The Association Between Neurocysticercosis and Hippocampal Atrophy is Related to Age

Oscar H. Del Brutto School of Medicine, Universidad Espíritu Santo–Ecuador, Guayaquil, Ecuador.
Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.

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Naoum P. Issa Department of Neurology, University of Chicago, Chicago, Illinois.

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Perla Salgado Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico.

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Victor J. Del Brutto Department of Neurology, University of Chicago, Chicago, Illinois.

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Mauricio Zambrano Atahualpa Project, Community Center, Atahualpa, Ecuador.

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Julio Lama Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador.

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Héctor H. García Center for Global Health, Tumbes, Perú.
Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Perú.
Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú.

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Neurocysticercosis (NCC) has been associated with hippocampal atrophy, but the prevalence and pathogenic mechanisms implicated in this relationship are unknown. Using a population-based, case–control study design, residents in a rural village (Atahualpa) aged ≥ 40 years with calcified NCC were identified as cases and paired to NCC-free individuals (control subjects) matched by age, sex, and level of education. Cases and control subjects underwent magnetic resonance imaging for hippocampal rating according to the Scheltens' scale for medial temporal atrophy and were interviewed to identify those with a clinical seizure disorder. The prevalence of hippocampal atrophy was compared between cases and control subjects by the use of the McNemar's test for correlated proportions. Seventy-five individuals with calcified NCC and their matched control subjects were included in the analysis. Hippocampal atrophy was noted in 26 (34.7%) cases and nine (12%) control subjects (odds ratio: 4.4; 95% confidence interval: 1.6–14.9, P < 0.0021). Stratification of pairs according to tertiles of age revealed an age-related trend in this association, which became significant only in those aged ≥ 68 years (P = 0.027). Only five cases and one control had recurrent seizures (P = 0.221); three of these five cases had hippocampal atrophy, and the single control subject had normal hippocampi. This study confirms an association between NCC and hippocampal atrophy, and shows that this association is stronger in older age groups. This suggests that NCC-related hippocampal atrophy takes a long time to develop.

Author Notes

* Address correspondence to Oscar H. Del Brutto, Air Center 3542, P.O. Box 522970, Miami, FL 33152-2970. E-mail: oscardelbrutto@hotmail.com

Financial support: This study was partially supported by Universidad Espíritu Santo – Ecuador, Guayaquil – Ecuador. Hector H. Garcia is supported by a Wellcome Trust International Senior Fellowship in Public Health and Tropical Medicine.

Authors' addresses: Oscar H. Del Brutto, School of Medicine, Universidad Espíritu Santo–Ecuador, Guayaquil, Ecuador and Department of Neurological Sciences, Hospital-Clínica Kennedy, E-mail: oscardelbrutto@hotmail.com. Naoum P. Issa and Victor J. Del Brutto, Department of Neurology, University of Chicago, Chicago, IL, E-mails: naoum.issa@uchospitals.edu and vjdelbrutto@gmail.com. Perla Salgado, Neuroimaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico, E-mail: pmtsalgado@yahoo.com.mx. Mauricio Zambrano, The Atahualpa Project, Community Center, Atahualpa, Ecuador, E-mail: zamaleon@hotmail.com. Julio Lama, Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador, E-mail: julama54@hotmail.com. Héctor H. García, Department of Microbiologia, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru, Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Perú, and Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú, E-mail: hgarcia1@jhu.edu.

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