Clinical, Immunological, and Neuroimaging Characteristics and Outcome Profile of Neurocysticercosis in Children at a Neurology Department in Antananarivo: A Retrospective Observational Study.

INTRODUCTION: Madagascar is an endemic area for neurocysticercosis (NCC). This study aimed to describe the clinical, immunological, and neuroimaging findings, as well as the clinical and radiological outcomes, in Malagasy children. METHODS: This retrospective, descriptive, observational cohort study was conducted from October 2013 to October 2017 in the neurology department of a hospital in Antananarivo. Pediatric cases of NCC were diagnosed using brain CT and serological tests (serum/cerebrospinal fluid). Clinical follow-up was performed for all patients, while CT/MRI follow-up was carried out only in active cases. RESULTS: Of the 125 patients enrolled, 30 (24%) were included in the study. The cohort consisted of 16 boys and 14 girls, with a mean age of 9.6 years (range: 2-15 years). The main symptoms were epilepsy in 26 patients (86.6%), headaches in three (10%), and dystonia in one (3.3%). Imaging revealed isolated parenchymal lesions in 11 cases (36.6%), isolated meningeal involvement in six cases (20%), and mixed involvement (parenchymal and meningeal) in 13 cases (43.3%). Analysis of outcomes showed stable epilepsy in cases with isolated parenchymal lesions or solitary calcified lesions, whereas seizure recurrence was observed in cases with mixed or multiple lesions. DISCUSSION: A high frequency of parenchymal and multiple meningeal forms was observed in Malagasy children. Early infection appears to be common, preceding the typical 5-10-year latency period required for lesion calcification. The long-term prognosis is poor in mixed forms, with a risk of drug-resistant epilepsy. CONCLUSION: Pediatric NCC requires an innovative approach to diagnosis and therapeutic management.