Instituto Nacional Of Ciencias Neurologicas

Lima, Peru

Instituto Nacional Of Ciencias Neurologicas

Lima, Peru
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Rodriguez S.,Instituto Nacional Of Ciencias Neurologicas | Wilkins P.,Centers for Disease Control and Prevention | Dorny P.,Institute of Tropical Medicine
Pathogens and Global Health | Year: 2012

Cysticercosis, the infection with the larval stage of Taenia solium, is a cause of neurological symptoms including seizures, affecting the quality of life of patients and their families. Diagnosis focuses on brain imaging and serological tests are mostly used as confirmatory tools. Most cases, however, occur in poor endemic areas, where both kinds of diagnostic tools are poorly available. Development of point of care diagnostic tests is one of the most important priorities for cysticercosis researches today. The ideal point of care test would require detection of viable cysticercosis and hopefully identify cases with severe or progressive forms of neurocysticercosis, leading to referral of the patient for specialized medical attention. This manuscript describes the evolution of the serological diagnosis of cysticercosis over time, and the characteristics of the most common currently available tools, their advantages and disadvantages, and their potential use in future diagnostic tests. © W. S. Maney & Son Ltd 2012.


Garcia H.H.,Instituto Nacional Of Ciencias Neurologicas | Garcia H.H.,Cayetano Heredia Peruvian University | Nash T.E.,National Institute of Allergy and Infectious Diseases | Del Brutto O.H.,Espiritu Santo University, Guayaquil | Del Brutto O.H.,Hospital Clinica Kennedy
The Lancet Neurology | Year: 2014

The infection of the nervous system by the cystic larvae of Taenia solium (neurocysticercosis) is a frequent cause of seizure disorders. Neurocysticercosis is endemic or presumed to be endemic in many low-income countries. The lifecycle of the worm and the clinical manifestations of neurocysticercosis are well established, and CT and MRI have substantially improved knowledge of the disease course. Improvements in immunodiagnosis have further advanced comprehension of the pathophysiology of this disease. This knowledge has led to individualised treatment approaches that account for the involvement of parenchymal or extraparenchymal spaces, the number and form of parasites, and the extent of degeneration and associated inflammation. Clinical investigations are focused on development of effective treatments and reduction of side-effects induced by treatment, such as seizures, hydrocephalus, infarcts, and neuroinjury. © 2014 Elsevier Ltd.


Garcia H.H.,Instituto Nacional Of Ciencias Neurologicas | Garcia H.H.,Cayetano Heredia Peruvian University | Gonzales I.,Instituto Nacional Of Ciencias Neurologicas | Lescano A.G.,Cayetano Heredia Peruvian University | And 10 more authors.
The Lancet Infectious Diseases | Year: 2014

Background: Neurocysticercosis causes a substantial burden of seizure disorders worldwide. Treatment with either praziquantel or albendazole has suboptimum efficacy. We aimed to establish whether combination of these drugs would increase cysticidal efficacy and whether complete cyst resolution results in fewer seizures. We added an increased dose albendazole group to establish a potential effect of increased albendazole concentrations. Methods: In this double-blind, placebo-controlled, phase 3 trial, patients with viable intraparenchymal neurocysticercosis were randomly assigned to receive 10 days of combined albendazole (15 mg/kg per day) plus praziquantel (50 mg/kg per day), standard albendazole (15 mg/kg per day), or increased dose albendazole (22·5 mg/kg per day). Randomisation was done with a computer generated schedule balanced within four strata based on number of cysts and concomitant antiepileptic drug. Patients and investigators were masked to group assignment. The primary outcome was complete cyst resolution on 6-month MRI. Enrolment was stopped after interim analysis because of parasiticidal superiority of one treatment group. Analysis excluded patients lost to follow-up before the 6-month MRI. This trial is registered with ClinicalTrials.gov, number NCT00441285. Findings: Between March 3, 2010 and Nov 14, 2011, 124 patients were randomly assigned to study groups (41 to receive combined albendazole plus praziquantel [39 analysed], 43 standard albendazole [41 analysed], and 40 increased albendazole [38 analysed]). 25 (64%) of 39 patients in the combined treatment group had complete resolution of brain cysts compared with 15 (37%) of 41 patients in the standard albendazole group (rate ratio [RR] 1·75, 95% CI 1·10-2·79, p=0·014). 20 (53%) of 38 patients in the increased albendazole group had complete cyst resolution at 6-month MRI compared with 15 (37%) of 41 patients in the standard albendazole group (RR 1·44, 95% CI 0·87-2·38, p=0·151). No significant differences in adverse events were reported between treatment groups (18 in combined treatment group, 11 in standard albendazole group, and 19 in increased albendazole group). Interpretation: Combination of albendazole plus praziquantel increases the parasiticidal effect in patients with multiple brain cysticercosis cysts without increased side-effects. A more efficacious parasiticidal regime without increased treatment-associated side-effects should improve the treatment and long term prognosis of patients with neurocysticercosis. Funding: National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health. © 2014 Elsevier Ltd.


Callacondo D.,Cayetano Heredia Peruvian University | Garcia H.H.,Cayetano Heredia Peruvian University | Garcia H.H.,Instituto Nacional Of Ciencias Neurologicas | Gonzales I.,Instituto Nacional Of Ciencias Neurologicas | And 2 more authors.
Neurology | Year: 2012

Objective: To determine the frequency of spinal neurocysticercosis (NCC) in patients with basal subarachnoid NCC compared with that in individuals with viable limited intraparenchymal NCC (≤20 live cysts in the brain). Methods: We performed a prospective observational case-control study of patients with NCC involving the basal cisterns or patients with only limited intraparenchymal NCC. All patients underwent MRI examinations of the brain and the entire spinal cord to assess spinal involvement. Results: Twenty-seven patients with limited intraparenchymal NCC, and 28 patients with basal subarachnoid NCC were included in the study. Spinal involvement was found in 17 patients with basal subarachnoid NCC and in only one patient with limited intraparenchymal NCC (odds ratio 40.18, 95% confidence interval 4.74-340.31; p < 0.0001). All patients had extramedullary (intradural) spinal NCC, and the lumbosacral region was the most frequently involved (89%). Patients with extensive spinal NCC more frequently had ventriculoperitoneal shunt placement (7 of 7 vs 3 of 11; p = 0.004) and tended to have a longer duration of neurologic symptoms than those with regional involvement (72 months vs 24 months; p = 0.062). Conclusions: The spinal subarachnoid space is commonly involved in patients with basal subarachnoid NCC, compared with those with only intraparenchymal brain cysts. Spinal cord involvement probably explains serious late complications including chronic meningitis and gait disorders that were described before the introduction of antiparasitic therapy. MRI of the spine should be performed in basal subarachnoid disease to document spinal involvement, prevent complications, and monitor for recurrent disease. Copyright © 2012 by AAN Enterprises, Inc.


Gonzales I.,Instituto Nacional Of Ciencias Neurologicas | Garcia H.H.,Cayetano Heredia Peruvian University
Pathogens and Global Health | Year: 2012

Neurological disease resulting from neurocysticercosis (NCC) is common in most of the world. The variability in the biology of the infection and in its clinical manifestations has led to much confusion regarding appropriate management. Therapeutic options have evolved from surgery, symptomatic measures, and steroids, to include the use of anti-parasitic drugs and minimally invasive neurosurgery. This manuscript reviews the principles of medical therapy for NCC, from discussion of the need for individualized management approaches for each type of NCC to exploration of the most likely potential additions or modifications currently under study. © W. S. Maney & Son Ltd 2012.


Del Brutto O.H.,Espiritu Santo University, Guayaquil | Del Brutto O.H.,Hospital Clinica Kennedy | Garcia H.H.,Instituto Nacional Of Ciencias Neurologicas | Garcia H.H.,Cayetano Heredia Peruvian University
Handbook of Clinical Neurology | Year: 2013

Cysticercosis, an infection caused by the cystic larvae of the pork tapeworm Taenia solium, is one of the most frequent parasitic infections of the human nervous system (neurocysticercosis). It is endemic in most of Latin America, the sub-Saharan Africa, and vast parts of Asia, including the Indian subcontinent. It has also been increasingly diagnosed in developed countries because of migration of people from endemic zones and exposure in travelers. The life cycle involves the development of the adult tapeworm in the human small intestine (after ingesting infected pork with cysts) and larval infection in pig tissues (after ingesting human stools containing the eggs of the tapeworm). Humans get infected by the fecal-oral route, most often from a direct contact with an asymptomatic Taenia carrier. Most common clinical presentations are seizures (particularly late-onset seizures), chronic headaches, and intracranial hypertension. However, cysticerci can locate anywhere in the human nervous system, thus potentially causing almost any neurological syndrome and making clinical diagnosis a difficult task. Neuroimaging is the main diagnostic tool, and specific serology confirms the diagnosis and helps to define the diagnosis when images are unclear. Factors such as location (extraparenchymal versus intraparenchymal), number, size and evolutive stage of the parasites determine the clinical manifestations, therapeutic approach, and prognosis. Management includes symptomatic drugs (analgesics, antiepileptic drugs, anti-inflammatory agents) and in many cases cysticidal drugs, either albendazole or praziquantel. In recent years, efforts have focused on transmission control and potential elimination in endemic regions. © 2013 Elsevier B.V.


Garcia H.H.,Cayetano Heredia Peruvian University | Garcia H.H.,Instituto Nacional Of Ciencias Neurologicas | Gonzalez A.E.,National Major San Marcos University | Gilman R.H.,Johns Hopkins University
Current Opinion in Infectious Diseases | Year: 2011

Purpose of Review: Taenia solium neurocysticercosis (NCC) has been long recognized as an important cause of neurological morbidity in most of the world. Unwarranted generalization of diagnostic and treatment recommendations made it difficult to assess individual prognosis and responses for each type of NCC. Understanding of the main clinical presentations (dependent on number, location, size, and stage of parasites, as well as on the immune response of the host) allows a better view of treatment options and expected outcomes. Recent Findings: Current treatment options are still limited and involve symptomatic agents, antiparasitic agents, or surgery. The importance of adequate symptomatic management, the potential for improved antiparasitic treatment regimes, in particular combination therapy, and the increasingly important role of minimally invasive neurosurgery are also reviewed in this article. Summary: Treatment decisions in NCC should be individualized in relation to the type of NCC. Initial measures should focus on the symptomatic management before considering antiparasitic therapy when appropriate. Appropriate patient categorization, new antiparasitic regimes, and minimally invasive surgery are improving the prognosis of patients with NCC. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Newton C.R.,Muhimbili Wellcome Programme | Newton C.R.,Center for Geographical Medicine Coast | Newton C.R.,University College London | Newton C.R.,University of Oxford | And 2 more authors.
The Lancet | Year: 2012

Epilepsy is a common disorder, particularly in poor areas of the world, and can have a devastating effect on people with the disorder and their families. The burden of epilepsy in low-income countries is more than twice that found in high-income countries, probably because the incidence of risk factors is higher. Many of these risk factors can be prevented with inexpensive interventions, but there are only a few studies that have assessed the effect of reducing risk factors on the burden of epilepsy. The mortality associated with epilepsy in low-income countries is substantially higher than in less impoverished countries and most deaths seem to be related to untreated epilepsy (eg, as a result of falls or status epilepticus), but the risk factors for death have not been adequately examined. Epilepsy is associated with substantial stigma in low-income countries, which acts as a barrier to patients accessing biomedical treatment and becoming integrated within society. Seizures can be controlled by inexpensive antiepileptic drugs, but the supply and quality of these drugs can be erratic in poor areas. The treatment gap for epilepsy is high (>60%) in deprived areas, but this could be reduced with low-cost interventions. The substantial burden of epilepsy in poor regions of the world can be reduced by preventing the risk factors, reducing stigma, improving access to biomedical diagnosis and treatment, and ensuring that there is a continuous supply of good quality antiepileptic drugs.


Nash T.E.,U.S. National Institutes of Health | Garcia H.H.,Instituto Nacional Of Ciencias Neurologicas
Nature Reviews Neurology | Year: 2011

Neurocysticercosis is a parasitic disease caused by the larval (cystic) form of the pork cestode tapeworm, Taenia solium, and is a major cause of acquired seizures and epilepsy worldwide. Development of sensitive and specific diagnostic methods, particularly CT and MRI, has revolutionized our knowledge of the burden of cysticercosis infection and disease, and has led to the development of effective antihelminthic treatments for neurocysticercosis. The importance of calcified granulomas with perilesional edema as foci of seizures and epilepsy in populations where neurocysticercosis is endemic is newly recognized, and indicates that treatment with anti-inflammatory agents could have a role in controlling or preventing epilepsy in these patients. Importantly, neurocysticercosis is one of the few diseases that could potentially be controlled or eliminated - an accomplishment that would prevent millions of cases of epilepsy. This Review examines the rationale for treatment of neurocysticercosis and highlights the essential role of inflammation in the pathogenesis of disease, the exacerbation of symptoms that occurs as a result of antihelminthic treatment, and the limitations of current antihelminthic and anti-inflammatory treatments. © 2011 Macmillan Publishers Limited. All rights reserved.


Cosentino C.,Instituto Nacional Of Ciencias Neurologicas | Nunez Y.,Instituto Nacional Of Ciencias Neurologicas | Torres L.,Instituto Nacional Of Ciencias Neurologicas
Arquivos de Neuro-Psiquiatria | Year: 2013

Introduction: Non-motor symptoms in Parkinson's disease are often not well recognized in clinical practice. Non-motor symptoms questionnaire (NMSQuest) is a simple instrument that allows patients or caregivers to report non-motor symptoms in a practical manner. Objective: We attempted to determine the prevalence of non-motor symptoms in three hundred Parkinson ́s disease outpatients. Results: The mean total non-motor symptoms was 12.41, ranging from 0 to 27 of a maximum of 30. At least one was present in 99.3% of patients. A progressive increase in mean total score was observed across each 5-year interval. Depression domain scored the most "positive" answers while urinary and anxiety /memory were secondly and thirdly most prevalent respectively. Conclusion: The large number of patients included in this study allowed evaluation of the occurrence of non-motor symptoms in early and advanced disease in addition to the relationship of these kinds of symptoms with progression of disease.

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