Estimating the global burden of neurocysticercosis: Distribution of manifestations among patients seeking care

Objective: To conduct a systematic review of the literature, and where possible, a meta-analysis of the distribution of neurological manifestations among cases of neurocysticercosis (NCC) who seek medical care.

Methods: PubMed, Commonwealth Agricultural Bureau (CAB) Abstracts, and 25 international databases were searched for data pertaining to manifestations associated with NCC. Identified references were reviewed according to a list of eligibility criteria and only publications reporting valid, original data on clinical manifestations associated with NCC were included. When at least two articles were eligible for a specific manifestation, a random-effects model for proportions was run using the R META package.

Results: A total of 1568 documents were initially screened for potential eligibility, 404 candidate articles were reviewed, and 21 articles meeting study criteria were included in the review. People diagnosed with NCC presented with a wide range of clinical manifestations. In all age groups, seizures and epilepsy were by far the most common manifestations (79%, 95%CI: 65%-90%) followed by headaches (38%, 95%CI: 23%-54%) with focal deficits (16%, 95%CI: 10%-24%) and signs of increased intracranial pressure (12%, 95%CI: 6%-19%) coming third with similar estimates.

Discussion: This is the first systematic review of the distribution of clinical manifestations among NCC patients. More than three-quarters of symptomatic NCC patients seeking medical care had seizures or epilepsy. Even though definitions of these conditions were rarely provided, the proportion of NCC cases with seizures/epilepsy was consistent across studies. Other manifestations were less consistent. There is a need for standardization in definition and reporting of NCC-associated manifestations.