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Oscar H. Del Brutto - One of the best experts on this subject based on the ideXlab platform.

  • Neurocysticercosis: A natural human model of epileptogenesis.
    Epilepsia, 2015
    Co-Authors: Theodore E. Nash, Oscar H. Del Brutto, Siddhartha Mahanty, Jeffrey A Loeb, William H Theodore, Alon Friedman, Josemir W Sander, Gagandeep Singh, Esper Cavalheiro, Osvaldo M Takayanagui
    Abstract:

    OBJECTIVE: To develop a better understanding of mechanisms of seizures and long-term epileptogenesis using Neurocysticercosis. METHODS: A workshop was held bringing together experts in epilepsy and epileptogenesis and Neurocysticercosis. RESULTS: Human Neurocysticercosis and parallel animal models offer a unique opportunity to understand basic mechanisms of seizures. Inflammatory responses to degenerating forms and later-stage calcified parasite granulomas are associated with seizures and epilepsy. Other mechanisms may also be involved in epileptogenesis. SIGNIFICANCE: Naturally occurring brain infections with Neurocysticercosis offer a unique opportunity to develop treatments for one of the world's most common causes of epilepsy and for the development of more general antiepileptogenic treatments. Key advantages stem from the time course in which an acute seizure heralds a start of the epileptogenic process, and radiographic changes of calcification and perilesional edema provide biomarkers of a chronic epileptic state.

  • clinical symptoms diagnosis and treatment of Neurocysticercosis
    Lancet Neurology, 2014
    Co-Authors: Hector H. Garcia, Theodore E. Nash, Oscar H. Del Brutto
    Abstract:

    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.

  • Clinical management of Neurocysticercosis
    Expert review of neurotherapeutics, 2014
    Co-Authors: Oscar H. Del Brutto
    Abstract:

    Neurocysticercosis is the most common helminthic disease of the nervous system and a leading cause of acquired epilepsy worldwide. Differences in the number and location of lesions as well as in the severity of the immune response against the parasites, makes Neurocysticercosis a complex disease. Therefore, a single therapeutic approach is not expected to be useful in every patient. Introduction of cysticidal drugs – praziquantel and albendazole – have changed the prognosis of thousands of patients with Neurocysticercosis. While pioneer trials of therapy were flawed by a poor design, recent studies have shown that cysticidal drugs results in disappearance of lesions and clinical improvement in most cases. Nevertheless, some patients with parenchymal Neurocysticercosis may be left with remaining cysts and may develop recurrent seizures after therapy, and many patients with subarachnoid cysts may need repeated courses of therapy. In addition, not all forms of the disease benefit from cysticidal drugs.

  • Neurocysticercosis on the Arabian Peninsula, 2003-2011.
    Emerging infectious diseases, 2013
    Co-Authors: Oscar H. Del Brutto
    Abstract:

    To the Editor: Neurocysticercosis occurs when humans become intermediate hosts of the tapeworm Taenia solium by ingesting its eggs after contact with a Taenia spp. carrier. This parasitic disease is endemic to most of the developing world, where it represents a leading cause of acquired epilepsy (1). In conjunction with an increasing number of immigrants from disease-endemic areas, there has been a recent increase in the number of patients with a diagnosis of Neurocysticercosis in industrialized countries. On the basis of the incorrect assumption that human Neurocysticercosis does not occur in countries in which religious laws prohibit swine breeding and consumption of pork, the disease has been considered nonexistent in Muslim countries of the Arab world. However, sporadic cases were reported during the last 2 decades of the 20th century, mainly in immigrants from India, and several case series have suggested that the prevalence of Neurocysticercosis in the Arab world has been increasing over the past few years. A Medline and manual search of the literature identified 7 reports of 39 patients with Neurocysticercosis on the Arabian Peninsula during 2003–2011 (2–8). Of these patients, 30 were from Kuwait, 5 from Saudi Arabia, and 4 from Qatar. Mean ± SD age of these patients was 16.9 ± 13.4 years (age range 2–44 years), and 25 (64%) were women. Twenty-four patients (62%) were

  • Neurocysticercosis in western europe a re emerging disease
    Acta Neurologica Belgica, 2012
    Co-Authors: Oscar H. Del Brutto
    Abstract:

    The objective of the study was to estimate the magnitude of Neurocysticercosis in Western Europe and to determine the pattern of disease expression in the region. Review of patients with Neurocysticercosis diagnosed in Western Europe from 1970 to 2011. Abstracted data included: demographic profile, clinical manifestations, form of Neurocysticercosis, and whether the disease occurred in immigrants, European international travelers, or Europeans who had never been abroad. A total of 779 patients were found. Of these, only 28 were diagnosed before 1985. Countries with more reported patients were Portugal (n = 384), Spain (n = 228), France (n = 80), The United Kingdom (n = 26), and Italy (n = 21). Information on citizenship status, clinical manifestations, and forms of the disease was available in only 30–40 % of patients. Immigrants accounted for 53 % of cases, European travelers for 8 %, and non-traveler Europeans for 39 %. Immigrants/European travelers were most often diagnosed during the new Millennium, presented most often with seizures, and had less frequently inactive (calcified) Neurocysticercosis than non-traveler Europeans. The prevalence of Neurocysticercosis in Western Europe may be on the rise. The pattern of disease expression is different among immigrants/European travelers than among non-traveler Europeans. It is possible that some patients had acquired the disease as the result of contact with Taenia solium carriers coming from endemic countries. Much remains to be learned on the prevalence of Neurocysticercosis in this region.

Hector H. Garcia - One of the best experts on this subject based on the ideXlab platform.

  • clinical symptoms diagnosis and treatment of Neurocysticercosis
    Lancet Neurology, 2014
    Co-Authors: Hector H. Garcia, Theodore E. Nash, Oscar H. Del Brutto
    Abstract:

    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.

  • Diagnosis and treatment of Neurocysticercosis
    Nature reviews. Neurology, 2011
    Co-Authors: Theodore E. Nash, Hector H. Garcia
    Abstract:

    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.

  • Corticosteroid use in Neurocysticercosis.
    Expert review of neurotherapeutics, 2011
    Co-Authors: Theodore E. Nash, Siddhartha Mahanty, Hector H. Garcia
    Abstract:

    The cystic larvae of Taenia solium commonly infect the human nervous system, resulting in Neurocysticercosis, a major contributor to seizure disorders in most of the world. Inflammation around the parasites is a hallmark of Neurocysticercosis pathophysiology. Although mechanisms regulating this inflammation are poorly understood, anti-inflammatory drugs, particularly corticosteroids, have been long used alone or with anthelmintics to manage disease and limit neurological complications and perhaps damage to neural tissues. Only scarce controlled data exist to determine when and what type of corticosteroids and the treatment regime to use. This article revisits the mechanisms of action, rationale, evidence of benefit, safety and problems of corticosteroids in the context of Neurocysticercosis, as well as alternative anti-inflammatory strategies to limit the damage caused by inflammation in the CNS.

  • Neurocysticercosis: some of the essentials
    Practical Neurology, 2006
    Co-Authors: Hector H. Garcia, Victor C W Tsang, Armando E. Gonzalez, Robert H. Gilman
    Abstract:

    Cysticercosis, widely endemic in most developing countries, is now beginning to appear with some frequency in industrialised countries as a result of both increasing travel and globalisation. Fortunately, advances in diagnostic methods, clinical knowledge, and the epidemiology of taeniasis and Neurocysticercosis have enriched our understanding of the evolution of this infection and the resulting disease. Modern neuroimaging can now demonstrate milder cases than hitherto, and epidemiological studies using computed tomography (CT) in endemic settings have revealed asymptomatic brain calcifications in 10–20% of the general population.1–3 Neurologically symptomatic individuals attending health centres clearly represent only the tip of a sizable iceberg of infection.4 This article will summarise basic information that should allow neurologists to make the diagnosis and manage human Neurocysticercosis. As the result of poor socioeconomic development and domestic pig raising, cysticercosis is highly endemic in most developing countries around the world (fig 1). Even in Europe, transmission (albeit at very low rates) still seems to occur in Portugal and Northern Spain.5 6 And in the USA and most of Europe, Neurocysticercosis is increasingly recognised as a cause of seizures,7 primarily in immigrants and individuals who have travelled to endemic areas where transmission is common and where serological evidence of exposure to the parasite can be found in 10–25% of the general population. Figure 1 Geographic distribution of Neurocysticercosis (Reproduced with permission from Roman G et al . A proposal to declare Neurocysticercosis an international reportable disease. Bull World Health Organ 2000;78:399–406. [OpenUrl][1][PubMed][2][Web of Science][3] ) Clinically, the magnitude of the disease burden associated with Neurocysticercosis in endemic countries is enormous; it is the most common cause of acquired epilepsy, and in nearly 30% of patients with seizures the cause is Neurocysticercosis.1–3 An estimated 75 million individuals in Latin America alone … [1]: {openurl}?query=rft.jtitle%253DBulletin%2Bof%2Bthe%2BWorld%2BHealth%2BOrganization%26rft.stitle%253DBull%2BWorld%2BHealth%2BOrgan%26rft.aulast%253DRom%25C3%25A1n%26rft.auinit1%253DG.%26rft.volume%253D78%26rft.issue%253D3%26rft.spage%253D399%26rft.epage%253D406%26rft.atitle%253DA%2Bproposal%2Bto%2Bdeclare%2BNeurocysticercosis%2Ban%2Binternational%2Breportable%2Bdisease.%26rft_id%253Dinfo%253Apmid%252F10812740%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10812740&link_type=MED&atom=%2Fpractneurol%2F6%2F5%2F288.atom [3]: /lookup/external-ref?access_num=000086348000019&link_type=ISI

  • Neurocysticercosis: updated concepts about an old disease
    The Lancet. Neurology, 2005
    Co-Authors: Hector H. Garcia, Oscar H. Del Brutto
    Abstract:

    Neurocysticercosis, the infection of the human brain by the larvae of Taenia solium, is a major cause of acquired epilepsy in most low-income countries. Cases of Neurocysticercosis are becoming more common in high-income countries because of increased migration and travel. Diagnosis by neuroimaging and serological assessment has greatly improved over the past decade, and the natural progression of the disease and response to antiparasitic drugs is now much better understood. Neurocysticercosis is potentially eradicable, and control interventions are underway to eliminate this infection. Meanwhile, updated information on diagnosis and management of Neurocysticercosis is required, especially for clinicians who are unfamiliar with its wide array of clinical presentations.

Philips Perera - One of the best experts on this subject based on the ideXlab platform.

Craig M. Powell - One of the best experts on this subject based on the ideXlab platform.

  • Multilevel Intramedullary Spinal Neurocysticercosis With Eosinophilic Meningitis
    Archives of Neurology, 2004
    Co-Authors: Amir M. Torabi, Mary Quiceno, Dianne B. Mendelsohn, Craig M. Powell
    Abstract:

    Background Cysticercal involvement of the spinal cord is a very rare form of Neurocysticercosis. Intramedullary cysts are even less common. Objective To describe a novel presentation of multilevel intramedullary Neurocysticercosis with eosinophilic meningitis. Design Case report. Patient A 35-year-old man with a history of cerebral Neurocysticercosis who presented with both cauda equina and Brown-Sequard syndromes associated with cerebrospinal fluid findings of eosinophilic meningitis. Results Magnetic resonance imaging confirmed the multilevel intramedullary cord lesions. The patient was treated medically with dexamethasone and albendazole and had a good recovery. Conclusion Intramedullary Neurocysticercosis should be considered as a potentially treatable cause of multilevel spinal lesions with subacute meningitis.

Brian Rice - One of the best experts on this subject based on the ideXlab platform.