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

...TermsHaving trouble viewing table? Expand...

Diagnosis

...gnosis...

...s of NeurocysticercosisHaving trouble viewin...


...e is a wide range of clinical manifestatio...


...aluation should include careful hist...


...ommends serologic testing with enzyme-linked immu...


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


...ends both a brain MRI and a non-contrast CT sca...


The Panel suggests screening for latent...


...Panel suggests screening or empir...


...ommends that all patients with NCC undergo...


...suggests that the patient with NCC who ha...


...ends that patients treated with albendazol...


...monitoring is needed for patients receiving c...


Treatment

Treatmen...

...renchymal Neurocysticercosis (VPN) ...

...with untreated hydrocephalus or diffu...

...the absence of elevated intracran...

...el recommends albendazole monotherap...

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

...el recommends albendazole (15 mg/kg/d) combined...

...he Panel suggests retreatment with ant...

...ecommends adjunctive corticosteroid th...

The Panel recommends anti-epileptic dru...

...patients with few seizures prior to anti-parasi...

...e of controlled data, the choice o...

...uggests that MRI be repeated at least every...


...ng Intraparenchymal NCC Including Patients With...

...he Panel recommends that patients with multipl...

...he Panel recommends anti-epileptic drugs f...

...nce of controlled data, the choice...

...o have been seizure free for 6 months...

...Panel suggests albendazole therapy rather than n...

...recommends that patients with SEL t...

...e Panel suggests that MRI be repeated at least ev...

The Panel suggests brain MRI in patients w...


...renchymal Neurocysticercosis (CPN)...

...ommends symptomatic therapy alone inste...

...gests that corticosteroids not be routinely...

...patients with refractory epilepsy and CP...


...cular Neurocysticercosis (IVN) ...

...recommends MRI with 3D volumetric sequencing t...

...le, the Panel recommends removal of the cy...

...es in which surgical removal of 4th ventricula...

...ts shunt surgery for hydrocephalus ra...

...mmends corticosteroids to decrease bra...

...c drugs with corticosteroid therapy fol...

...either after successful removal of intraven...


...d Neurocysticercosis (SAN)...

...commends that patients with subara...

...Panel suggests that anti-parasitic t...

...Panel recommends anti-inflammatory therapy (such...

...ts that methotrexate be considered...

...ecommends that patients with hydrocep...

...anel suggests that some patients ma...


...al Neurocysticercosis (SN)Â...

...mends corticosteroid treatment for patients with S...

...uggests that both medical (anti-parasiti...


Ocular Cysticercosis (O...

...nel suggests that intra-ocular cysticer...

...is no evidence that management of NCC...

...nel suggests that antihelminthic therapy sh...


Table 1. Classification of Neurocystic...


...tment Recommendations for Different F...

...ble parenchymal (VPN)...

...parasitic therapy Anti-parasitic drugs...

...ysts Monotherapy with albendazole...

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

...nflammatory therapyCorticosteroids...

...-epileptic therapyAnti-epileptic d...

...Enhancing Lesion due to NCC (SE...

...parasitic therapyAlbendazole (15 mg/k...

...ammatory therapyCorticosteroids sho...

...tic therapyAntiepileptic drugs should be used...

...Parenchymal Neurocysticercosis with or without...

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

...leptic therapyTreatment with anti-e...

...i-inflammatory therapyCorticosteroids...

...cephalitis (with diffuse cerebral edema)...

...id anti-parasitic drugs; treat diffuse c...

...a Two well-designed rando...


...ions for Therapy of Extraparenchymal Neurocystice...

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

...entricular (fourth ventricle...

...pic or microsurgical cystectomy is suitable, d...

...n via a ventriculoperitoneal shuntá...

...ar – when surgical removal not feasible (e.g....

...i-parasitic and anti-inflammatory therap...

...anagement of hydrocephalusInitial...

...arachnoidᔈ (SA...

...rasitic therapyᔉSubarachnoid cysts do not...

...flammatory therapyConcomitant adminis...


...endoscopic surgical approach often requi...


Figure 1. Endemicity of Taenia solium

...ndemicity of Taenia solium...