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
...efinition of TermsHaving trouble viewing t...
Diagnosis
...agnosis...
...nifestations of Neurocysticercosis...
...ere is a wide range of clinical mani...
...ation should include careful history and physical...
...l recommends serologic testing with enzyme-linked...
...sing crude antigen should be avoided du...
...nel recommends both a brain MRI and a no...
...ests screening for latent tuberculosis infect...
...el suggests screening or empiric therapy for Str...
...ecommends that all patients with NCC undergo...
...ests that the patient with NCC who has...
...ommends that patients treated with albendazo...
...monitoring is needed for patients receivin...
Treatment
Treatmen...
...aparenchymal Neurocysticercosis (VPN...
...tients with untreated hydrocephalus or diffuse ce...
...of elevated intracranial pressure,...
...ommends albendazole monotherapy for 10...
...combination anti-parasitic therapy...
...mends albendazole (15 mg/kg/d) comb...
...suggests retreatment with anti-parasitic therapy f...
...mends adjunctive corticosteroid therapy...
...recommends anti-epileptic drugs in al...
...ts with few seizures prior to anti-parasitic...
...f controlled data, the choice of anti-epilep...
The Panel suggests that MRI be repeated a...
...traparenchymal NCC Including Patien...
...mends that patients with multiple enhanc...
...nel recommends anti-epileptic drugs for all pati...
...ce of controlled data, the choice of anti...
...tients who have been seizure free for 6 mo...
...l suggests albendazole therapy rather...
...Panel recommends that patients with SEL treated...
...sts that MRI be repeated at least every 6 mon...
...gests brain MRI in patients with seizu...
...Parenchymal Neurocysticercosis (...
...el recommends symptomatic therapy alone inst...
The Panel suggests that corticosteroids not be...
...with refractory epilepsy and CPN, the Panel su...
...raventricular Neurocysticercosis (IVN) ...
...mmends MRI with 3D volumetric sequenc...
...e, the Panel recommends removal of the c...
...h surgical removal of 4th ventricular cys...
...ggests shunt surgery for hydrocephalus rather t...
...Panel recommends corticosteroids to decrease bra...
...rasitic drugs with corticosteroid therapy followi...
...fter successful removal of intraventricular cys...
...rachnoid Neurocysticercosis (SAN)
...nel recommends that patients with subarachnoid...
...he Panel suggests that anti-parasitic therapy be...
The Panel recommends anti-inflammatory therapy...
...ts that methotrexate be considered as a stero...
...Panel recommends that patients with hydrocephalu...
...suggests that some patients may benefit from su...
...urocysticercosis (SN) ...
...el recommends corticosteroid treatment...
...uggests that both medical (anti-parasiti...
...ular Cysticercosis...
...he Panel suggests that intra-ocular cysticer...
...here is no evidence that managemen...
...el suggests that antihelminthic therapy shou...
...lassification of Neurocysticercosis B...
...of Treatment Recommendations for Diffe...
...iable parenchymal (...
...nti-parasitic therapy Anti-parasitic drugs sh...
...ble Cysts Monotherapy with albendazole (15...
...le CystsAlbendazole (15mg/kg/d in 2 dail...
...y therapyCorticosteroids should be...
...-epileptic therapyAnti-epileptic drugs shou...
...ing Lesion due to NCC (SEL)
...asitic therapyAlbendazole (15 mg/kg/d in...
...lammatory therapyCorticosteroids should be g...
...c therapyAntiepileptic drugs should...
...renchymal Neurocysticercosis with or witho...
...c therapyAnti-parasitic treatment NOT recommend...
...-epileptic therapyTreatment with anti-epile...
...i-inflammatory therapyCorticosteroids...
...cal encephalitis (with diffuse cerebral edema)...
...arasitic drugs; treat diffuse cerebral edema...
...a Two well-designed random...
...ecommendations for Therapy of Extr...
...cular (lateral or 3rd Ventricle) (IVN)Re...
...ricular (fourth ventricle)...
...her endoscopic or microsurgical cystectomy is su...
...SF diversion via a ventriculoperito...
...entricular – when surgical removal not...
...rasitic and anti-inflammatory therapy...
...gement of hydrocephalusInitial management shoul...
...rachnoidᵈ (SA...
...ic therapyᵉSubarachnoid cysts do not respond we...
...nti-inflammatory therapyConcomitant a...
...e endoscopic surgical approach often r...
Figure 1. Endemicity of Taenia solium
...re 1. Endemicity of Taenia solium...