Neurocysticercosis: an update on diagnosis, treatment, and prevention

Abstract

Neurocysticercosis (NCC) is an important cause of neurological disease worldwide, including imported cases in nonendemic countries.Purpose of reviewThe purpose of this review is to update information on diagnosis, management, and prevention of neurocysticercosisRecent findingsWHO and Infectious Diseases Society of America/American Society of Tropical Medicine and Hygiene guidelines emphasize the importance of corticosteroids and antiparasitic drugs for viable parenchymal disease and single enhancing lesions. Subarachnoid NCC is associated with a high fatality rate unless optimally treated. Advances in subarachnoid NCC include use of prolonged antiparasitic and anti-inflammatory courses and the increasing use of antigen-detection and quantitative PCR assays in diagnosis and follow-up. Emerging data support the safety and efficacy of minimally invasive surgery in ventricular cases. Calcified neurocysticercosis continues to be associated with a high burden of disease. Field studies are demonstrating the feasibility of eradication using a combination of mass chemotherapy for human tapeworms and vaccination/treatment of porcine cysticercosis.SummaryNCC remains an important and challenging cause of neurological disease with significant morbidity despite advances in treatment and prevention.

Consistent Measurement of Parasite-Specific Antigen Levels in Sera of Patients with Neurocysticercosis Using Two Different Monoclonal Antibody (mAb)-Based Enzyme-Linked Immunosorbent Assays

“…In clinical settings, the definitive diagnosis of NCC is provided by neuroimaging findings using either a computed tomography (CT) scan or magnetic resonance imaging (MRI), which allow the visualization of the parasites in the CNS [9]. However, neuroimaging findings are not always conclusive, as some lesions are nonspecific, while others may be missed on CT or MRI [10,11]. Neuroimaging equipment is also frequently not available in clinical settings in most rural endemic areas.…”

Massive neurocysticercosis in a ten-year-old girl: a case report

“…The most common clinical presentations of neurocysticercosis include seizures, headache and vomiting, focal neurological deficits, and cognitive alterations. Parenchymal neurocysticercosis is the most common form and represents more than 60% cases [ 7 ]. Extraparenchymal neurocysticercosis includes ventricular, subarachnoid, spinal, and ocular neurocysticercosis.…”

“…Patients with massive parenchymal neurocysticercosis could have evident inflammatory reaction to the cysticerci and diffused cerebral edema, and present with severe headaches and altered consciousness, which is denominated “cysticercotic encephalitis”, the most severe form of massive parenchymal neurocysticercosis. Other forms of massive parenchymal neurocysticercosis can be described as massive parenchymal calcifications, heavy nonencephalitic cysticercosis, and starry sky presentation [ 7 ]. Our patient presented no typical manifestations of cysticercotic encephalitis and had been regarded as “heavy nonencephalitic neurocysticercosis”.…”

“…Antiparasitic drugs including albendazole and praziquantel have improved the prognosis of many patients diagnosed with neurocysticercosis and play an important role in the management of some types of this disease. Nevertheless, because antiparasitic drugs could exacerbate the inflammatory reaction which can worsen symptoms in the short term, these drugs should be given under the cover of anti-inflammatory drugs such as corticosteroids [ 7 ]. Antiparasitic therapy is contraindicated in patients with cysticercotic encephalitis.…”

“…T. solium has been regarded as a potentially eradicable pathogen [ 18 ]. Traditional efforts for disease control including improving sanitation, health education, and inspection of pork were largely unsuccessful in highly endemic areas [ 7 ]. Mass chemotherapy for the control of infection of T. solium using albendazole and praziquantel has been implemented in some endemic communities.…”