What Do Leander Paes, Kamran Akmal, and Robert F. Kennedy Jr. Have in Common?
At first glance, very little.
One is an Indian tennis legend, another a Pakistani cricketer, and the third an American political figure. Yet all three have been linked to the same neurological condition — neurocysticercosis (NCC), a parasitic infection of the brain that is one of the most important preventable causes of seizures and epilepsy worldwide.
Their stories highlight an important preventable and treatable cause of Epilepsy and seizures.
Understanding Epilepsy and Seizures
A seizure is a sudden burst of abnormal electrical activity in the brain. It may manifest as limb jerking, loss of consciousness, staring spells, unusual sensations, or temporary confusion.
Epilepsy is a chronic disease of the brain, a condition characterised by a tendency to have recurrent unprovoked seizures.
More than 50 million people live with epilepsy, and India has >12 million Persons with Epilepsy. A significant proportion of epilepsy cases are linked to preventable causes like brain infections, head injuries, birth-related brain injuries in newborns and substance abuse, especially in low and middle-income nations. Neurocysticercosis is among the most important of these causes. In endemic regions, it may account for up to 30% of epilepsy cases.
What Is Neurocysticercosis?
Neurocysticercosis occurs when the larvae of the pork tapeworm, Taenia solium, enter the human nervous system and form cysts within the brain.
One of the most common misconceptions I encounter in my clinic is, “Doctor, I don’t eat pork, so how can I have neurocysticercosis?” The answer lies in the life cycle of the pork tapeworm (Taenia solium).
Many patients with neurocysticercosis have never consumed pork. This is because the disease is most often acquired through accidental ingestion of tapeworm eggs contaminating food, vegetables, water, or hands. Poor sanitation, open defecation, inadequate sewage disposal, and improper food handling allow these eggs to reach the human mouth through the faecal–oral route.
In agricultural settings, vegetables grown in fields contaminated with untreated human waste or produce washed with contaminated water may carry these microscopic eggs. Since many vegetables and salads are consumed raw, a person can develop neurocysticercosis if they’re not washed properly.
Once ingested, the eggs hatch in the intestine, release larvae, and enter the bloodstream. These larvae can migrate to muscles, skin, eyes, and the brain. When they lodge in the brain, the condition is called neurocysticercosis, one of the leading causes of preventable seizures and acquired epilepsy in developing countries.
Why Does It Cause Seizures?
The brain reacts to the presence of these cysts. As the parasite evolves, degenerates, or dies, inflammation develops around the lesion. This irritation of brain tissue can trigger seizures.
Seizures are the most common clinical presentation of NCC. Depending on the location and stage of the lesion, patients may experience focal seizures, generalised seizures, headaches, raised intracranial pressure, or other neurological symptoms.
In fact, neurocysticercosis is considered one of the leading causes of acquired epilepsy worldwide and remains a major contributor to the epilepsy burden in many developing countries.
The Indian Perspective
India carries a substantial burden of neurocysticercosis.
Studies have shown that NCC is the most common identifiable cause of new-onset seizures in several parts of the country. Research from different regions has demonstrated that a significant proportion of epilepsy cases are attributable to NCC, and estimates suggest that over a million Indians may be living with epilepsy related to this infection.
The disease is not restricted to rural areas or any particular community. Cases are encountered across socioeconomic groups, particularly where sanitation and food hygiene remain inadequate.
How Is It Diagnosed?
Diagnosis begins with a careful clinical evaluation, especially in a person presenting with a first seizure.
Neuroimaging remains the cornerstone of diagnosis.
CT scans are excellent for detecting calcified lesions, while MRI provides superior visualisation of active cysts, surrounding inflammation, ventricular involvement, and other complications. Blood tests and specialised immunological assays may support the diagnosis in selected situations.
Importantly, not every ring-enhancing lesion on imaging represents NCC. Conditions such as tuberculosis, tumours, abscesses, and other inflammatory disorders must also be considered.
Can It Be Treated?
Yes. It’s a treatable disease. Treatment depends on the number, location, and stage of the lesions. Treatment includes regular anti-seizure medications, anti-helminthic medicines and sometimes steroids for short periods. Many patients experience excellent outcomes with appropriate treatment, and seizure control is often achievable. Some patients may require brain surgery.
Prevention: The Real Cure
The encouraging fact about neurocysticercosis is that it is largely preventable.
Simple measures can dramatically reduce transmission:
- Wash hands thoroughly before eating and after using the toilet.
- Consume safe drinking water.
- Wash fruits and vegetables properly.
- Improve sanitation and sewage disposal.
- Identify and treat tapeworm carriers.
- Ensure proper meat inspection and cooking practices.
- Public health interventions targeting hygiene, sanitation, and awareness can prevent countless cases of seizures and epilepsy.
The Take-Home Message
The next time you hear about a seizure, remember that the cause may not always be lifelong epilepsy. Sometimes, the culprit is a tiny parasite that entered the body through contaminated food or water.
The stories of Leander Paes, Kamran Akmal, and Robert F. Kennedy Jr. remind us that neurocysticercosis can affect anyone. The good news is that it is often diagnosable, treatable, and, most importantly, preventable.
In a country like India, where epilepsy continues to carry medical and social consequences, improving awareness about neurocysticercosis may be one of the simplest ways to reduce the burden of preventable seizures.
