Historical perspective: The British contribution to the understanding of neurocysticercosis

Gagandeep Singh,Josemir W. Sander

doi:10.1080/0964704x.2018.1564523

Gagandeep Singh, Josemir W. Sander

Open Access

https://doi.org/10.1080/0964704x.2018.1564523

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Abstract

ABSTRACTNeurocysticercosis, or brain infestation with the larval stage of Taenia solium, is the most common risk factor for epilepsy in many endemic regions of the world. Hardly any cases are seen in Western developed countries, including Britain. However, a sizeable number (n = 450) was seen among British soldiers returning from deputation to India, then a British colony, first reported by Col. MacArthur at the Queen Alexandria Military Hospital in 1931. Here, we review the influence of the perceptive observations of British Army medics on the understanding of the parasitic disorder. The majority of these people presented with epilepsy. Among the contributions of the army medics were establishing the diagnosis, initially by histological examination of subcutaneous and muscular infestation, and later by radiography, clarifying the prognosis and the role of medical and surgical treatments and uncovering the close relationship between the larval (cysticercosis) and adult (intestinal tapeworm) stages of T. solium.

Highlights

Cysticercosis denotes the infestation of living human tissue with the larval stage of the pork tapeworm, Taenia solium
The presence of the adult tapeworm in human intestines is known as intestinal taeniasis, which is linked to the occurrence of larvae in pigs, known as porcine cysticercosis
Credit goes to MacArthur for creating interest in the disorder as a cause of new-onset epilepsy and other neurological symptoms in British army personnel. (MacArthur, 1933, 1934, 1935)

Summary

Introduction

Cysticercosis denotes the infestation of living human tissue with the larval stage of the pork tapeworm, Taenia solium. The estimated number of people infested with NCC worldwide is between 2.6 and 8.3 million (WHO, 2018) It is the main preventable risk factor for epilepsy, but, is endemic across resourcepoor settings in Latin America, South and Southeast Asia and sub-Saharan Africa (Garcia, Del Brutto & Cysticercosis Working Group in Peru, 2005). From 1970 to 2011, 26 cases were identified from Great Britain, mostly in people of Asian origin (Wadley, Shakir & Rice Edwards 2000; Thaker, Tacconi & Snow 2001; Choksey & Hamid, 2002; Del Brutto, 2012) Prior to these recent reports, a number of cases were described from Britain in the early part of the twentieth century (MacArthur, 1933, 1934 a, b; Dixon & Smithers, 1934; Dixon & Hargreaves, 1944). Notwithstanding the few cursory allusions to this remarkable British contribution in scientific literature, we revisit a series of historical papers to ascertain the evolution of views relating to the pathophysiology, clinical presentations and course of NCC. (Wadia & Singh, 2002; Del Brutto & Garcia, 2015)

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