural epilepsy.[2]

El-Kady et al.[3] reviewed the literature about the possible neuropsychiatric manifestations associated with NCC. They observed that depression/mixed anxiety depression, cognitive dysfunction, dementia, psychosis, personality changes, and visual hallucinations are commonly reported. Apparently, the clinical spectrum of psychiatric disorders may be dependent on the cysts' location and size. We agree with the authors that immigrants from endemic areas presenting with psychiatric symptoms or treatment-resistant depression should be investigated with neuroimaging to exclude NCC as a potential organic etiology.

The association of cysticercosis and CNS infection was extensively described in the early twentieth century by English authors. In 1903, Pereira et al.[4] probably reported the first case of the occurrence of abnormal movements during a tapeworm infection. In a recent review, 148 individuals who developed a movement disorder related to NCC were identified. The abnormal movements reported, in order of frequency, were parkinsonism, ataxia, chorea, dystonia, tremor, myokymia, myoclonus, ballism, and tics. 58.90% of the subjects had a full recovery and two deaths were reported. It is worthy of mentioning that the majority of the individuals were only diagnosed because they had classical clinical manifestations generally investigated by neuroimaging, resulting in incidental findings suggestive of NCC, which were later supported by laboratory examinations.[4]

Bustos et al.[5] assessed the proportion of residual calcification in 220 individuals with parenchymal NCC, and defined risk factors associated with calcification. The predicted factors for calcification were larger cysts with surrounding edema, long-term seizures, mild antibody response, high doses of albendazole, low doses of dexamethasone, and not receiving early antiparasitic re-treatment. The description of these risk factors is important because some of them are modifiable and may be promptly approached to decrease or prevent calcification, potentially decreasing the risk for seizures.

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1Suneeth J, Moorthy NL, Rao GP, Chander DM, Kumar NA. Intramedullary cysticercosis. J NTR Univ Health Sci 2020;9:267-9.
2Rissardo JP, Caprara AL. Toxoplasma gondii, Taenia solium, and adult-onset epilepsy. Menoufia Med J 2021;34:757-8.
3El-Kady AM, Allemailem KS, Almatroudi A, Abler B, Elsayed M. Psychiatric disorders of neurocysticercosis: Narrative review. Neuropsychiatr Dis Treat 2021;17:1599-610.
4Rissardo JP, Caprara AL, Durante Í. Neurocysticercosis and movement disorders: A literature review. Brain Circ 2020;6:225-41.
5Bustos JA, Arroyo G, Gilman RH, Soto-Becerra P, Gonzales I, Saavedra H, et al. Frequency and determinant factors for calcification in neurocysticercosis. Clin Infect Dis 2021;73:e2592-600.