Q: I am a 28 years old male who got seizures within a gap of half an hour. An MRI scan showed 7 x 6 x 7 mm ring enhancing lesion with extensive peri-lesional oedema in the posterior part of the left frontal lobe. The lesion shows no restriction of diffusion. Final diagnosis is solitary ring enhancing CNS lesion - probable neurocysticercosis. I have been taking Albendazole (twice daily), Wysolone and Epsolin er (300 mg). I don't eat pork and no one in my family has this problem. I have not even got fever also for the last two years. Why am I suffering from seizures? Am I on right treatment for seizures?

A:In all probability the lesion in this case appears to be neurocysticercosis, though MRI alone is not a concluding evidence, and tuberculosis is also a possibility. This parasite completes its life cycle in two hosts- human and pig, and pork consumption was considered a common risk factor in the past. However, nowadays, contamination of vegetables through pig excreta etc is possible. Hence this infestation is also seen among vegetarians. Hence it is always advisable to eat only thoroughly washed, cleaned and properly cooked raw vegetables.

Once it has formed a cyst in the human brain, the parasite dies in a few weeks. While dying, it liberates some poisons, due to which the surrounding brain gets swollen and seizures or other neurological dysfunction may occur.

The treatment you have received is correct. Three months after finishing the albendazole course, you should repeat MRI brain with contrast, to check whether the cyst has resolved.

You should continue the antiepileptic Eptoin (Phenytoin) for at least one year, though some recommend it for three years. Some people may still have risk of seizures for the rest of their lives, but these seizures are usually well controlled with medicines. Rare patients tend to develop recurrent neurocysticercosis, which has similar treatment.