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| LETTER TO THE EDITOR |
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| Year : 2021 | Volume
: 34
| Issue : 2 | Page : 757-758 |
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Toxoplasma gondii, Taenia solium, and adult-onset epilepsy
Jamir P Rissardo, Ana L. F. Caprara
Department of Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| Date of Submission | 03-Apr-2020 |
| Date of Decision | 05-May-2020 |
| Date of Acceptance | 16-May-2020 |
| Date of Web Publication | 30-Jun-2021 |
Correspondence Address:
Jamir P Rissardo
Brazil
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/mmj.mmj_117_20
How to cite this article:
Rissardo JP, Caprara AL. Toxoplasma gondii, Taenia solium, and adult-onset epilepsy. Menoufia Med J 2021;34:757-8 |
We read the article entitled 'Probable relationship between Toxoplasma gondii and children with cryptogenic epilepsy' on the esteemed Menoufia Medical Journal with great interest. Khatab et al. [1] studied cryptogenic epilepsy in children, who were investigated for the seropositivity rate for antitoxoplasma immunoglobulin G antibodies. They found that the percentage of patients with chronic T. gondii infection is higher in cryptogenic epileptic patients than in individuals with known-cause epilepsy.
Herein, we would like to discuss more the relation between helminths infection and epilepsy, which is a particularly important topic in developing countries.
Some drawbacks of the study of Khatab and colleagues are that a small and selected population was studied, their percentage of cryptogenic epilepsy was higher than other general studies, and probably the association of antitoxoplasma immunoglobulin G antibodies could not directly explain the origin of epilepsy [2]. The presence of these antibodies positivity only suggests an immune memory to an infection. In this way, we believe that only larger studies assessing the epilepsy features since its beginning will probably elucidate this question [1].
However, their study contributed to the literature reinforcing the association of toxoplasmosis and cryptogenic epilepsy. Moreover, Khatab and colleagues discussed that maybe cryptogenic epileptic individuals are susceptible to the parasitic infection, for reasons unrelated to epilepsy, or owing to intrinsic immunologic differences that predispose them to epilepsy. Therefore, an explanation could be a misleading immunological response that would lead to the susceptibility of infection and epilepsy. A supporting finding of this theory is the presence of seizures caused by an abnormal inflammatory response in some infections, in which before and after the event, a marked elevation of these biomarkers was observed [3].
Another interesting point that the authors could have discussed is how much difficult was it to control the epilepsy of these patients? How many drugs were used? Were there any clinical predictors associated with drug-resistant epilepsy? Caprara et al. [4] assessed the clinical predictors associated with drug-resistant adult-onset epilepsy in Brazil during a long-term follow-up, in which more than 300 patients were followed for almost 10 years. Structural epilepsy etiology was associated with an increased chance of relapsing of 1.74 odds ratio (OR) [confidence interval (CI): 1.66–1.89], but the infectious etiology (neurocysticercosis) was positively associated with non-drug resistant (OR: 1.012, CI: 1.001–1.215). Thus, it is possible the association of neurocysticercosis as a protective factor in the development of drug-resistant epilepsy. We believe that this association should also be mentioned or analyzed by Khatab and colleagues.
A recent meta-analysis evaluating the association between T. gondii infection and risk of epilepsy in almost 800 individuals showed that cryptogenic epilepsy (OR: 2.65, CI: 1.91–3.68) and active convulsive epilepsy (OR: 1.37, CI: 1.09–1.72) were significantly associated with toxoplasmosis [5]. However, a seroepidemiological study with an Iranian population, which assessed epilepsy without subgroup analysis, revealed that the rate of T. gondii infection in epileptic patients was not higher than non-epileptic patients and healthy people in the Iranian population [6].
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Khatab AA, Soliman MA, Abd El-Naby SA, El-Dabaa SS. Probable relationship between Toxoplasma gondii and children with cryptogenic epilepsy. Menoufia Med J 2020; 33:157.  |
| 2. | Hedman K, Lappalainen M, Seppäiä I, Mäkelä O. Recent primary toxoplasma infection indicated by a low avidity of specific IgG. J Infect Dis 1989; 159:736-740. |
| 3. | Rissardo JP, Caprara AL, Silveira JO. Generalized convulsive status epilepticus secondary to jarisch-herxheimer reaction in neurosyphilis: a case report and literature review. Neurologist 2019; 24:29-32. |
| 4. | Caprara ALF, Rissardo JP, Leite MT, Silveira JO, Jauris PG, Arend J, et al. Course and prognosis of adult-onset epilepsy in Brazil: a cohort study. Epilepsy Behav 2020; 105:106969. |
| 5. | Sadeghi M, Riahi SM, Mohammadi M, Saber V, Aghamolaie S, Moghaddam SA, et al. An updated meta-analysis of the association between Toxoplasma gondii infection and risk of epilepsy. Trans R Soc Trop Med Hyg 2019; 113:453-462. |
| 6. | Babaie J, Sayyah M, Gharagozli K, Mostafavi E, Golkar M. Seroepidemiological study of Toxoplasma gondii infection in a population of Iranian epileptic patients. EXCLI J 2017; 16:256. |
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