Neurocysticercosis

Publication Date: April 3, 2018

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.
a Symptomatic therapy includes anti-epileptic drugs for seizures, anti-inflammatory drug such as corticosteroids and methotrexate, and surgery for hydrocephalus.
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

...of TermsHaving trouble viewing table?...

Diagnosis

...iagnos...

...anifestations of NeurocysticercosisH...


...there is a wide range of clinical manifestatio...


...nitial evaluation should include careful his...


...ends serologic testing with enzyme-linked...


...ng crude antigen should be avoided due...


...ommends both a brain MRI and a non-contrast CT...


...l suggests screening for latent tuberculosis...


...gests screening or empiric therapy...


...Panel recommends that all patients with NCC u...


...uggests that the patient with NCC who has pr...


...nel recommends that patients treated wi...


...itional monitoring is needed for patien...


Treatment

...reatment

...able Intraparenchymal Neurocysticercosis (VPN)Â...

...ts with untreated hydrocephalus or dif...

...of elevated intracranial pressure, the...

...anel recommends albendazole monoth...

...on anti-parasitic therapy. ( W , M)...

...recommends albendazole (15 mg/kg/d) com...

...ts retreatment with anti-parasitic therapy...

...e Panel recommends adjunctive corticosteroid...

The Panel recommends anti-epileptic dr...

...ts with few seizures prior to anti-p...

...e of controlled data, the choice of ant...

...e Panel suggests that MRI be repeated at least e...


...egenerating Intraparenchymal NCC Including P...

...recommends that patients with multiple enha...

...nel recommends anti-epileptic drugs for all...

...he absence of controlled data, the ch...

...s who have been seizure free for 6 months, t...

...anel suggests albendazole therapy...

...Panel recommends that patients with SEL...

...uggests that MRI be repeated at least every 6 mon...

...ggests brain MRI in patients with seizures or hyd...


...lcified Parenchymal Neurocysticerco...

...Panel recommends symptomatic therapy alone in...

...suggests that corticosteroids not be routinel...

...nts with refractory epilepsy and CPN,...


...aventricular Neurocysticercosi...

...el recommends MRI with 3D volumetric sequen...

...the Panel recommends removal of the cyst...

...s in which surgical removal of 4th ven...

...suggests shunt surgery for hydrocephal...

...mends corticosteroids to decrease brain ede...

...nti-parasitic drugs with corticosteroid the...

...r successful removal of intraventri...


...barachnoid Neurocysticercos...

...nel recommends that patients with subarac...

...el suggests that anti-parasitic therapy be cont...

...commends anti-inflammatory therapy (such as hig...

...sts that methotrexate be considered as...

...nel recommends that patients with hydroc...

...he Panel suggests that some patients...


Spinal Neurocysticercos...

...mends corticosteroid treatment for pa...

...ests that both medical (anti-parasitic d...


...ar Cysticercosis (OC)Â...

...Panel suggests that intra-ocular cys...

There is no evidence that management of NCC in ch...

...el suggests that antihelminthic therapy shou...


...sification of Neurocysticercosis Based on Locati...


...eatment Recommendations for Different Fo...

...le parenchymal (VPN) ...

...herapy Anti-parasitic drugs should be used...

...ble Cysts Monotherapy with albendazole (15 m...

...lbendazole (15mg/kg/d in 2 daily doses...

...-inflammatory therapyCorticosteroids...

...ti-epileptic therapyAnti-epileptic...

...ncing Lesion due to NCC (SEL)...

...tic therapyAlbendazole (15 mg/kg/d...

...nflammatory therapyCorticosteroids should be given...

Anti-epileptic therapyAntiepileptic drugs shoul...

...renchymal Neurocysticercosis with o...

...asitic therapyAnti-parasitic treatment...

...ti-epileptic therapyTreatment with anti-epilep...

Anti-inflammatory therapyCorticosteroids s...

...ercal encephalitis (with diffuse cerebral ed...

...id anti-parasitic drugs; treat diffu...

...Two well-designed randomized trials...


...ons for Therapy of Extraparenchymal...

...icular (lateral or 3rd Ventricle)...

...ntricular (fourth ventricle...

...ic or microsurgical cystectomy is suit...

...on via a ventriculoperitoneal shuntᶜ ( W ,...

...ventricular – when surgical removal...

...nti-parasitic and anti-inflammator...

...management of hydrocephalusInitial manageme...

...chnoidᔈ (SAN)...

...therapyᔉSubarachnoid cysts do not respond well...

...flammatory therapyConcomitant administ...


...e endoscopic surgical approach often requires...


Figure 1. Endemicity of Taenia solium

.... Endemicity of Taenia solium...