Volume 98, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Neurocysticercosis causes substantial neurologic morbidity in endemic regions around the world. In this cross-sectional study, we describe the frequency of neurocysticercosis among a presumed high-risk group of people in an endemic community in northern Peru. Participants who screened positive on a nine-question seizure survey were evaluated clinically to diagnose epilepsy using International League Against Epilepsy criteria. Those with epilepsy were offered a noncontrast computerized tomography (CT) of the head. We also tested sera from all participants using the lentil lectin-bound glycoprotein enzyme-linked immunoelectrotransfer blot (EITB) to detect anti-cysticercus antibodies and enzyme-linked immunosorbent assay (ELISA) B60/B158 to detect cysticercosis antigens. Participants with strongly positive ELISA (ratio ≥ 3) were offered a noncontrast magnetic resonance imaging (MRI) of the brain. We diagnosed 16 cases of epilepsy among 527 people screened (lifetime prevalence 30 per 1,000). Twelve with epilepsy accepted CT scan and five (41.7%) had parenchymal calcifications. None had viable cysts. Of the 514 who provided a blood sample, 241 (46.9%) were seropositive by EITB and 12 (2.9%) were strongly positive by ELISA (ratio ≥ 3). Eleven accepted MRI and eight (72.3%) had neurocysticercosis, including five with extraparenchymal cysts, five with parenchymal vesicular cysts, and two with parenchymal granulomas. These findings show that clinically relevant forms of neurocysticercosis and epilepsy can be found by applying screening interventions in communities endemic to . Longitudinal controlled studies are needed to better understand which subgroups are at highest risk and which are most likely to have improved prognosis as a result of screening.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Scharf D, , 1998. Neurocysticercosis. Two hundred thirty-eight cases from a California hospital. Arch Neurol 45: 777780. [Google Scholar]
  2. Shandera WX, White AC, Chen JC, Diaz P, Armstrong R, , 1994. Neurocysticercosis in Houston, Texas. A report of 112 cases. Medicine (Baltimore) 73: 3752. [Google Scholar]
  3. García HH, Gonzalez AE, Evans CAW, Gilman RH, , 2003. Taenia solium cysticercosis. Lancet 362: 547556. [Google Scholar]
  4. Schantz PM, Wilkins PP, Tsang VC, , 1998. Immigrants, imaging and immunoblots: the emergence of neurocysticercosis as a significant public health problem. Scheld WM, Craig WA, Hughes JM, eds. Emerging Infections 2. Washington, DC: ASM Press, 213242.
  5. Coyle CM, 2012. Neurocysticercosis: neglected but not forgotten. PLoS Negl Trop Dis 6: e1500. [Google Scholar]
  6. Bern C, García HH, Evans C, Gonzalez AE, Verastegui M, Tsang VC, Gilman RH, , 1999. Magnitude of the disease burden from neurocysticercosis in a developing country. Clin Infect Dis 29: 12031209. [Google Scholar]
  7. Del Brutto OH, Nash TE, White AC, Jr Rajshekhar V, Wilkins PP, Singh G, Vasquez CM, Salgado P, Gilman RH, García HH, , 2017. Revised diagnostic criteria for neurocysticercosis. J Neurol Sci 372: 202210. [Google Scholar]
  8. Garcia-Noval J, 1996. Epidemiology of Taenia solium taeniasis and cysticercosis in two rural Guatemalan communities. Am J Trop Med Hyg 55: 282289. [Google Scholar]
  9. Cruz ME, Cruz I, Preux PM, Schantz P, Dumas M, , 1995. Headache and cysticercosis in Ecuador, South America. Headache 35: 9397. [Google Scholar]
  10. Del Brutto OH, 2005. Epilepsy and neurocysticercosis in Atahualpa: a door-to-door survey in rural coastal Ecuador. Epilepsia 46: 583587. [Google Scholar]
  11. Montano SM, Villaran MV, Ylquimiche L, Figueroa JJ, Rodriguez S, Bautista CT, Gonzalez AE, Tsang VC, Gilman RH, García HH, , 2005. Association between seizures, serology, and brain CT in rural Peru. Neurology 65: 229233. [Google Scholar]
  12. Fleury A, 2003. High prevalence of calcified silent neurocysticercosis in a rural village of Mexico. Neuroepidemiology 22: 139145. [Google Scholar]
  13. Moyano LM, 2016. High prevalence of asymptomatic neurocysticercosis in an endemic rural community in Peru. PLoS Negl Trop Dis 10: e0005130. [Google Scholar]
  14. Prasad KN, Verma A, Srivastava S, Gupta RK, Pandey CM, Paliwal VK, , 2011. An epidemiological study of asymptomatic neurocysticercosis in a pig farming community in northern India. Trans R Soc Trop Med Hyg 105: 531536. [Google Scholar]
  15. García HH, 2003. Hyperendemic human and porcine Taenia solium infection in Perú. Am J Trop Med Hyg 68: 268275. [Google Scholar]
  16. Jayashi CM, Arroyo G, Lightowlers MW, García HH, Rodriguez S, Gonzalez AE, , 2012. Seroprevalence and risk factors for Taenia solium cysticercosis in rural pigs of northern Peru. PLoS Negl Trop Dis 6: e1733. [Google Scholar]
  17. Montano SM, 2005. Neurocysticercosis: association between seizures, serology, and brain CT in rural Perú. Neurology 65: 229233. [Google Scholar]
  18. O’Neal SE, Moyano LM, Ayvar V, Rodriguez S, Gavidia C, Wilkins PP, Gilman RH, García HH, Gonzalez AE, Cysticercosis Working Group in Perú; , 2014. Ring-screening to control endemic transmission of Taenia solium. PLoS Negl Trop Dis 8: e3125. [Google Scholar]
  19. Placencia M, Sander JW, Shorvon SD, Ellison RH, Cascante SM, , 1992. Validation of a screening questionnaire for the detection of epileptic seizures in epidemiological studies. Brain 115: 783794. [Google Scholar]
  20. Placencia M, Suarez J, Crespo F, Sander JW, Shorvon SD, Ellison RH, Cascante SM, , 1992. A large-scale study of epilepsy in Ecuador: methodological aspects. Neuroepidemiology 11: 7484. [Google Scholar]
  21. Fisher RS, 2014. ILAE official report: a practical clinical definition of epilepsy. Epilepsia 55: 475482. [Google Scholar]
  22. Tsang VC, Brand JA, Boyer AE, , 1989. An enzyme-linked immunoelectrotransfer blot assay and glycoprotein antigens for diagnosing human cysticercosis (Taenia solium). J Infect Dis 159: 5059. [Google Scholar]
  23. Wilson M, Bryan RT, Fried JA, Ware DA, Schantz PM, Pilcher JB, Tsang VC, , 1991. Clinical evaluation of the cysticercosis enzyme-linked immunoelectrotransfer blot in patients with neurocysticercosis. J Infect Dis 164: 10071009. [Google Scholar]
  24. Singh G, Kaushal V, Ram S, Kaushal RK, Dhanuka AK, Khurana S, , 1999. Cysticercus immunoblot assay in patients with single, small enhancing lesions and multilesional neurocysticercosis. J Assoc Physicians India 47: 476479. [Google Scholar]
  25. Brandt JR, Geerts S, De Deken R, Kumar V, Ceulemans F, Brijs L, Falla N, , 1992. A monoclonal antibody-based ELISA for the detection of circulating excretory-secretory antigens in Taenia saginata cysticercosis. Int J Parasitol 22: 471477. [Google Scholar]
  26. García HH, 2002. Circulating parasite antigen in patients with hydrocephalus secondary to neurocysticercosis. Am J Trop Med Hyg 66: 427430. [Google Scholar]
  27. García HH, Harrison LJS, Parkhouse RM, Montenegro T, Martinez SM, Tsang VC, Gilman RH, , 1998. A specific antigen-detection ELISA for the diagnosis of human neurocysticercosis. Trans R Soc Trop Med Hyg 92: 411414. [Google Scholar]
  28. García HH, Parkhouse RM, Gilman RH, Montenegro T, Bernal T, Martinez SM, Gonzalez AE, Tsang VC, Harrison LJ, , 2000. Serum antigen detection in the diagnosis, treatment, and follow-up of neurocysticercosis patients. Trans R Soc Trop Med Hyg 94: 673676. [Google Scholar]
  29. Rodriguez S, Wilkins P, Dorny P, , 2012. Immunological and molecular diagnosis of cysticercosis. Pathog Glob Health 106: 286298. [Google Scholar]
  30. Lerner A, Shiroishi MS, Zee CS, Law M, Go JL, , 2012. Imaging of neurocysticercosis. Neuroimaging Clin N Am 22: 659676. [Google Scholar]
  31. Nash TE, 2004. Calcific neurocysticercosis and epileptogenesis. Neurology 62: 19341938. [Google Scholar]
  32. Newton CR, García HH, , 2012. Epilepsy in poor regions of the world. Lancet 380: 11931201. [Google Scholar]
  33. García HH, Pretell EJ, Gilman RH, Martinez SM, Moulton LH, Del Brutto OH, Herrera G, Evans CA, Gonzalez AE, , 2004. A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N Engl J Med 350: 249258. [Google Scholar]
  34. García HH, Nash TE, Del Brutto OH, , 2014. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol 13: 12021215. [Google Scholar]

Data & Media loading...

  • Received : 07 Jun 2017
  • Accepted : 02 Sep 2017
  • Published online : 04 Dec 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error