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Se presenta un caso de Panencefalitis Esclerosante sub aguda post sarampión (PEESA), el primero en nuestro medio corroborado por técnicas de inmuno histoquímica y con el cual deseamos llamar la atención en varios puntos:

Neurocysticercosis is an infection of the nervous system caused by Taenia solium. It is the most important human parasitic neurological disease and a common cause of epilepsy in Africa, Asia, and Latin America, representing enormous costs for anticonvulsants, medical resources and lost production. Neurocysticercosis is a human-to-human infection, acquired by the faecal-enteric route from carriers of intestinal T. solium, most often in areas with deficient sanitation. Intestinal tapeworms cause few symptoms, but adult taeniae carried by humans release large numbers of infective eggs and are extremely contagious. Ingestion of poorly cooked pig meat infested with T. solium larvae results in intestinal taeniosis but not neurocysticercosis. With a view to hastening the control of taeniosis and neurocysticercosis we propose that neurocysticercosis be declared an international reportable disease. New cases of neurocysticercosis should be reported by physicians or hospital administrators to their health ministries. An epidemiological intervention could then be launched to interrupt the chain of transmission by: (1) searching for, treating and reporting the sources of contagion, i.e. human carriers of tapeworms; (2) identifying and treating other exposed contacts; (3) providing health education on parasite transmission and improvement of hygiene and sanitary conditions; and (4) enforcing meat inspection policies and limiting the animal reservoir by treatment of pigs. We believe that the first step required to solve the problem of neurocysticercosis is to implement appropriate surveillance mechanisms under the responsibility of ministries of health. Compulsory notification also has the major advantage of providing accurate quantification of the incidence and prevalence of neurocysticercosis at regional level, thus permitting the rational use of resources in eradication campaigns.

Neurocysticercosis is the main cause of acquired epilepsy in developing countries and is an emerging disease in the United States. Introduction of the immunoblot assay provided a new tool for the diagnosis and monitoring of neurocysticercosis. This study analyzed the relationship between clinical characteristics of cerebral infection (number and type of lesions) plus the baseline response on immunoblot and the changes observed after therapy. Reaction to all 7 diagnostic bands was associated with severe infection (more lesions). Seventeen patients (35%) had no active lesions on computed tomography (CT) 3 months after therapy and were considered cured. Although most cured patients remained seropositive after 1 year, 3 became seronegative before 9 months. In these 3 cases, the lesions had resolved on CT at 3 months. Persistent seropositivity does not necessarily indicate active infection. Serologic follow-up will be clinically helpful only in rare cases in which early antibody disappearance occurs.

In most developing countries, 10% of acute neurologic cases are patients with neurocysticercosis (NCC). Determining specific factors associated with contracting NCC will facilitate its diagnosis and prevention. We examined multiple socioeconomic, demographic, environmental, medical, and behavioral characteristics of 946 Peruvian neurologic patients for a correlation with NCC, which was diagnosed by the highly specific and sensitive electroimmunotransfer blot (EITB) or immunoblot assay. Eighteen percent (172 of 932) of serum samples and 28% (101 of 362) of cerebrospinal fluid samples were EITB-positive. The proportion of EITB-positive persons was similar for all socioeconomic levels. Significant factors associated with NCC were: 1) being born outside Lima, 2) having raised pigs, 3) more than 20 years of age, 4) a history of seizures, and 5) a history of taeniasis. Of these factors, raising pigs is the only one that is amenable to intervention, via improvements in animal husbandry.

We tested a novel approach to assay Taenia solium prevalence using the enzyme-linked immunoelectrotransfer blot assay in sentinel piglets to determine environmental contamination with T. solium eggs in a disease-endemic zone in Peru. Twelve sentinel piglets from an area where the disease is not present were tested at two months of age, moved to an area where the disease is endemic, and retested at the of age nine months. Sentinel piglets native from this T. solium-endemic area were also tested concurrently at two and nine months of age. Of the non-native pigs, 33% (4 of 12) acquired new infection. Of the 28 native pigs tested, 64% (18 of 28) acquired the infection. In a subset of the native piglets from seronegative sows, 44% (4 of 9) were infected at five months of age. Serodiagnosis of sentinel piglets is a practical method to detect T. solium eggs in the environment. Furthermore, it permits indirect assessment of human risk, which may be useful for monitoring the efficacy of intervention programs.

Serum samples from sequential patients who underwent cerebral computed axial tomography (CT) scan in a Peruvian radiologic clinic were tested by the highly sensitive and specific enzyme-linked immunoelectrotransfer blot (EITB) test to detect antibodies to Taenia solium. The results of the EITB test were compared with those obtained by CT scan for the diagnosis of neurocysticercosis. Of the 383 patients sampled, 32 (8%) were seropositive. The results of CT and EITB were frequently discrepant. When compared with the EITB assay, the CT scan was 44% sensitive and 95% specific. The sensitivity of CT increased to 63% if less specific images (single calcifications, granulomas, or hydrocephalus) were included. The CT scan for diagnosis of cysticercosis can best be used in conjunction with a reliable serologic test such as the EITB.

This study was carried out to determine the prevailing type of epilepsy in neurocysticercosis. We also evaluated if it could account for the predominance of generalized epilepsy in Peru. We studied the records and EEGs of 49 cases of neurocysticercosis, representing 5.9% of all hospital admissions. Cysticercosis was diagnosed using clinical, blood, CSF (complement fixation, ELISA, immunoblot) and CT scan criteria. We found 49 epileptic patients. Their type of epilepsy was as follows: 35 subjects had generalized epilepsy and 14 had partial epilepsy (5 motor partial, 5 complex partial, both with secondary generalization and 4 motor partial). All but 3 patients were over 25 years old (mean 33 years). We conclude that generalized epilepsy is frequent among cysticercosis patients and that it may account, partially, for the predominance of generalized seizures in Peru and in other areas of South America where cysticercosis is endemic.

Three of 6 patients with spastic paraparesis in Lima, Peru, were found to have antibodies to human T-lymphotropic virus type I (HTLV-I). Blood and cerebrospinal fluid antibodies were confirmed by Western blot analysis. Multilobulated lymphocytes in blood and cerebrospinal fluid of the index case stained with monoclonal antibodies for T-helper cells and for T10, an activation marker. Blood mononuclear cells from patients with HTLV-I–associated myelopathy showed spontaneous proliferation in culture, evidence of interleukin-2 receptors, and decreased natural killer cell activity.

A 66 year-old man suffered of a manic-depressive illness. Tardive dyskinesia appeared after a treatment with chlorpromazine. Abnormal movements were present at normal and depressive states, but disappeared during manic phases. A few similar cases have been reported. The authors suggest that a modification in the sensibility of monoaminergic receptors could explain the disappearance of dyskinetic movements during mania.

Annals of NeurologyVolume 16, Issue 5 p. 621-621 Letter Successful treatment of two cases of intention tremor with clonazepam Luis Trelles MD, PhD, Luis Trelles MD, PhD Department of Neurology Santo Toribio Neurological Hospital Lima, PeruSearch for more papers by this authorJ. O. Trelles Md, PhD, J. O. Trelles Md, PhD Department of Neurology Santo Toribio Neurological Hospital Lima, PeruSearch for more papers by this authorConrado Castro MD, Conrado Castro MD Department of Neurology Santo Toribio Neurological Hospital Lima, PeruSearch for more papers by this authorJuan Altamirano MD, Juan Altamirano MD Department of Neurology Santo Toribio Neurological Hospital Lima, PeruSearch for more papers by this authorMax Benzaquen MD, Max Benzaquen MD Department of Neurology Santo Toribio Neurological Hospital Lima, PeruSearch for more papers by this author Luis Trelles MD, PhD, Luis Trelles MD, PhD Department of Neurology Santo Toribio Neurological Hospital Lima, PeruSearch for more papers by this authorJ. O. Trelles Md, PhD, J. O. Trelles Md, PhD Department of Neurology Santo Toribio Neurological Hospital Lima, PeruSearch for more papers by this authorConrado Castro MD, Conrado Castro MD Department of Neurology Santo Toribio Neurological Hospital Lima, PeruSearch for more papers by this authorJuan Altamirano MD, Juan Altamirano MD Department of Neurology Santo Toribio Neurological Hospital Lima, PeruSearch for more papers by this authorMax Benzaquen MD, Max Benzaquen MD Department of Neurology Santo Toribio Neurological Hospital Lima, PeruSearch for more papers by this author First published: November 1984 https://doi.org/10.1002/ana.410160516Citations: 23AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume16, Issue5November 1984Pages 621-621 RelatedInformation