Question: Hello Doctor, In 2005, patient(F) had initial headache and one seizure, and was diagnosed for Neurocysticercosis. Doctor gave normal NCC course for 3 year and was continued since patient missed some of the medicine in 2009 and 2010. As patient missed medicine in 2010 for around 15 days, it caused a split headache (pulsating in nature). This was diagnosed as Migraine. Having the MRI done in 2010, Neuro Physician (MD, DNB,DM (AIIMS) again asked to start the course of medicine for 3 years till 2013 and one year extra for precaution for 2014. Now the only medication is Lavera (1000 mg x 2). For Migraine, Topiramate was given for one year in period from 2010-2013. From 2010 till date there is no seizure activity and the patient is completely normal and active in the current medication. Please find EEG reports and MRI reports and by looking in the case history, EEGs and MRI reports, please answers my following questions: 1) Is the patient is now having NCC? 2) What is the size of calicified Granulomas (by reading the latest report)? Will it cause any problem in future? Will it dissolve in future? 3) Will focal gliotic area cause problem in this now and in future? 4) Please let me know the meaning of latest MRI report for the 3 spots in layman terms? 5) By going through EEG reports, can we predict that patient will not have seizure in future? 6) In this case, what are the chances that seizure will not happen in life time after leaving medication (by tapering it slowly and stopping it eventually), if the patient is on medication for 3 years & precautionary 1 year( currently on Lavera 1000 mg x 2) and there is no seizure till date in medication? 7) Is there any side effect while taking Lavera in females when they have to conceive a baby in general? 8) Is there a side effect of antiepileptic drugs (like lavera) if taken for long time like 15-20 years in general? 9) Is the immune system become weak due to i) antiepileptic drug and ii) NCC medicine course for 3 years if drug taken for a)5 years, b) 10 years, c) 15 years, d) 20 years? 10) How alcohol contribute to seizure after NCC? 11) Why seizure happens when the NCC is over? Is it because of immune system response or can be the hindrance of signals caused by calcified Granulomas? 12) How the life of a person is changed after NCC is over, if it is completely cured in this case? 13) Is the life span of person is reduced due to NCC and medication for long period? 14) In one EEG report, Seizure[INV] is written but patient reported split headache(pulsation in nature), what it means? Please answer my every question so that I can understand it systematically and secondly if you can provide some research articles matching this case that will help too. Thanks,

Hello Dr. XXXXXXX Thanks for the useful information and answering my questions. I have some follow up questions: 1) Since the size of calcified granuloma is unknown in latest MRI report. A) Is it possible to find the size using the MRI scan images? I can send those in couple of days. B) Secondly, in period of medication, will the size of calcified granuloma usually decrease? C) And how the size affects the chances of seizure in future? 2) In this case, is 10-20 % chances of future seizure is based on 3-4 mm calcified granuloma and present location of it? And is it means that in life time, chances of having seizure is very low (10-20%)? 3) In this case, how can we reduce the chances of seizure further in future? 4) Is there any possibility that Focal gliotic area can go off in future? And how can we help to make it go off( in terms of life style and medications, multivitamins, minerals and superfoods)? 5) What precautions are needed to minimize any seizure activity in future? 6) To investigate further, Can I send medical treatment history in terms of medical prescriptions and MRI scan images? I can provide in couple of days. 7) If medication taken for long time, can it create some problem in other organs like liver and kidney? 8) When can we start tapering the medication? 9) In worse case after tapering and stopping the medication, if some seizure activity is seen in future what can be done? Is it, patient have to start the 3 year course again? And while driving or travelling some activity of seizure if happens, is there any emergency support or medication available? 10) What is the difference between seizure and epilepsy? 11) From reports and my previous narration of medical history, does it means that patient has epilepsy or seizure? 10) Is there any possibility, I can have a phone consultation with you. Please answer these questions in same sequence as you did before. The previous answers helped me a lot to understand the problem. I appreciate your previous prompt reply and making me understand better regarding the case. Thanks again!

Hello Dr. XXXXXXX Thanks for the answers. I am sending prescriptions from 2010 onward, when the patients started missing previous medicines and had a split headache (pulsation in nature). The doctor diagnosed as migraine. Gave those medications prescribed in prescription. Please let me know: 1) What are the future chances of seizure in specific with prescription and MRI report I sent? 2) Whether the patient has to continue with medication in future and for how much time? 3) Please explain the situation according to treatment given in sequence? 4) Whether patient has NCC now? I have MRI CD file which is like 3.8 MB zip format, please advise how I can send those. Thanks,

Hi Dr. XXXXXXX Please suggest on what basis we can say patient have mild to moderate chances of seizure and is this mild to moderate means still 10-20%? Please also suggest what mentioned in prescription or report that patients should continue the medication for 3-5 yrs and what medication patient should take. Thanks

Hello Dr XXXXXXX Thanks for the answers. I have sent the MRI CD to HCM team via email. I hope you get it soon with images from past to latest MRI scans present. 1) Please let me know the findings of the MRI CD. 2) In the last email you mentioned if Lesion is present then the patient has to continue medication for another 3-5 years. In this case, the final MRI report had calcified granuloma and gliotic area, but it doesn't said any lesion. Please advise me on this how patient should continue medication for 3-5 year. Thanks again,

Hi Dr. XXXXXXX I forgot to ask, 1) what is the size of calcified granuloma and gliotic area present in the latest MRI scan image? 2) and usually how much time the medication has to be taken in general here to get over with the risk of seizure like 5 yr or 10 yr or 15 yr or more? 3) what is meant by ' In a k/c/o neurocysticercosis finding are suggestive of regression of the right occipital lesion as described'? Does it means NCC is over or reduced (regression)? Thanks,

Thanks Dr. XXXXXXX for the answers. As you told me earlier that calcified granuloma size can tell the chances of seizure( I mean, chances can tend to 0 if the size tends to 0). I will ask about size to a radiologist. 1) Please let me know what software I can use to see the MRI CD scan images. 2) I was reading online, had some question: a) Is it possible that calified granuloma get diluted and can increase in size and might affect other part of Brain in later stages? b) Is calcified granuloma considered inactive in this case? b) Does the calified granuloma need to be monitored by MRI after every 3 years to see if the size has increased? c) Does taking MRI after 2-3 years can create some problem like tumor in Brain? 3) I was thinking you found the size of Calcified granuloma from MRI CD, and that's why suggested 3-5 year of medication. But it looks like the presence of calcified granuloma in Brain itself a cause to take medication for 3-5 years. Is my understanding correct? 4)Is the patient has be in touch with a Neurologist for taking medication course of 3-5 years? Like the patient has to visit doctor with 6 months frequency or 1 yr or more. Thanks,