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Our aim was to study long-term clinical and radiologic outcome in children with parenchymal neurocysticercosis (NCC) and its predictors.Five hundred children with NCC registered in the pediatric NCC clinic between January 1996 and December 2002 and followed till December 2009 were enrolled. Demographic details, clinical presentations and therapy received were recorded. Outcome was evaluated in terms of seizure recurrence and resolution of lesions on neuroimaging. Various factors that could influence outcome were studied.Mean age at presentation was 8 ± 2.7 years, and the mean duration of follow-up was 8.8 ± 2.03 years; 79.6% (398) had single lesion, and 20.4% (102) had multiple lesions at presentation; 14.5% (58) of children with single lesion, and 28.4% (29) of children with multiple lesions had recurrent seizures (P < 0.001) during follow-up. At 6-month follow-up neuroimaging, resolution was seen in 52.7% (210) and 31.3% (32) of children with single and multiple lesions, respectively (P < 0.001). On prolonged follow-up, 94.6% (384) of single-lesion NCC and 88% (90) of multiple-lesion NCC (P < 0.001) had radiologic resolution. Single-lesion NCC, radiologic resolution and cysticidal therapy were associated with better seizure outcome (P < 0.05). Children with multiple lesions had significantly higher percentage of calcified lesions on long-term follow-up compared with those with a single lesion (11.7% vs. 3.6%, P < 0.05).Children with a single-lesion NCC have favorable outcome with resolution of most of the lesions and few seizure recurrences. Cysticidal therapy leads to better seizure control and increased resolution of lesions on short-term follow-up.