TABLE 1.

Parasitic Infestations Causing Epilepsy

PARASITE	REGION	DIAGNOSIS/CHARACTERISTICS	COMMENT
Taenia solium (neurocysticercosis)	Latin America; regions of Africa	May be associated with cysts; appears in muscles and breast	Important to assure seizures represent epilepsy and not acute provoked seizure, which may require a much shorter duration of treatment. No clear consensus: cysticidal treatment does not improve long-term epilepsy outcome and is associated with increased cost. Reference: Carpio and Hauser (30)
Echinococcosis granulosum (cerebral hydatid disease)	Middle East, Australia, New Zealand, South America, Turkey, North and East Africa, China, southern and eastern Europe	Lesions can grow slowly and might be quite large before patient present with symptoms.	Caution is needed, as biopsy or excision that ruptures cysts may precipitate anaphylaxis and death.
Trypanosoma brucei gambiense T.b. rhodesiense (human African trypanosomiasis)	Central, southern, and eastern Africa	Acute provoked seizures are common. Anecdotal information indicates later epilepsy is typical in persons surviving to long-term treatment.	Diagnosis requires a high level of suspicion. Formal surveillance is poor.
Trypanosoma Cruzi (South American Tryps)	Latin America	Cardiac disease with arrhythmias and dilated cardiomyopathy is associated with high rates of stroke and thus, secondary epilepsy.	Underlying parasitic infection must be treated to avoid cardiac disease progression.
Paragonimus westermani	Asia regions where raw shellfish (especially drunken crab) are consumed	CNS infection is uncommon but occurs in regions where pulmonary disease is well recognized.	Underlying parasitic infection must be treated. Anecdotally, survivors of CNS lesions may develop epilepsy after full treatment and acute recovery.
Schistosoma japonicum (bilharzia)	Asia	Underlying parasitic infection must be treated.	Other schistosoma species rarely infect brain.
P. falciparum	Primarily Africa, also Asia	History of cerebral malaria, usually with seizures and prolonged coma; remote parasite infection	Usually a localization-related epilepsy, unless patient is neurologically devastated after cerebral malaria recovery.

For additional information on parasites, see Meyer and Birbeck (18).