Neurocysticercosis
Key Points
Key Points
- Neurocysticercosis (NCC) is a spectrum of diseases that differ in pathogenesis and optimal management.
- Symptomatic therapya should be the focus of initial and emergency management.
- Anti-parasitic treatment is important, but never an emergency.
- Parenchymal cystic NCC has better outcomes if treated with anti-parasitic drugs along with corticosteroids.
- Subarachnoid NCC does not respond well to single anti-parasitic drugs at doses and durations used for parenchymal NCC. Optimal management may require chronic anti-inflammatory therapy, intensive anti-parasitic therapyb and surgical therapy.c
- Ventricular NCC of the 3rd and lateral ventricles should be treated with minimally invasive surgery when possible, but minimally invasive and open craniotomy are options for 4th ventricular disease. Open craniotomy or cerebrospinal fluid (dCSF) diversion along with anti-parasitic drugs are optimal in select cases. Anti-parasitic therapy should be deferred until after surgical therapy.
- Calcified lesions do not contain viable parasites and should not be treated with anti-parasitic drugs.
b Anti-parasitic therapy for subarachnoid NCC may include prolonged courses of albendazole, high dose albendazole, or combinations of praziquantel and albendazole.
c
Surgical therapy for subarachnoid NCC may include CSF diversion for hydrocephalus or minimally invasive surgical debulking.
d
Adherent cysticerci should be managed with CSF diversion along with anti-parasitic drugs. Open craniotomy is effective for 4th ventricular lesions and the choice of approaches should depend on local surgical expertise.
Definition of Terms
...nition of TermsHaving trouble viewing table? Ex...
Diagnosis
...agnosis
...ifestations of NeurocysticercosisHaving t...
...re is a wide range of clinical manifes...
...ion should include careful history and physi...
...recommends serologic testing with en...
...ng crude antigen should be avoided due to poor s...
...mmends both a brain MRI and a non-co...
...ests screening for latent tuberculosis infectio...
...Panel suggests screening or empiric th...
...nel recommends that all patients w...
...ts that the patient with NCC who has probably ac...
...anel recommends that patients treated with albe...
...itional monitoring is needed for patients rece...
Treatment
...atment...
...arenchymal Neurocysticercosis (VPN)Â...
...th untreated hydrocephalus or diffuse cerebr...
...absence of elevated intracranial pressure,...
...he Panel recommends albendazole mon...
...anti-parasitic therapy. ( W , M)705...
...e Panel recommends albendazole (15 mg/k...
The Panel suggests retreatment with anti-parasiti...
...he Panel recommends adjunctive corticosteroid...
...nel recommends anti-epileptic drugs in...
...few seizures prior to anti-parasitic thera...
...ce of controlled data, the choice of anti-...
...ests that MRI be repeated at least every 6...
...generating Intraparenchymal NCC Including Pat...
...recommends that patients with multipl...
...Panel recommends anti-epileptic drugs for all...
...bsence of controlled data, the choice of anti-...
...ho have been seizure free for 6 mo...
...nel suggests albendazole therapy rather t...
...nel recommends that patients with...
...suggests that MRI be repeated at least every...
...sts brain MRI in patients with seizur...
...arenchymal Neurocysticercosis (CPN)...
...l recommends symptomatic therapy alone...
...Panel suggests that corticosteroids no...
In patients with refractory epilepsy and CPN,...
...cular Neurocysticercosis (IVN)Â ...
...el recommends MRI with 3D volumetric...
...ible, the Panel recommends removal of the...
...cases in which surgical removal of 4th ven...
...gests shunt surgery for hydrocephalus...
...recommends corticosteroids to decrease bra...
...-parasitic drugs with corticosteroid therapy foll...
...her after successful removal of intraventricular...
...chnoid Neurocysticercosis (S...
The Panel recommends that patients with subarachno...
...suggests that anti-parasitic therapy...
...Panel recommends anti-inflammatory thera...
...ests that methotrexate be consider...
...el recommends that patients with hydrocepha...
...ts that some patients may benefit from sur...
...Neurocysticercosis (S...
...anel recommends corticosteroid treatment for...
...nel suggests that both medical (anti-parasiti...
Ocular Cysticercosis (OC)...
The Panel suggests that intra-ocular cysticerci sh...
...ere is no evidence that management of NCC i...
...suggests that antihelminthic therapy sho...
...ble 1. Classification of Neurocysticercosis...
...ry of Treatment Recommendations for Differe...
...able parenchymal (VPN)Â ...
...sitic therapy Anti-parasitic drugs should be...
...2 Viable Cysts Monotherapy with albendazole (15...
...sAlbendazole (15mg/kg/d in 2 daily doses up to 12...
...ory therapyCorticosteroids should be used...
...nti-epileptic therapyAnti-epileptic drugs should...
...le Enhancing Lesion due to NCC (S...
...arasitic therapyAlbendazole (15 mg/kg/d in 2 da...
...ry therapyCorticosteroids should be gi...
Anti-epileptic therapyAntiepileptic drugs s...
...ified Parenchymal Neurocysticercosis with or witho...
...arasitic therapyAnti-parasitic treatment N...
...i-epileptic therapyTreatment with anti-epile...
...ammatory therapyCorticosteroids should NOT be...
...rcal encephalitis (with diffuse cerebr...
...itic drugs; treat diffuse cerebral edem...
...a Two well-designed randomized trial...
...ions for Therapy of Extraparenchymal Neurocysticer...
...traventricular (lateral or 3rd Ventricl...
...tricular (fourth ventricle)...
...pic or microsurgical cystectomy is s...
...ia a ventriculoperitoneal shuntá¶...
...ular â when surgical removal not feasible...
...juvant anti-parasitic and anti-inflammatory therap...
...management of hydrocephalusInitial management...
...achnoidá” (SAN...
...therapyá”Subarachnoid cysts do not respond...
...ory therapyConcomitant administration...
...c surgical approach often requires ventricul...
Figure 1. Endemicity of Taenia solium
...ure 1. Endemicity of Taeni...