RESEARCH Table 2. Emergency department physicians’ diagnoses for 1,348a neuroimaged seizure patients Diagnosis Etiology uncertain Alcohol or drug abuse/withdrawal Head injury Epilepsy Otherb Brain tumor Metabolic disorder (e.g., hypoglycemia) Stroke Neurocysticercosis Nontraumatic cerebral hemorrhage Syncope, possibly not seizure Meningitis or brain abscess Pseudoseizure Toxoplasmosis No diagnosis documented Seizure patients (%) 515 (38) 253 (19) 105 (7.8) 92 (6.8) 104 (7.7) 42 (3.1) 39 (2.9) 36 (2.7) 30 (2.2) 22 (1.6) 25 (1.9) 18 (1.3) 14 (1.0) 12 (0.9) 42 (3.1) aThe method of categorizing discharge diagnoses was modified during the study. These data represent the last 1,348 of 1,833 patient encounters. bOther category includes six patients with recent neurosurgery, three with toxic levels of anticonvulsant medications, three with reactions to non-anticonvulsant medication, three with systemic lupus erythematosus, and several other less frequently occurring causes. cases. No significant differences were detected in age, seizure history, seizure type, prior history of neurocysticercosis, immi- grant status, or exposure to an endemic region between the patients who underwent serologic testing and those who did not. Nine of the seropositive patients had CT scan findings consistent with neurocysticercosis; nine did not. Compared with the seronegative patients, seropositive patients were more likely to be Hispanic (RR 8.7; CI 3.1 to 24.1), have visited or lived in a neurocysticercosis-endemic region (RR 6.8; CI 2.2 to 20.5), and have an abnormal CT scan (RR 1.7; CI 1.2 to 2.3). Seropositivity was not significantly associated with either new-onset seizures or prior seizure history. Serology was posi- tive in 27% of the patients who had neuroimaging findings characteristic of neurocysticercosis, 5.3% of those with consis- tent neuroimaging findings, and 1.1% of those with neuroim- aging findings inconsistent with neurocysticercosis. Seven patients reported a history of neurocysticercosis. Four (57%) of these patients had neuroimaging findings typi- cal of or consistent with neurocysticercosis. Serologic testing was performed on two of the seven patients with one negative and one positive result. The use of our case definition identified two patients who were not diagnosed with neurocysticercosis by the emergency department physician but who were later clinically diagnosed with neurocysticercosis. One was a child born in the United States to Laotian parents whose travel history was unknown; the other was a man of Hispanic ethnicity whose travel history and immigration status were not available. On the other hand, half of the patients diagnosed with neurocysticercosis by their treating physician did not satisfy our case definition. No con- firmed cases of domestically acquired neurocysticercosis were identified during the study period. Discussion Immigrants continue to make up an increasing proportion of the U.S. population. By some reports, they will constitute up to 60% of the new immigrants and new births over the next few decades (18,19). By the year 2037, Latinos will outnum- ber whites as the dominant ethnic group in California, mirror- ing a population surge that is sweeping across the Southwest (20). Because neurocysticercosis is endemic in many of the countries from which these persons are emigrating, its pres- ence in the United States reflects these immigration trends. Table 3. Neurocysticercosis and selected demographic characteristics of seizure patients, U.S. sites Total seizure patients enrolled Hispanic patients enrolled (%) Immigrants enrolleda (%) Neurocysticercosis patients identified (%) 107 146 300 164 91 174 184 68 185 243 171 1,833 58 (54) 4 (3) 11 (4) 12 (7) 52 (57) 9 (5) 50 (27) 6 (9) 20 (11) 90 (37) 8 (5) 320 (17) 9 (8) 6 (4) 17 (6) 3 (2) 21 (23) 8 (5) 54 (29) 9 (13) 19 (10) 27 (11) 5 (3) 179 (10) 6 (5.6) 0 (0.0) 4 (1.3) 1 (0.6) 9 (9.9) 2 (1.1) 1 (0.5) 0 (0.0) 1 (0.5) 10 (4.1) 4 (2.3) 38 (2.1) Site Albuquerque, NM Atlanta, GA Charlotte, NC Kansas City, MO Los Angeles, CA New Orleans, LA New York, NY Orlando, FL Philadelphia, PA Phoenix, AZ Portland, OR Total 610 aImmigration data were not obtained from the first 490 patients enrolled. Emerging Infectious Diseases • Vol. 8, No. 6, June 2002