When Krishna Thapa experienced a sudden bout of seizure, his friends rushed him to the emergency room. The episode lasted about three minutes and Krishna became somnolent afterwards. By the time the 20-year-old found himself on the hospital bed, he was less drowsy and was able to answer simple questions. He told the doctors that he was experiencing a throbbing headache.
Except for the recent history of seizure and somnolence which seemed to be improving, Krishna’s preliminary medical tests came out positive and he had no other problems. After being treated with anti-seizure medicines, his health improved remarkably within hours and the doctors discharged him at the care of his hostel friends. They asked him to come back for a follow up a few days later and recommended a CT scan. Krishna had no further episodes of seizure, but the CT scan was abnormal. It revealed a ‘worm’ in the brain lesion.
Worm in the brain or neurocysticercosis is a very common cause of epilepsy among young Nepalis. We have all seen how pigs and wild boars forage the garbage dumps along the banks of the Bagmati. So it is little wonder the disease is endemic here. Indeed all of South Asia is considered an area of endimicity for this disease.
Infections are caused by a tapeworm found in pigs called taenia solium which are transmitted either through the consumption of undercooked pork or through the faecal-oral method ie eating food contaminated with taenia solium eggs. Once the cystecerci (larva) enters the human body, it develops in the intestine, penetrates the walls, and gets into the bloodstream. The eggs then travel to the brain, eyes, or muscles and form cysts. Pigs get the disease by eating human faeces that contain the eggs of the tapeworm. The eggs turn into larvae in a pig’s muscles which humans then ingest. And so the vicious cycle continues.
In Krishna’s case, the cysts formed in the brain, caused an inflammatory reaction, and led to seizure. So whenever young people experience seizures it is important to carry out a CT scan to rule out neurocysticercosis as treatment with drugs like albendazole or praziquantel may be necessary.
Since neurocysticercosis is extremely rare in the developed world, and doctors there have little experience regarding this disease, travellers with the disease are often incorrectly diagnosed with brain tumor after returning to their native countries. An important reason why developed countries have few cases of neurocysticercosis is that post Second World War, there was a strong public health campaign to keep pigs away from human faeces and confine them to enclosed piggeries.
With the festive season right around the corner, the consumption of pork in Nepal is likely to sky rocket. Besides following general health and hygiene precautions – whether dining at home or out – only eat well cooked pork meat if you want to avoid spending the holidays in a hospital bed.
Finally, for prevention for those living in areas of endimicity some doctors advocate taking a dose of worm medicine like albendazole once or twice a year.