Does ensuring optimum vitamin D levels result in early resolution of neurocysticercosis?

Abstract

Background

Neurocysticercosis is a leading cause of acquired epilepsy. Calcified granulomas are known to cause seizure recurrence. Researchers have reported that vitamin D deficiency is associated with brain calcification and reduction in calcification occurs with vitamin D receptor agonist calcitriol through upregulation of SLC20A2. Based on these observations, a hypothesis was proposed that the occurrence of calcification could be reduced by optimizing vitamin D levels, resulting in early resolution of neurocysticercosis.

Methodology

A case-control (retrospective and prospective) study on 60 children with solitary intraparenchymal neurocysticercosis, 20 new cases prior to starting cysticidal therapy and other 40 resolved cases was carried out. Among new cases, children deficient in vitamin D were given megadose of vitamin D and vitamin D levels were rechecked after 30 days. Children having normal vitamin D were taken as cases and the deficient ones were taken as controls. Standard treatment for neurocysticercosis was given. Three monthly MRI scans were done. Outcome was evaluated as resolution/persistence of neurocysticercosis at 3, 6, 9 and 12 months.

Statistics and Results

Pearson chi square/Fisher’s exact test was used along with Kaplan Meier and log rank test. Of 60 patients, at 6 months 3 cases and 4 controls (p value 0.43), at 9 months 2 cases and 6 controls (p value 0.037) and at 12 months 3 cases and 6 controls (p value 0.029) had complete resolution of NCC.

Conclusion

The results do not show that adequate vitamin D levels result in early resolution of neurocysticercosis.

Keywords:

• Calcified neurocysticercosis
• Vitamin D
• early resolution

Acknowledgment

I thank Dr. Roosy Aulakh, Dr. Pankaj Kumar, Dr.Ravinder Kaur and Dr. Jasbinder Kaur for their expertise and assistance throughout all aspects of the study and for their help in writing the manuscript

Disclosure statement

No potential conflict of interest was reported by the authors.

Table 1. Group division and analysis.

Table 2. Comparison of demographic variables of CASES and CONTROLS.

Table 3. Comparison of seizure specific variables of CASES and CONTROLS.

Table 4. Comparison of NCC specific variables of CASES and CONTROLS.

Table 5. Comparison of vitamin D levels among various groups.

Figure 1. Study algorithm and flow diagram.

Figure 2. Neuroimaging follow up in cases and controls to look for NCC resolution or persistence.

Funding

The author(s) reported there is no funding associated with the work featured in this article.