Neurocysticercosis in Radiographically Imaged Seizure Patients in U.S. Emergency Departments

Samuel Ong, David A. Talan, Gregory J. Moran, William Mower, Michael Newdow, Victor C.W. Tsang, Robert W. Pinner, and the EMERGEncy ID NET Study Group

Disclosures

Emerging Infectious Diseases. 2002;8(6) 

In This Article

Abstract and Introduction

Neurocysticercosis appears to be on the rise in the United States, based on immigration patterns and published cases series, including reports of domestic acquisition. We used a collaborative network of U.S. emergency departments to characterize the epidemiology of neurocysticercosis in seizure patients. Data were collected prospectively at 11 university-affiliated, geographically diverse, urban U.S. emergency departments from July 1996 to September 1998. Patients with a seizure who underwent neuroimaging were included. Of the 1,801 patients enrolled in the study, 38 (2.1%) had seizures attributable to neurocysticercosis. The disease was detected in 9 of the 11 sites and was associated with Hispanic ethnicity, immigrant status, and exposure to areas where neurocysticercosis is endemic. This disease appears to be widely distributed and highly prevalent in certain populations (e.g., Hispanic patients) and areas (e.g., Southwest).

Neurocysticercosis is the most common parasitic disease of the central nervous system. It is endemic in many developing countries and has been cited as the primary reason that "epilepsy" is twice as common in these countries as in more industrialized nations such as the United States[1]. The prevalence of neurocysticercosis in some of these developing countries exceeds 10%[2,3], where it accounts for up to 50% of cases of late-onset epilepsy[4].

International travel and immigration are bringing neurocysticercosis to areas where it is not endemic. Several case series have been published from a variety of institutions throughout the United States, especially in the Southwest[5,6,7,8,9,10], but none has directly assessed the prevalence of neurocysticercosis. Domestic acquisition of the disease has been documented not only in large, metropolitan centers that attract large numbers of immigrants but also in less urban areas of North and South Carolina[11]. Local acquisition has even been demonstrated in such unlikely areas as an Orthodox Jewish community, where it was attributed to the employment of domestic workers from Central and South American countries[12].

Seizures are the most frequent, and often the only, clinical manifestation of neurocysticercosis; they occur in 70% to 90% of cases[10,13]. Because seizure patients frequently go to emergency departments, we chose this setting to perform a prospective study to determine the prevalence and epidemiology of this disease.

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