Browsing by Author "Bagiella, Emilia"

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Effects of albendazole treatment on neurocysticercosis: A randomised controlled trial
(2008-06) Kelvin, Elizabeth A.; Carpio, Arturo; Bagiella, Emilia; Leslie, Denise; León, Pedro; Howard, Andrews; Hauser, W. Allen; Lisanti, Noemí; Aguirre, R.; Serrano, M.; Pesántes, J.; Moncayo, J.; Roman, M.
AIM: The aim of this trial was to evaluate the effects of albendazole (ALB) on cyst disappearance, reduction of the number of cysts and seizure recurrence. METHODS: 178 patients with new onset symptoms due to active or transitional neurocysticercosis were randomly assigned to receive either 800 mg of ALB daily or placebo for 8 days. All patients also received prednisone. Imaging studies were done at baseline and at months 1, 6 and 12 of follow-up. RESULTS: Active cysts were identified in 59 of 88 people randomised to ALB and 57 of the 90 in the placebo arm. By 1 month, 31% were free of active cysts in the treatment group compared with 7% in the placebo group (p = 0.001). In addition, the ALB group had a greater reduction in the number of active cysts compared with the placebo group (p = 0.001). After 1 month following treatment there was no additional gain by treatment group in the disappearance or reduction in the number of active cysts. ALB treatment had little effect on cysts in the transitional or calcification stage. We found no difference between the ALB and placebo groups in symptoms during treatment or in seizure recurrence during the 12 months after treatment. CONCLUSION: Albendazole plus symptomatic treatment leads to the disappearance of active cysts in 31% of patients compared with 7% of those with symptomatic treatment alone. This treatment effect occurs within the first 30 days after treatment.
Investigation of familial aggregation of seizures in neurocysticercosis patients
(2009-03) Kelvin, Elizabeth A.; Carpio, Arturo; Bagiella, Emilia; Leslie, Denise; León, Pedro; Howard, Andrews; Hauser, W. Allen; Hesdorffer, Dale C.
Regional differences in the clinical manifestations of human neurocysticercosis (NCC) may indicate a role of host genetics. We examined whether there is familial aggregation of seizures in first-degree relatives of NCC patients with seizure versus NCC patients without seizure as presenting symptom in a group of patients in Ecuador. The results of our analyses were null, and there was no trend toward familial aggregation of seizures in NCC patients.
Seizure in people with newly diagnosed active or transitional neurocysticercosis
(2011-03) Kelvin, Elizabeth A.; Carpio, Arturo; Bagiella, Emilia; Leslie, Denise; León, Pedro; Howard, Andrews; Hauser, W. Allen
Purpose: The aim of this study is to describe seizure as a presenting symptom in individuals with recently diagnosed neurocysticercosis (NCC). Methods: Using logistic regression, we examined the probability of having seizures as a presenting symptom among those with active or transitional NCC by host age and gender, and by number of cysts, location of the cysts in the brain, and phase of evolution of the encysted parasite. Results: We found that the odds of having seizures as presenting symptom for those in the youngest age group (3–24 years old) were 12.9 times that of the oldest participants (age 55–82 years) (p = 0.006). People with cysts in parenchymal locations had a significantly higher odds of seizures compared to those with all their cysts elsewhere (ventricles or subarachnoid) (OR = 6.2, p = 0.028); and the number of cysts was significantly associated with having seizures (OR = 1.1, p = 0.026). Host gender and cyst phase were not significantly associated with having seizures after adjusting for confounders and covariates. Conclusion: Children, those with cysts in parenchymal locations, and those with a higher number of cysts appear to be more likely to experience seizure when they have NCC cysts in the active or transitional stage.
The association of host age and gender with inflammation around neurocysticercosis cysts
(2009-09-01) Kelvin, Elizabeth A.; Carpio, Arturo; Bagiella, Emilia; Leslie, Denise; León, Pedro; Howard, Andrews; Hauser, W. Allen; Lisanti, Noemí; Aguirre, R.; Serrano, M.; Pesántes, J.; Moncayo, J.; Roman, M.
The results of previous investigations indicate that age and gender may influence the strength of the human host's immune response to infection of the central nervous system with the larvae of Taenia solium. Most of the relevant research on such neurocysticercosis (NCC) has, however, been conducted on hospital-based samples in developing countries, where differential access to healthcare may bias the study results. Using data from 171 NCC patients participating in a treatment trial, the associations of patient age and gender with the presence of inflammation around NCC cysts (i.e. cysts in the transitional phase) have recently been explored, after controlling for measures of economic and geographical access to healthcare. Data on cysts were collected from computed-tomography or magnetic-resonance images taken at four time-points, from baseline to 12-months post-treatment. The odds of having transitional cysts were evaluated by logistic regression whereas Poisson regression was used to explore the numbers of transitional cysts, with generalised estimating equations (GEE) used to account for the multiple observations over time. After controlling for healthcare access, the odds of having transitional cysts were found to be 1.5-fold higher for the female patients than for the male, although this association was not statistically significant (P = 0.136). In the Poisson model, however, the number of transitional cysts was found to be 1.8-fold higher in the female patients than in the male, and this gender effect was not only statistically significant (P = 0.002) but also constant over time. The association of host age with transitional cysts was more complicated, with significant interaction between age and time. It therefore appears that there are significant gender and age differences in the local immune response to NCC, even after adjusting for differences in healthcare access.