Current Consensus Guidelines for Treatment of Neurocysticercosis

Abstract

Taenia solium neurocysticercosis is a common cause of epileptic seizures and other neurological morbidity in most developing countries. It is also an increasingly common diagnosis in industrialized countries because of immigration from areas where it is endemic. Its clinical manifestations are highly variable and depend on the number, stage, and size of the lesions and the host's immune response. In part due to this variability, major discrepancies exist in the treatment of neurocysticercosis. A panel of experts in taeniasis/cysticercosis discussed the evidence on treatment of neurocysticercosis for each clinical presentation, and we present the panel's consensus and areas of disagreement. Overall, four general recommendations were made: (i) individualize therapeutic decisions, including whether to use antiparasitic drugs, based on the number, location, and viability of the parasites within the nervous system; (ii) actively manage growing cysticerci either with antiparasitic drugs or surgical excision; (iii) prioritize the management of intracranial hypertension secondary to neurocysticercosis before considering any other form of therapy; and (iv) manage seizures as done for seizures due to other causes of secondary seizures (remote symptomatic seizures) because they are due to an organic focus that has been present for a long time

Combined use of an antigen and antibody detection enzyme‐linked immunosorbent assay for cysticercosis as tools in an epidemiological study of epilepsy in Burundi

“…As far as treatment of NCC is concerned, the availability of serological results is not sufficient to start an antiparasitic treatment. Images are necessary to obtain information on the number and localization of the cysts in the brain and to decide whether or not anthelmintic treatment will be used (Garcia et al 2002).…”

Racemose neurocysticercosis - neuroimaging guide the diagnosis

“…Actualmente, se utiliza la derivación ventrículo-peritoneal para disminuir la hipertensión intracraneal y la cirugía mínima-mente invasiva con neuroendoscopio flexible para la resección y absorción de los quistes (22)(23)(24)(25).…”

Steroids in neuroinfection

“…Steroids can be used to combat perilesional edema in degenerating cysts ( figures 1 and 2) and are recommended during treatment with antiparasitic drugs, either albendazole or praziquantel, to decrease symptoms associated with the death of parasites 18 . Likewise antibiotics, steroids may negatively influence parasiticides efficacy.…”

“…Dexamethasone is the most frequently preferred steroid in these cases, in variable regimens. Doses may range from 4,5 to 32 mg daily 18 , depending on the inflammatory reaction intensity, but lower doses have shown to be equally efficacious 20 . Neurocysticercosis is accompanied by prolonged, sometimes recurrent, periods of inflammatory status leading to long-term treatments, and consequently accumulation of steroids side-effects.…”