Dear Editors,
Carpio and Romo have emphasized the limitations in our understanding of symptomatic seizures and the epileptogenic process that follows in some, but not all patients with neurocysticercosis. Their letter also highlights a critical need for careful, systematic studies of clinical and molecular biomarkers in these patients. Fundamental knowledge gained from these patients could be extrapolated to many other causes of epilepsy. We are glad that in these aspects the authors agree with us on the potential usefulness of neurocysticercosis to unravel the pathophysiology of seizures and epilepsy in neurocysticercosis as well as in other seizure disorders. Our report is not a general review of neurocysticercosis and accordingly does not discuss other issues raised by the Carpio and Romo. The disease is relatively unstudied and many points controversial, so there is room for differences of opinion. For a number of reasons, this is not the forum to discuss these differences. However, our group of epilepsy and neurocysticercosis experts believe most evidence suggests that a small proportion, rather than a “few people with NC” develop epilepsy and that the evidence implicating neurocysticercois as a cause of epilepsy, we believe, is quite strong. Supporting evidence originates from number of kinds of information including numerous epidemiology reports, follow up of treated patients, and studies implicating specific calcifications as seizure foci in patients with epilepsy. In the later specific calcified lesions in patients with epilepsy have been implicated by their semiology and EEG findings implicating specific calcifications in about 50%-60% of patients studied. Similarly, whether repeated seizures over an extended period of time arising from an inflammatory focus is epilepsy or is a series of acute symptomatic seizures is important from a pathophysiology point of view, but applying outdated definitions of epilepsy to recurrent seizures in neurocysticercosis only begs for an improved classification scheme.
Acknowledgments
Supported in part by the Intramural Research Program of the National Institute of Allergy and Infectious Diseases, the Office of Rare Diseases Research, the National Center for Advancing Translational Sciences, and Fogarty International Center Training Grant D43 TW00114, all from the National Institutes of Health. H.G. is supported by a Wellcome Trust Senior International Research Fellowship in Tropical Medicine and Public Health
Footnotes
Disclosures
The authors have no conflict of interest to disclose. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.