Reflection and Reaction

even if the cysticercus is located outside limbic circuits. Another possible mechanism is that the cysticerci might lead to variable inflammatory responses and perhaps to hippocampal damage in patients with some still unknown genetic predisposition, similar to that reported in other forms of meningoencephalitis. 4-6 Because women are prone to develop more severe forms of cNCC and more intense inflammatory reactions than men, 3 our observation that significantly more women than men have MTLE-HS and cNCC accords with the idea of inflammation-dependent hippocampal damage caused by neurocysticercosis. Thus, not only acute seizures or status epilepticus provoked by the cysticerci, but also inflammation-mediated hippocampal damage could lead to hippocampal sclerosis and subsequent MTLE-HS. 6 Of course, both mechanisms could contribute to the disorder in the same patient. If this is the case, then neurocysticercosis would act as an initial precipitating injury (IPI) in many patients with MTLE-HS. 4-6 Because of the high prevalence of neurocysticercosis in several regions, this possibility should be seriously considered. Indeed, it may change the way we associate neurocysticercosis with epilepsy, affecting diagnosis, treatment, and other clinical aspects in a very large number of patients worldwide. In our opinion, the association of neurocysticercosis with mesial temporal lobe epilepsy has been poorly reported until now because in areas were the disease is endemic (developing countries) there are few centres dedicated to epilepsy surgery, and many patients might