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Calcified Neurocysticercosis Associates with Hippocampal Atrophy: A Population-Based Study

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  • School of Medicine, Universidad Espíritu Santo – Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico; Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Community Center of the Atahualpa Project, Atahualpa, Ecuador; Outpatient Center North, Ecuadorian Institute of Social Security, Guayaquil, Ecuador; Center for Global Health, Tumbes and the Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Perú; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú

Calcified neurocysticercosis has been associated with hippocampal atrophy in patients with refractory epilepsy, but the relevance of this association in the population at large is unknown. We assessed calcified cysticerci and its association with hippocampal atrophy in elderly persons living in Atahualpa, an Ecuadorian village endemic for neurocysticercosis. All Atahualpa residents ≥ 60 years of age were invited to undergo computed tomography/magnetic resonance imaging for neurocysticercosis detection. Twenty-eight (11%) out of 248 enrolled persons had calcified cysticerci (case-patients) and were matched 1:1 by age, sex, and years of education to individuals without neurocysticercosis on computed tomography/magnetic resonance imaging (controls). Four case-patients and none of the controls had epilepsy (P = 0.134). Cognitive performance was similar across both groups. The Scheltens' medial temporal atrophy scale was used for hippocampal rating in case-patients and matched controls without neurocysticercosis. Mean score in the Scheltens' scale was higher in case-patients than in controls (P < 0.001). Atrophic hippocampi were noticed in 19 case-patients and five controls (P = 0.003). Atrophy was bilateral in 11 case-patients and unilateral in eight. All case-patients with unilateral hippocampal atrophy had at least one ipsilateral calcification. This study shows an association between calcified cysticerci and hippocampal atrophy and raises the possibility of an inflammation-mediated hippocampal damage as the responsible mechanism for these findings.

Author Notes

* Address correspondence to Oscar H. Del Brutto, Air Center 3542, PO 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. HHG 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, E-mail: oscardelbrutto@hotmail.com. Perla Salgado, Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico 22 DF, Mexico, E-mail: pmtsalgado@yahoo.com.mx. Julio Lama, Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador, E-mail: julama54@hotmail.com. Victor J. Del Brutto and Mauricio Zambrano, Community Center of the Atahualpa Project, Atahualpa, Ecuador, E-mails: vjdelbrutto@gmail.com and zamaleon@hotmail.com. Xavier Campos, Outpatient Center North, Ecuadorian Institute of Social Security, Guayaquil, Ecuador, E-mail: xaviercampos63@hotmail.com. Héctor H. García, Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú, E-mail: hgarcia@jhsph.edu.

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