Academic journal article Indian Journal of Psychiatry

A Study of Neuropsychiatric Manifestations in Patients of Neurocysticercosis

Academic journal article Indian Journal of Psychiatry

A Study of Neuropsychiatric Manifestations in Patients of Neurocysticercosis

Article excerpt

Byline: Smita. Srivastava, Rakesh. Chadda, Kiran. Bala, Pradipta. Majumdar

Background: Neurocysticercosis (NCC) is an endemic parasitic infection of Asia, Africa, Latin America, and central Europe. Neuropsychiatric manifestations of the illness include epilepsy and behavioral disturbances. There is a dearth of systematic studies on psychiatric manifestations of NCC from various Asian counties. The present study assessed the prevalence of various psychiatric disorders in a cohort of patients with NCC attending a neurological service. Materials and Methods: Detailed psychiatric assessment was carried out on 50 patients of NCC with epilepsy and 50 patients of epilepsy without any evidence of NCC. Comprehensive Psychopathological Rating Scale was used to elicit the symptoms. Cognitive functions were assessed using Mini Mental Status Examination. Psychiatric diagnoses were made as per International Classification of Diseases, 10 [sup]th edition (ICD-10). Results: Sixty eight percent of the patients with NCC suffered from a psychiatric disorder, as compared to 44% of those without NCC (P=0.02). Major depression and mixed anxiety depression were the two most common diagnoses. None of the patients was to found to suffer from a psychotic disorder. The most frequent site of brain lesion of NCC was the parietal lobe, followed by frontal lobes and disseminated lesions. Left sided lesions were associated with greater psychiatric morbidity. Focal seizures with or without secondary generalizations were present more frequently in patients with NCC whereas primary generalized seizures were more common in patients with idiopathic epilepsy (P=0.05). Conclusion: Psychiatric manifestations are more common in patients of epilepsy with NCC than those without NCC. The treating clinician need to be vigilant about the phenomenon.

Introduction

Neurocysticercosis (NCC) is a common neuroparasitic infection with a worldwide distribution. The infection is endemic in rural areas of the developing countries of Asia, Africa, Latin America, and central Europe. [sup][1] Prevalence has been found to be mainly related to socioeconomic factors and feeding habits, especially in Asia and Africa. The illness is especially common in areas where pork is consumed such as Sub-Saharan Africa, India, and in most countries of Southeast Asia. [sup][1],[2],[3],[4] NCC is characterized by the deposition of cysticerci in the brain as a result of eating of undercooked pork. It is the most common parasitic disease of the central nervous system (CNS). [sup][1] NCC is reported to be responsible for nearly half of the late onset cases of epilepsy in the endemic areas, [sup][3] and is also associated with psychiatric manifestations. In an earlier study from Venezuela, nearly 18% of patients admitted to a psychiatric hospital tested positive for cysticercosis on Western Blot test. Most of the positive cases suffered from schizophrenia, organic mental illness, mental retardation, or epilepsy. [sup][5]

Clinical presentation of NCC is diverse and perplexing, varying from an asymptomatic form to a "malignant" form. The polymorphous symptomatology seen in NCC is mimicked only by neuro-tuberculosis and neurosyphilis in India and other developing countries, and multiple sclerosis in the Western countries. Psychiatric symptoms are commonly a part of the clinical presentation of an infectious process. Though psychiatric aspects of classic infectious diseases, such as neurosyphilis and newer infectious diseases such as human immunodeficiency virus (HIV) have been well described in literature and are well researched, psychiatric manifestations of NCC have not been investigated to that extent. [sup][6],[7]

Usual presentation of NCC is with focal seizures or raised intracranial pressure due to internal hydrocephalus. [sup][4],[5] Localizing signs are relatively uncommon, though sudden neurological deficits can result from infarcts. Cases of dementia occurring as a complication of NCC have also been described. …

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