Impacto do tratamento cisticida no controle das crises epilépticas relacionadas a neurocisticercose

OBJECTIVE: To evaluate the clinical features and seizure control of epilepsy related to neurocysticercosis. METHOD: 18 patients with partial epilepsy and neurocysticercosis were treated with albendazol or praziquantel and followed from 3 months to 12 years. We analyzed results from the CSF exam, interictal electroencephalogram (EEG), head computerized tomography and/or magnetic resonance imaging. RESULTS: The patients' mean age was 36.4 years. The mean duration of epilepsy was 16 years. 83% patients had simple partial seizures ; 17% had complex partial seizures . All patients underwent routine EEGs: 62% had abnormalities and 38% were normal. A relationship was observed between focal EEG abnormality and the location of cyst in 28% of the patients. The CSF exams showed pleocytosis in 33% of the patients, and 28% had elevated protein levels. Only 22% of patients had positive titer for cysticercosis in the CSF. In all patients who had somatosensory and special sensory seizures there was a relationship between location of the cysts and seizure semiology (n=11). After cysticidal therapy, 83% patients had a significant improvement in controlling seizures. CONCLUSION: In this group, we found a predominance of simple partial seizures and a relationship between somatosensory and special sensory seizures and the location of the cysts. Cysticidal therapy was effective in controlling seizures in these patients and should be considered for patients with partial seizures and semiology related to cyst location.OBJETIVO: Avaliar as características e o controle das crises em pacientes com epilepsia associada à neurocisticercose. MÉTODO: Foram avaliados 18 pacientes tratados com albendazol ou praziquantel, com seguimento após tratamento variando de 3 meses a 12 anos. Todos pacientes tinham LCR, EEG interictal, tomografia computadorizada e/ou ressonância magnética de crânio. RESULTADOS: A idade média foi de 36,4 anos. O tempo de epilepsia foi em média 16,2 anos; 83% dos pacientes apresentavam crises parciais simples e 17%; crises parciais complexas. O EEG foi normal em 38%. Em apenas 28% dos pacientes houve relação entre alterações focais do EEG e a localização do cisto. Em relação ao LCR; 33% apresentavam pleiocitose, 28% hiperproteinorraquia e apenas 22% apresentavam imunologia positiva para cisticercose . Foi observada relação entre localização do cisto e semiologia das crises em todos os pacientes com crises de início sensitivo-motor e sensorial especial (n= 11). Após tratamento cisticida, 83% tiveram redução de pelo menos 50% das crises . CONCLUSÃO: Na epilepsia relacionada a neurocisticercose predominam crises parciais simples e observa-se relação entre crises sensitivo-motoras ou sensoriais especiais e localização do cisto. O tratamento cisticida deve ser considerado nos pacientes com crises parciais com semiologia relacionada à localização do cisto