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

Definition of TermsHaving trouble viewing tabl...

Diagnosis

...agnosis

...tations of NeurocysticercosisHaving trouble vi...


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


...itial evaluation should include careful hist...


...Panel recommends serologic testing with en...


...tests using crude antigen should be avo...


...he Panel recommends both a brain MRI and a non-c...


The Panel suggests screening for latent tuberculos...


...ggests screening or empiric therapy for Strong...


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


...anel suggests that the patient with NCC who...


...recommends that patients treated with albendazo...


...itional monitoring is needed for patients receivi...


Treatment

...eatment...

...le Intraparenchymal Neurocysticercosis (VPN)Â...

...h untreated hydrocephalus or diffuse cerebral ede...

...absence of elevated intracranial pressure, t...

...recommends albendazole monotherapy for 10-1...

...tion anti-parasitic therapy. ( W , M)705...

...mmends albendazole (15 mg/kg/d) combined with p...

...ests retreatment with anti-parasitic...

...nel recommends adjunctive corticosteroid therapy b...

...mends anti-epileptic drugs in all NCC patients w...

...few seizures prior to anti-parasitic thera...

...ence of controlled data, the choice of anti-e...

...uggests that MRI be repeated at leas...


...generating Intraparenchymal NCC Incl...

...e Panel recommends that patients with...

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

...ce of controlled data, the choice of anti-ep...

...have been seizure free for 6 months, th...

...e Panel suggests albendazole therapy rather t...

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

...el suggests that MRI be repeated at leas...

...uggests brain MRI in patients with seizures or...


...Parenchymal Neurocysticercosis (CPN)...

The Panel recommends symptomatic therapy alone...

...suggests that corticosteroids not be r...

...th refractory epilepsy and CPN, the Panel sugges...


...ular Neurocysticercosis (IVN) ...

...ommends MRI with 3D volumetric sequenci...

...the Panel recommends removal of the cysti...

...in which surgical removal of 4th ventricu...

...ts shunt surgery for hydrocephalus rathe...

...commends corticosteroids to decrease brain e...

...parasitic drugs with corticosteroid therapy follo...

...either after successful removal of in...


...arachnoid Neurocysticercos...

...e Panel recommends that patients with sub...

...ts that anti-parasitic therapy be continued unti...

...Panel recommends anti-inflammatory th...

...gests that methotrexate be considered...

...Panel recommends that patients with hydr...

...Panel suggests that some patients may benefit from...


...pinal Neurocysticercosis...

...recommends corticosteroid treatment for...

...nel suggests that both medical (anti-par...


...cular Cysticercosis (OC) 

...anel suggests that intra-ocular cysticerci shou...

...ere is no evidence that management of NCC...

...suggests that antihelminthic therapy should...


...e 1. Classification of Neurocysticercosi...


...ummary of Treatment Recommendations for Di...

Viable parenchymal...

...asitic therapy Anti-parasitic drugs sh...

...sts Monotherapy with albendazole (15 mg/ kg/d i...

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

...inflammatory therapyCorticosteroids...

Anti-epileptic therapyAnti-epileptic drugs should...

...cing Lesion due to NCC (SEL...

...herapyAlbendazole (15 mg/kg/d in 2 dail...

...matory therapyCorticosteroids shoul...

...leptic therapyAntiepileptic drugs should be used...

...Parenchymal Neurocysticercosis with or...

...asitic therapyAnti-parasitic treatment NOT rec...

...herapyTreatment with anti-epileptic dr...

...inflammatory therapyCorticosteroids should...

...cephalitis (with diffuse cerebral edema)...

...-parasitic drugs; treat diffuse cerebr...

a Two well-designed randomized...


...ecommendations for Therapy of Extraparenchy...

...cular (lateral or 3rd Ventricle) (IVN)Removal of...

...ntraventricular (fourth...

Either endoscopic or microsurgical cystectom...

...rsion via a ventriculoperitoneal shuntá¶...

...lar – when surgical removal not feasi...

...juvant anti-parasitic and anti-inf...

...urgical management of hydrocephalusInitial manage...

...chnoidᔈ (SAN)

...therapyᔉSubarachnoid cysts do not respo...

...matory therapyConcomitant administration of c...


...endoscopic surgical approach often requires...


Figure 1. Endemicity of Taenia solium

...e 1. Endemicity of Taenia soliu...