We discussed a case of a young man who presented to the hospital after having a seizure. He had a history of neurocysticercosis complicated by seizures many years ago. His most recent seizure was in the setting of restarting albendazole.
We discussed how to come up with a broad and organized ddx for the cause of seizures using the MIST mnemonic, practical knowledge for acute seizure management, and highlights regarding the management and treatment of neurocysticercosis.
Acute seizure management
- Check the patient’s ABCs and IV access
- Check for hypoglycemia
- Ativan 2-4 mg IV pushes x3
- Status epilepticus:
- continuous seizure that lasts ≥5 min OR
- ≥2 discrete seizures w/out return to neuro baseline between seizures
- Neuroimaging can definitely diagnose neurocysticercosis
- Serologies can be helpful. The test of choice is enzyme-linked immunoelectrotransfer blot (EITB)
- Antiparasitic therapy can cause degeneration of cysticerci -> inflammatory response.
- In patients with ocular disease, the inflammatory response can cause edema and lead to blindness. Therefore, always consult ophthalmology to rule out ocular neurocysticercosis prior to starting antiparasitics.
- In patients with CNS disease, the inflammatory response can cause edema and lead to seizures. Therefore, concomitant corticosteroids with antiparasitic medications (and AEDs) is recommended.