Neurocysticercosis in Bhutan: a cross-sectional study in people with epilepsy

Abstract

Background

Neurocysticercosis (NCC) prevalence among people with epilepsy (PWE) has not been reported in Bhutan. We sought to provide an initial assessment of disease burden and evaluate the yield of diagnostic tests for Taenia solium among PWE in Bhutan.

Methods

We prospectively enrolled PWE at the referral hospital in Thimphu, Bhutan (2014-2015). Serum was tested for anti- Taenia solium IgG using enzyme-linked immunoassay (ELISA), enzyme-linked immunoelectrotransfer blot (EITB), and circulating parasite antigen. Results were compared to brain magnetic resonance imaging (MRI). Participants were categorized as definite (MRI and EITB positive), probable (MRI or EITB positive), or not having NCC.

Results

12/205 [6%, 95%CI: 2%, 9%] and 40/205 [20%, 95%CI 14%, 25%] participants met diagnostic criteria for definite and probable NCC. 25/205 [12%] with positive EITB did not have NCC on MRI, and 15/205 [7%] participants with positive MRI had negative EITB. Participants with NCC-suggestive lesions on MRI had an average of 1.2 cysts, predominantly parenchymal [26/27, 96%] and in the nodular/calcified stage [21/27, 78%]. People with NCC were more likely to be older (mean 23.8 years vs. 28.9 years, p=0.01), but no other statistically significant associations were identified.

Conclusions

NCC is associated with 6% to 25% of epilepsy in a cohort from Bhutan. Diagnostic strategies combining EITB and MRI could aid diagnosis of NCC among PWE since neither test could identify all NCC cases.