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 Terms Terms Definition...
Diagnosis
...Diagnosis...
Manifestations of Neurocysticercosis...
...is a wide range of clinical manifestations of n...
...itial evaluation should include caref...
...el recommends serologic testing with enzyme...
...g crude antigen should be avoided due to poor s...
...ommends both a brain MRI and a non-cont...
...nel suggests screening for latent tuberculosis inf...
...he Panel suggests screening or empiric therapy...
...ommends that all patients with NCC under...
...anel suggests that the patient with NCC who...
...l recommends that patients treated with...
...al monitoring is needed for patients...
Treatment
...Treatment...
...Viable Intrap...
...with untreated hydrocephalus or diffuse cerebral...
...ence of elevated intracranial pressure, the...
...Panel recommends albendazole monotherapy...
...r combination anti-parasitic therapy. ( W , M)...
...recommends albendazole (15 mg/kg/d)...
...anel suggests retreatment with anti-parasit...
...Panel recommends adjunctive cortico...
...mends anti-epileptic drugs in all NCC...
...patients with few seizures prior to...
...the absence of controlled data, the choice of a...
...suggests that MRI be repeated at least every 6...
...Degenerating I...
...he Panel recommends that patients with multiple en...
...commends anti-epileptic drugs for all pati...
...sence of controlled data, the choice of...
...ts who have been seizure free for 6 months, the...
...gests albendazole therapy rather than...
...Panel recommends that patients with SEL treated wi...
...ts that MRI be repeated at least e...
...el suggests brain MRI in patients with sei...
...Calcified P...
...el recommends symptomatic therapy alone instea...
The Panel suggests that corticosteroi...
...patients with refractory epilepsy an...
...Intraventricular Neuro...
...recommends MRI with 3D volumetric sequencing...
When possible, the Panel recommends removal of the...
...es in which surgical removal of 4th ventricular cy...
...suggests shunt surgery for hydrocephalus...
...e Panel recommends corticosteroids to dec...
...i-parasitic drugs with corticosteroid...
...r successful removal of intraventricu...
...Subarachnoid N...
...recommends that patients with subarachnoid cysts...
...ggests that anti-parasitic therapy be continued...
...he Panel recommends anti-inflammatory therapy...
...ests that methotrexate be considered as a...
...el recommends that patients with hy...
...nel suggests that some patients may benefit...
...Spinal Neurocysticercosis...
...he Panel recommends corticosteroid treat...
...nel suggests that both medical (anti-p...
Ocular Cy...
...sts that intra-ocular cysticerci should be tre...
There is no evidence that management of NCC in...
...he Panel suggests that antihelminthic therapy sh...
...1. Classification of Neurocysticerco...
...Summary of T...
...Viab...
Anti-parasitic therapy Anti-parasitic drugs shoul...
...iable Cysts Monotherapy with albendazole (15 mg/...
...Viable CystsAlbendazole (15mg/kg/d in 2 daily...
...mmatory therapyCorticosteroids should be us...
...eptic therapyAnti-epileptic drugs shoul...
...Single Enhanc...
...ic therapyAlbendazole (15 mg/kg/d...
...nti-inflammatory therapyCorticosteroid...
...eptic therapyAntiepileptic drugs sho...
...rasitic therapyAnti-parasitic treatment NOT recom...
...ic therapyTreatment with anti-epileptic dru...
...ry therapyCorticosteroids should NOT be routinely...
...Cysticercal ence...
...d anti-parasitic drugs; treat diffuse cerebral e...
...a Two well-designed randomized tri...
...Recommen...
...cular (lateral or 3rd Ventricle) (IVN)Rem...
...Intra...
...endoscopic or microsurgical cystectomy is s...
...sion via a ventriculoperitoneal shun...
...Intr...
...rasitic and anti-inflammatory therapy.ᶜ ( S...
...agement of hydrocephalusInitial ma...
...Subarachnoidᵈ (SAN)...
...rasitic therapyᵉSubarachnoid cysts do no...
...tory therapyConcomitant administra...
...doscopic surgical approach often requires...
Figure 1. Endemicity of Taenia solium
...1. Endemicity of Taenia solium...