Diagnosis and treatment of neurocysticercosis

Abstract

Neurocysticercosis, a major cause of acquired seizures and epiilepsy, is caused by infection with the larval cystic form of the tapeworm, Taenia solium. CT and MRI imaging, development of sensitive and specific diagnostic methods, and discovery of relatively effective anti-cestode drugs, revolutionized knowledge of the burden of infection and disease and led to effective treatments. Here we review the rationale of treatment, the essential role of inflammation in the genesis of disease and its exacerbation as a result of anti-parasitic treatment, and limitations in the efficacy of current anti-parasitic and anti-inflammatory treatments. The importance of “end stage” calcified granulomas as foci of seizures and epilepsy with and without perilesional edema in endemic populations has recently been recognized. New information indicates perilesional inflammation around some calcified foci is associated with seizures and perilesional edema, which suggests that anti-inflammatory treatments may play a role in controlling or preventing epilepsy in these patients. Most importantly, neurocysticercosis is one of the few diseases that can be eradicated, an accomplishment that would prevent millions of cases of epilepsy.

Current status and future perspectives on the medical treatment of neurocysticercosis

“…Due to low cost and broad availability, carbamazepine and phenytoin are the usual choices for clinicans in NCC-endemic regions. 19,20 Most patients can be adequately controlled at standard therapeutic doses. Whether AED can be safely withdrawn after the parasitic cysts have died is open to question.…”

A case of cerebral tuberculoma mimicking neurocysticercosis

“…Another factor making the differential diagnosis of the two diseases difficult is the partial coincidence of their endemic areas. The fact that the present patient was from Peru is important, as both cerebral tuberculoma and neurocysticercosis are prevalent in this area,3 and this initially resulted in an incorrect diagnosis. Considering the extremely high mortality rate of 80% in patients with symptomatic cerebral tuberculoma for ≥2 months,2 as in the present case, accurate diagnosis is essential.…”

“…For the diagnosis of central nervous system tuberculosis, the sensitivity and specificity of ADA levels in the CSF (>5.8 U/L) are reportedly 89% and 73%, respectively, and those for the T‐SPOT assay are 71% and 57%, respectively 5. For the diagnosis of neurocysticercosis, the sensitivity and specificity of antibody testing are 70–90% and nearly 100%, respectively, and the sensitivity of antigen testing is also high 3. Unfortunately, the result of the antigen testing in the present case was not reported until several days after sample submission.…”

Validez de tres métodos de inmuno-diagnóstico de neurocisticercosis: revisión sistemática de la literatura con meta-análisis 1960-2014

“…Para establecer el diagnóstico definitivo y el tipo de enfermedad se requiere la tomografía computarizada (TC) y/o la imagen por resonancia magnética (RM); sin embargo, son procedimientos muy costosos, poco disponibles en zonas endémicas y en muchos pacientes no se obtienen resultados claros debido a la ubicación cerebral o al estado de desarrollo del cisticerco. Por esta razón, se utilizan pruebas serológicas como ayudas diagnósticas; no obstante, en muchos ensayos se han reportado datos de sensibilidad y especificidad muy bajas, por lo que actualmente sólo se utiliza de rutina el ensayo inmunoenzimático de electrotransferencia (EITB) para la detección de anticuerpos y el inmunoensayo ligado a enzimas (ELISA) para la detección de antígenos o anticuerpos, que además de presentar alta sensibilidad y especificidad, son menos costosos, más asequibles en zonas endémicas, lo que deriva en un menor tiempo de diagnóstico, tratamiento oportuno y disminución de las secuelas de la enfermedad [15][16][17] .…”