Intractable Epilepsy associated with Neurocysticercosis :
Perilesional Epileptogenic Features

J Korean Neurol Assoc > Volume 17(5); 1999 > Article

Journal of the Korean Neurological Association 1999;17(5): 645-650.

뇌낭미충증으로 인한 난치성 간질에서 병변 주변의 간질 생성 소견

윤수진, 서대원 홍승봉 홍승철*서연림**이광호 이원용 김병준

성균관대학교 의과대학 삼성서울병원 신경과,신경외과*,진단병리과**

Intractable Epilepsy associated with Neurocysticercosis : Perilesional Epileptogenic Features

Soo Jin Yoon, Dae Won Seo, Seung Bong Hong, Seung Chul Hong*, Yeon-Lim Suh**, Kwang Ho Lee, Won Yong Lee, Byoung Joon Kim

Departments of Neurology, Neurosurgery*, and Diagnostic Pathology** Samsung Medical Center, Sungkyunkwan University School of Medicine

Abstract

Background : Neurocysticercosis (NCC) is the most common parasitic disease of the CNS and seizures are the most frequent clinical manifestations of it. Although the medical treatment of NCC is effective, epilepsy surgery is still need-ed to treat refractory seizures. We investigated five cases with refractory seizures due to NCC to verify perilesional epileptogenic changes in NCC. Methods : We included 5 intractable epilepsy patients who had epilepsy surgery and pathologically proven cysticercosis although serological tests were negative. A routine EEG and brain MRI were per-formed in all patients. Video scalp-EEG monitorings were done in 5 patients, including an invasive-EEG monitoring in one. We analyzed the relationships between semiology, brain MRI, interictal, and ictal EEG findings, pathologic fea-tures and surgical outcomes. Results : All patients had abdominal or psychic aura, evolving into automotor seizure and then secondarily generalized tonic clonic seizures. Two patients often had only the aura. In brain MRI, four patients had showed NCC lesions in the mesial temporal area, and one had it in the basal occipital area. Hippocampal atrophy was also detected in 3 patients. Irritative and ictal onset zones on an EEG were located around the lesions. Pathologic findings confirmed hippocampal sclerosis in 3 patients and coritcal dyslamination and many single heterotopic neurons in the temporal lobe in 1 patient. Surgical outcomes showed 3 patients in class IA, 1 in class IC, and 1 in class IIB by Engel classification. Conclusions : Epileptic foci could be formed focally around the NCC lesion and hippocampal sclerosis frequently accompanied when the lesion was located near the mesial temporal structures. After verifying epileptic foci and lesion, epilepsy surgery had good surgical outcome. J Kor Neurol Ass 17(5):645~650, 1999 Key Words : Neurocysticercosis, Hippocampal atrophy, Intractable epilepsy, EEG monitoring, Epilepsy surgery