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

...finition of TermsHaving trouble viewing table...

Diagnosis

...Dia...

...festations of NeurocysticercosisHaving troub...


...e there is a wide range of clinical m...


...l evaluation should include careful his...


...recommends serologic testing with...


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


...el recommends both a brain MRI and a non-con...


...suggests screening for latent tuberculosis inf...


...l suggests screening or empiric ther...


...commends that all patients with NCC unde...


...Panel suggests that the patient with...


...el recommends that patients treated with albend...


...monitoring is needed for patients...


Treatment

...Treatme...

...Viabl...

...s with untreated hydrocephalus or diffus...

...bsence of elevated intracranial press...

...l recommends albendazole monotherapy for 10-14 d...

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

...anel recommends albendazole (15 mg/...

...gests retreatment with anti-parasitic therapy...

...mends adjunctive corticosteroid therap...

...Panel recommends anti-epileptic drugs in all NCC...

...tients with few seizures prior to anti-parasitic...

...the absence of controlled data, the choice of a...

...ests that MRI be repeated at least...


...Degene...

...ecommends that patients with multiple enhanci...

...l recommends anti-epileptic drugs for all p...

...absence of controlled data, the choice of an...

...ents who have been seizure free for 6 month...

...nel suggests albendazole therapy r...

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

...l suggests that MRI be repeated at least every 6...

...ts brain MRI in patients with seizures...


...Calci...

...e Panel recommends symptomatic therapy alone inst...

...sts that corticosteroids not be routinely...

...ients with refractory epilepsy and CPN, the P...


...Intravent...

...ends MRI with 3D volumetric sequencing to identify...

...he Panel recommends removal of the cysticerc...

...es in which surgical removal of 4t...

...Panel suggests shunt surgery for hydrocephalu...

...el recommends corticosteroids to decrease br...

...sitic drugs with corticosteroid therapy foll...

...after successful removal of intraventricular cy...


...Subarachnoid Neurocysti...

...Panel recommends that patients with s...

...sts that anti-parasitic therapy be continued...

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

...Panel suggests that methotrexate be co...

...ecommends that patients with hydrocephalus from...

...ests that some patients may benefit...


...Spinal...

...ends corticosteroid treatment for patients with...

...suggests that both medical (anti-parasi...


...Ocular...

...uggests that intra-ocular cysticerci should...

...dence that management of NCC in children sh...

...ts that antihelminthic therapy should be def...


.... Classification of Neurocysticercosis Based...


...Summary of...

...Viable paren...

...parasitic therapy Anti-parasitic...

...iable Cysts Monotherapy with albendazole (15 mg/...

...ble CystsAlbendazole (15mg/kg/d in 2 daily d...

Anti-inflammatory therapyCorticosteroids should b...

...nti-epileptic therapyAnti-epileptic drugs shoul...

...Single Enhancing Les...

...ic therapyAlbendazole (15 mg/kg/d i...

...ry therapyCorticosteroids should be given...

...herapyAntiepileptic drugs should be used in...

Cal...

...tic therapyAnti-parasitic treatment NOT...

...i-epileptic therapyTreatment with anti-epil...

...ory therapyCorticosteroids should NOT be routin...

...Cysticercal encephaliti...

...oid anti-parasitic drugs; treat diffus...

...a Two well-designed randomized trials demo...


...Recommendations...

...tricular (lateral or 3rd Ventricle) (IVN)Remo...

...Intraventricular (fourth...

...her endoscopic or microsurgical cystectomy is...

...version via a ventriculoperitoneal shu...

...Intraventricular – when s...

...ant anti-parasitic and anti-inflammatory therapy....

...ment of hydrocephalusInitial manage...

...therapyᵉSubarachnoid cysts do not r...

...lammatory therapyConcomitant admin...


...ndoscopic surgical approach often require...


Figure 1. Endemicity of Taenia solium

.... Endemicity of Taenia so...