Interictal epileptiform discharges in calcified neurocysticercosis–associated epilepsy: An exploratory study

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Abstract
The objective of the study was to assess the frequency of interictal epileptiform discharges (IEDs) in calcified neurocysticercosis (NCC) and its relationship with calcification burden. Forty‐nine patients with calcified NCC (low‐burden, 1–2 calcifications, n = 24; high‐burden, ≥15 calcifications, n = 25) and seizure history underwent prolonged (8‐h) electroencephalography (EEG), interpreted by epileptologists who were blinded to patient history and calcification category. Clinical seizure outcomes were also assessed. We found that IEDs occurred in 7 of 49 participants (14.3%), with no difference between low‐burden (12.5%) and high‐burden (16.0%) groups ( p = 1.000). All IEDs (spikes and/or sharp waves) in the high‐burden group ( n = 4) were high‐voltage (100–150 μV), whereas those in the low‐burden group ( n = 3) were low or medium voltage (20–70 μV). Among the participants who had IEDs, 5 (71.4%) had seizures in the last year, compared with 14 (33.3%) in the group without IEDs detected ( p = 0.093). Among 19 participants with seizures in the last year, 5 were identified as having drug‐resistant epilepsy (DRE). All five cases of DRE occurred in individuals with 15 or more calcifications (5/25, 20%, vs 0/24, p = 0.023). We conclude that IEDs occur frequently in individuals with calcified NCC. Although calcification burden itself was not associated with the presence of IEDs, drug‐resistant cases and high‐voltage IEDs were concentrated in the high‐burden group, supporting the role of calcified parasites as epileptogenic foci.
Funding Information
  • National Institutes of Health (D43 TW001140)

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