(1) Background: This study presents the baseline characteristics of a community-level population of people with epilepsy (n = 1975) living in an area endemic for Taenia solium, the pathogen responsible for neurocysticercosis (NCC). (2) Methods: Participants were sequentially enrolled in a clinical cohort from 2007 to 2020 in Tumbes, Peru. All participants provided demographic and clinical history and received clinical evaluations. Diagnostics, including neuroimaging, cysticercosis serologies, and EEG, were obtained where possible. The data presented are from the cross-sectional baseline assessment of cohort participants. (3) Results: Approximately 38% of participants met the criteria for NCC. Those with NCC were more likely to have adult-onset epilepsy, as well as a longer duration of epilepsy, as compared to their counterparts without NCC. Overall, the data indicate a large treatment gap, with only approximately a quarter of the baseline population with prescriptions for anti-seizure medications. (4) Conclusions: These data reveal a high proportion of NCC among people living with epilepsy in these communities, with limited health care resources. At baseline, 74% of the population were not receiving anti-seizure treatments. Further analyses of these data will clarify the natural history of the disease for this population.

Subarachnoid neurocysticercosis (SANCC) is a severe and progressive brain infection with Taenia solium. We performed a pilot study of noninvasive screening for SANCC in two endemic villages in northern Peru using a urine antigen screen followed by brain magnetic resonance imaging for participants with elevated levels of antigen. Among the 978 participants screened, we identified eight individuals with SANCC, many of whom were asymptomatic. This represents a minimum prevalence of 0.8% of SANCC, a level higher than expected based on prior studies, and a positive predictive value of 62% for our novel urine screening test. Future studies should confirm whether early detection and management improve clinical outcomes.

Mass drug administration (MDA) with niclosamide (NSM) can be used to control taeniasis, the cause of neurocysticercosis. NSM is 84.3% effective against taeniasis and is considered safe as it is not absorbed from the intestinal tract. However, information on its safety and effectiveness during MDA is limited. We evaluated the effectiveness of NSM and reported adverse events (AEs) during a cysticercosis elimination program in Tumbes, Peru. Three rounds of NSM at 4-month intervals were offered to 77,397 eligible residents. We revisited all participants in their homes 72 h after each round to collect information regarding AEs. We also collected post-treatment stool samples to diagnose taeniasis after the first round, followed by a second sample at 30 days from those infected to evaluate NSM's effectiveness. During implementation, 68,751 individuals were administered at least one dose of NSM (mean age 29 years, SD 20; 52% male), and 65,551 (95.3%) were visited post-treatment. 988 (1.5%) reported experiencing at least one AE. Almost all AEs (99.2%) were of mild intensity, with no severe AEs recorded. Of 211 participants diagnosed with taeniasis, 188 provided a follow-up stool sample 30-days after treatment and 141 were cured (treatment effectiveness 75.0%). Older age and higher coproantigen levels were significantly associated with treatment failure. MDA with NSM is safe in Taenia solium endemic settings. However, the effectiveness following one dose is lower than expected, which suggests additional treatment may be necessary to enhance the infection control efforts. The Bill and Melinda Gates Foundation.

Background/Objectives: People of childbearing potential with epilepsy who live in regions endemic for Taenia solium represent a particularly vulnerable population due to the high burden of epilepsy related to neurocysticercosis (NCC) combined with limited access to safer anti-seizure medications (ASMs). However, the extent of these resource limitations and current prescribing practices remains poorly characterized, limiting the development of appropriate clinical guidelines. This study aimed to characterize ASM prescribing patterns, including pregnancy-associated risk profiles and polytherapy, and to evaluate how these patterns vary by demographic and clinical characteristics among people of childbearing potential in an epilepsy cohort in Peru, a region highly endemic for T. solium . Methods: Participants were drawn from a prospective, population-based epilepsy cohort established in Tumbes, Peru (2006–2020). The analytic population included individuals with epilepsy of childbearing potential, defined as females aged 15–49 years. The primary outcome was ASM risk, categorized by pregnancy-associated risk of congenital malformations and adverse neurodevelopmental outcomes. ASMs were classified as “Established Low Risk” (lamotrigine, levetiracetam), “Possible Risk/Inadequate Data” (carbamazepine, phenobarbital, phenytoin), and “Established High Risk” (valproic acid). Prescription patterns were analyzed in relation to demographic and clinical characteristics. Results: Among 1,975 individuals with epilepsy in the cohort, 685 were people of childbearing potential. Approximately one-third met criteria for probable or definite NCC (34.9%). Most ASM prescriptions fell into the “Possible Risk/Inadequate Data” category (87.0%), while 12.8% of participants received medications in the “Established High Risk” category. In multivariable analysis, factors associated with high-risk prescriptions included ASM use prior to enrollment and polytherapy. Discussion: People of childbearing potential with epilepsy in this cohort were predominantly treated with carbamazepine, phenytoin, phenobarbital, and valproate, the ASMs most consistently available in this region during the study period. Despite strong evidence supporting the use of newer-generation agents such as lamotrigine and levetiracetam for individuals who may become pregnant, prescribing patterns in this cohort reflect significant formulary and resource constraints. Current recommendations for the management of people of childbearing potential with epilepsy do not adequately address the realities of care in resource-limited, NCC-endemic settings.

Objective: Cognitive impairment is a common comorbidity among people with epilepsy (PWE) and is associated with disability and reduced quality of life. We characterized the burden of cognitive impairment and identified factors associated with cognitive performance in a large, population-based cohort of PWE living in Northern Peru, a region highly endemic for Taenia solium where neurocysticercosis (NCC) is a common cause of acquired epilepsy. Methods: PWE enrolled in a population-based cohort in Northern Peru between 2007 and 2020 completed the Mini-Mental State Examination (MMSE) at enrollment. Cognitive impairment was defined as an MMSE score <24. Demographic and clinical data, including epilepsy characteristics and NCC status, were collected. Negative binomial regression was used to identify factors associated with the number of MMSE errors. Results: Among 764 participants, the mean MMSE score was 26.4 (SD 4.2), and 16.4% met criteria for cognitive impairment. Memory and attention were the most affected domains. In multivariable analysis, older age and lower educational attainment were independently associated with poorer cognitive performance. Conclusion: In this large, community-based cohort from Northern Peru, approximately 1 in 6 PWE had abnormal global cognition on the MMSE, with memory and attention most affected. These findings underscore the importance of incorporating cognitive evaluation and management into comprehensive epilepsy care, particularly in resource-limited settings where cognitive morbidity may be underrecognized. Given the potential for cognitive difficulties to compound disability and adversely affect quality of life, identifying and addressing cognitive morbidity may be especially important in populations already facing substantial barriers to epilepsy care.