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
...of TermsHaving trouble viewing table? Expand...
Diagnosis
...gnosis...
...anifestations of NeurocysticercosisHaving troubl...
...ere is a wide range of clinical manifestations of...
...evaluation should include careful hi...
...el recommends serologic testing with enzyme-link...
...LISA tests using crude antigen should be avoid...
The Panel recommends both a brain MRI and...
...ggests screening for latent tuberc...
...l suggests screening or empiric therapy for S...
...Panel recommends that all patients with...
...ts that the patient with NCC who has probably ac...
...el recommends that patients treated with albenda...
...monitoring is needed for patients...
Treatment
...reatment
...iable Intraparenchymal Neurocysticercosis...
...patients with untreated hydrocephalus or diffuse...
...ce of elevated intracranial pressure, t...
...mmends albendazole monotherapy for 10-14 days com...
...on anti-parasitic therapy. ( W , M)705...
...Panel recommends albendazole (15 mg/kg/d) c...
...Panel suggests retreatment with a...
The Panel recommends adjunctive corticost...
...anel recommends anti-epileptic drugs in all NC...
...th few seizures prior to anti-parasitic t...
In the absence of controlled data, the ch...
...he Panel suggests that MRI be repeated at least...
...traparenchymal NCC Including Patients With S...
...mends that patients with multiple enhanc...
...anel recommends anti-epileptic drug...
...sence of controlled data, the choice of anti-...
In patients who have been seizure free for 6 month...
...el suggests albendazole therapy rat...
...nel recommends that patients with SE...
...he Panel suggests that MRI be repeated at lea...
The Panel suggests brain MRI in patients with sei...
...renchymal Neurocysticercosis (CPN)...
...anel recommends symptomatic therapy alone inst...
...suggests that corticosteroids not...
...h refractory epilepsy and CPN, the Panel...
...ntricular Neurocysticercosis (IVN) ...
The Panel recommends MRI with 3D volume...
...possible, the Panel recommends rem...
...in which surgical removal of 4th v...
...el suggests shunt surgery for hydr...
...nel recommends corticosteroids to decrease br...
...ti-parasitic drugs with corticoste...
...ther after successful removal of intraventric...
...d Neurocysticercosis (SAN)...
...mmends that patients with subarach...
...Panel suggests that anti-parasitic therapy be co...
...anel recommends anti-inflammatory thera...
...Panel suggests that methotrexate be considered a...
...recommends that patients with hydrocepha...
...suggests that some patients may benefit from s...
...eurocysticercosis (SN)
...recommends corticosteroid treatment for pa...
...ests that both medical (anti-parasitic drugs p...
...lar Cysticercosis (O...
...anel suggests that intra-ocular cysticerc...
...dence that management of NCC in children...
...ests that antihelminthic therapy should be deferr...
...lassification of Neurocysticercosis Based on Locat...
...mmary of Treatment Recommendations for Differe...
...ble parenchymal (VPN)...
...c therapy Anti-parasitic drugs should be use...
...iable Cysts Monotherapy with albendazole (15...
...iable CystsAlbendazole (15mg/kg/d in 2 daily...
...ry therapyCorticosteroids should be used wh...
...-epileptic therapyAnti-epileptic drugs shoul...
...ncing Lesion due to NCC (SEL)...
...arasitic therapyAlbendazole (15 mg/kg/d in...
...lammatory therapyCorticosteroids s...
...pileptic therapyAntiepileptic drugs should b...
...alcified Parenchymal Neurocysticer...
...itic therapyAnti-parasitic treatment NOT recommen...
...therapyTreatment with anti-epilepti...
...tory therapyCorticosteroids should N...
...encephalitis (with diffuse cerebral edema)...
...d anti-parasitic drugs; treat diffuse cere...
...wo well-designed randomized trials demonstrat...
...endations for Therapy of Extraparenchyma...
...ricular (lateral or 3rd Ventricle) (IVN)Removal o...
...cular (fourth ventricle)...
...endoscopic or microsurgical cystect...
...diversion via a ventriculoperitoneal shuntᶜ (...
...– when surgical removal not feasible (e.g. adh...
...vant anti-parasitic and anti-inflammato...
...l management of hydrocephalusInitial managemen...
...rachnoidᵈ (SAN)...
...arasitic therapyᵉSubarachnoid cysts do not...
...atory therapyConcomitant administration of...
...ndoscopic surgical approach often requires ventric...
Figure 1. Endemicity of Taenia solium
...Endemicity of Taenia solium...