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“CLINICAL PROFILE OF CHILDHOOD NEURO CYSTICERCOSIS”

 By

Dr. P.Yashodhara M.D

Asst. Professor of Pediatrics

Guntur Medical College,Guntur

 

Dr. M. ANIL MOHAN M.D. DCH

PROFESSOR OF PEDIATRICS
GOVERNMENT GENERAL HOSPITAL
GUNTUR
Dr. H. S. V. S. SASTRY MD. DCH.
PROFESSOR AND HEAD OF THE DEPARTMENT OF PEDIATRICS
GOVERNMENT GENERAL HOSPITAL
GUNTUR
                                 &
Dr. V. RAMATARAKNATH M.D. DM.
PROFESSOR OF NEUROLOGY
GOVERNMENT GENERAL HOSPITAL
GUNTUR

 

MATERIAL AND METHODS
 

CHILDREN WITH UNPROVOKED SEIZURES 1 TO 12 YEARS ATTENDED  DEPT. OF PED.  GGH  GUNTUR FROM  SEPT, 2000 TO AUG ,2001.

 

HISTORY AND CLINICAL EXAMINATION

- 

ROUTINE INVESTIGATION

-
- 

C. T. SCAN BRAIN   PLAIN / CONTRAST

-
(HYPODENSE ,   RING ENHANCING , DISC ENHANCING)

 

 

OBSERVATIONS

•TOTAL NUMBER OF O. P. CASES – 54066

•

* TOTAL No. OF CASES ADMITTED  FROM      SEPTEMBER 2000  TO AUGUST  2001 – 3093 ( 1%)

* TOTAL NO. OF CASES ADMITTED WITH SEIZURES – 148

 * NO. OF CASES PROVED TO BE NCC – 31

 

 

RESULTS

 

AGE DISTRIBUTION :

Age in Years 1 2 3 4 5 6 7 8 9 10 11 12
No.of Cases 0 0 4 3 2 0 1 2 3 5 4 7
•NO. OF CASES     < 5 YRS           =      9   =   29.03%
•
         > 5 YEARS     =    22   =   70.97%
•
•MAXIMUM NO. OF CASES  SEEN  AROUND
 12 YEARS AGE GROUP
 

SEX DISTRIBUTION

M 17 54.80%
F 14 45.25%

 

Rural Vs Urban Incidence :-
RURAL 29 93.60%
URBAN 2 6.50%
 

SOCIO ECONOMIC GROUPS:

LOW 29 93.60%
MIDDLE 1 3.20%
HIGH 1 3.20%
 

FOOD HABITS

VEG. 16 51.60%
NON.VEG 15 48.40%

 

 

 

CLINICAL PRESENTATIONS

 

 

1.SEIZURES

CPS 14 45.20%
SPS 10 32.30%
GS 7 22.60%
2. HEADACHE: 11(35.5%)
3.VOMITINGS : 8 CASES (25.8%)
4.FEVER : 4 CASES (12.9%)
5.PYRAMIDAL TRACT SIGNS : 2 CASES (6.5%)
6.CRANIAL NERVE INVOLVEMENT : UMN    TYPE OF FACIAL WEAKNESS - 1 (3.2%)
 
7.PAPILLOEDEMA : EARLY PAPILLOEDEMA 
    – 1 (3.2%)
8.CEREBELLAR SIGNS
      NOT SEEN
9.HYDROCEPHALUS
10.LATERALISATION
RT 11/21 52.40%
LT 10/21 47.60%
C. T. CHARACTERS RAISED   ICT
SOLITARY 21/31 67.70% 7/21 33.30%
MULTIPLE 10/31 32.30% 6/10 60%

 

HYPODENSE 2/21 19.50%
RING ENHANCING 12/21 57.10%
  DISC ENHANCING 7/21 33.30%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SITE OF LESION Vs TYPE OF SEIZURES

LOBE EFFECTED INC % TYPE OF SEIZURES INC. %
PARIETAL LOBE 14/31 45.20% SPS 8/14 57.10%
      CPS 5/14 35.70%
      GS 1/14 7.10%
FRONTO PARIETAL 4/31 12.90% SPS 1/14 25%
      CPS 2/4 50%
      GS 1/4 25%
FRONTAL 3/31 9.70% SPS 0 0
      CPS 2/3 66.60%
      GS 1/3 33.30%
MULTIPLE 10/31 32.30% SPS 1/10 10%
      CPS 5/10 50%
      GS 4/10 40%

 

 

 

DISCUSSION

 

* IN OUR INSTITUTE

    1% OF TOTAL ADM. IN 1 YEAR       –   NCC
     *  COMMON IN RURAL – 29 (93.6)
[URBAN – 2 (6.5%)]
      * COMMON IN LOW SOCIOECONOMIC – 29 (93.6)
     [ MIDDLE – 1 (3.2%) & HIGH –1 (3.2%)]
     * VEG   16 (51.6%)
NON.VEG   15 (48.4%)
     * AGE :
> 5 YEARS    22 (70.97 %)
< 5 YEARS 9  (29.03%)

 

 

COMPARITIVE STUDY OF NCC IN RESPECT TO

CLINICAL AND C.T
CHARACTERS PRESENT STUDY PURI ET AL
  NO % NO %
TOTALCASES 31 100 27 100
M 17 54.8 13 48.10%
F 14 45.20% 14 51.90%
SEIZURES 31 100.00% 21 77.70%
CPS 14 45.20% - -
SPS 10 32.30% - -
GS 7 22.60% - -
FEATURES OF INCREASED ICP 13 49.90% 15 55.5
PYRAMIDAL SIGNS 2 6.50% 7 25.9
SIGNS OF MENINGEAL IRRITATION 0 - RF 14.8
SOLITARY 21 67.70% 2 7.4
MULTIPLE 10 32.30% 25 92.6
HYDROCEPHALUS     5 18.5
* PARENCHYMAL LESIONS ARE COMMON (KALRA VEENA  ASIAN JOURNAL OF PEAD. JULY – SEPT 97)
 

Clinical Profile:

  * SEIZURES – PARTIAL  - COMMON
   (PURI ET AL NOV 91 I. P.)
* PARTIAL SEIZURES  - SOLITARY
  
* MULTIPLE LESIONS  -  GS (Or) CPS  WITH SEC. GEN.  
* ­ICP  -  MULTIPLE LESIONS WITH EXTENSIVE
   PERIFOCAL EDEMA (6/10) (60%)
   (CORRELATED WITH PURI ET AL)
 

 

C.T.FINDINGS

•SINGLE LESIONS 21 (67.7%) -  COMMONEST   (CORRELATED  WITH STUDY OF  KALRA SETHI - 92)         
* COMMON SITE  -  PARIETAL LOBE 14 (45.2%)
* FOLLOWED BY FRONTO PARIETAL – 4 (12.9%)
* PARIETAL LOBE LESIONS – SPS COMMON      8/1(57.1%) 
* FRONTOPARIETAL LESIONS - CPS COMMON.          AND  FRONTAL
* MULTIPLE LESIONS – GS (OR) CPS COMMON

 

* LATERALISATION     (PURI ET AL)
     RT SIDE LESIONS –    11  
     LT  SIDE  -- 10  
SUPPORTIVE DIAGNOSIS BY
* STOOL MICROSCOPY – ADULT WORMS
PROGLATTIDS.
                                                                 
*   BIOPSY AND HPE OF THE TISSUE
  *  ELISA USING IgG or IgM - Not available in            our institute 
 

 

TREATMENT

•TREATMENT OF SEIZURES IS RECOMMENDED FOR AT LEAST 12-18 MONTHS PERIOD WITH SINGLE  A E D PHENYTOIN OR CARBAMAZEPINE IS THE CHOICE.
      *  OUR RECENT OBSERVATIONS
  SHORTER COURSE OF A E D FOR 6 MONTHS
     *  ­ICP WITH STEROIDS FOR 1 WEEK
   ALBENDAZOLE – 15 mg/Kg FOR 2-3 WKS
        ( BUT CRUZ et al OBSERVED 8 DAY COURSE
             OF AIBENDAZOLE IS EFFECTIVE)
 

SUMMARY

1.THE INCIDENCE OF NCC
< 5YRS IS LOW   – 9 (29.03%)
      >5 YRS IS HIGH  – 22 (70.9%)
2. THERE IS NO SEX PREDILECTION .
3. THE INC. IS HIGH IN LOW SOCIOECONOMIC
GROUPS AND IN RURAL AREAS
4. BOTH VEG/NON-VEG ARE EQUALLY AFFECTED
5. SEIZURE TYPES  – PARTIAL -- COMMON
    SOLITARY  - SPS – COMMON
    MULTIPLE – CPS OR GS – COMMON
6. ­ ICP -- COMMON -- MULTIPLE
 
7.COMMONEST SITE – PARIETAL LOBE
    FOLLOWED BY FRONTO PARIETAL REGION
8.PARIETAL LOBE LESIONS –  SPS
   FRONTO PARIETAL AND FRONTAL --  CPS
        
9.NEUROLOGICAL SIGNS :   LESS COMMON
10. THOUGH SEROLOGICAL TESTS & HPE
     ARE IMPORTANT IN DIAGNOSIS OF NCC, BUT
     THEIR NON-AVAILABILITY AND COST,
     C. T. PLAYS AN IMP. ROLE IN DIAGNOSIS
     OF NCC
11.THE OUTLOOK IS VERY GOOD     BECAUSE OF IMPROVED NEUROIMAGING AND
    THERAPAUTIC MODALITIES
12. NO SEQUELAE WERE LEFT IN ALL NCC
      CASES AFTER TREATING WITH  STEROIDS ,  ALBENDAZOLE FOR 2-3 WEEKS  AND  A E D  FOR 6 MONTHS

 

 


 

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