Neurocysticercosis
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.
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
...ition of TermsHaving trouble viewing table...
Diagnosis
...iagnosis
...tions of NeurocysticercosisHaving trou...
...there is a wide range of clinical manifes...
...ation should include careful history...
...nel recommends serologic testing with e...
...g crude antigen should be avoided due t...
...ends both a brain MRI and a non-contrast CT...
...sts screening for latent tuberculosis infectio...
The Panel suggests screening or empiric th...
...recommends that all patients with...
...ggests that the patient with NCC who has pro...
...ommends that patients treated with albendaz...
...monitoring is needed for patients receivin...
Treatment
...atment
...Intraparenchymal Neurocysticercosis (VPN)...
...nts with untreated hydrocephalus or diffuse cere...
...nce of elevated intracranial pressu...
...mends albendazole monotherapy for 10-14 days co...
...combination anti-parasitic therapy. (...
...anel recommends albendazole (15 mg...
...ggests retreatment with anti-parasitic th...
The Panel recommends adjunctive corti...
...e Panel recommends anti-epileptic drugs in...
...h few seizures prior to anti-paras...
...e of controlled data, the choice of anti-epilept...
...he Panel suggests that MRI be repeated...
...generating Intraparenchymal NCC Incl...
...ecommends that patients with multiple en...
...Panel recommends anti-epileptic drugs fo...
...nce of controlled data, the choice of anti-epilep...
...patients who have been seizure free for 6 months...
...uggests albendazole therapy rather than no ant...
...recommends that patients with SEL treated with an...
...el suggests that MRI be repeated at...
...gests brain MRI in patients with seiz...
...chymal Neurocysticercosis (CPN)...
...recommends symptomatic therapy alone ins...
...Panel suggests that corticosteroids not...
...patients with refractory epilepsy and...
...tricular Neurocysticercosis (IVN) ...
...ecommends MRI with 3D volumetric sequencing to...
...possible, the Panel recommends removal of the cy...
...ases in which surgical removal of 4th v...
...ggests shunt surgery for hydrocephalus...
...l recommends corticosteroids to decrease...
...ti-parasitic drugs with corticosteroid the...
...neither after successful removal...
...chnoid Neurocysticercosis (SAN...
...ends that patients with subarachnoid cy...
...suggests that anti-parasitic therapy be...
...l recommends anti-inflammatory the...
...sts that methotrexate be considered as a ste...
...el recommends that patients with hydroc...
...nel suggests that some patients may benefit from...
...l Neurocysticercosis (SN) ...
...ommends corticosteroid treatment for pat...
...nel suggests that both medical (anti-par...
...sticercosis (OC) ...
...Panel suggests that intra-ocular cysticerci s...
...no evidence that management of NCC in childr...
...he Panel suggests that antihelminthic therapy...
...e 1. Classification of Neurocysticercosis...
...mary of Treatment Recommendations for Different F...
...le parenchymal (VPN) ...
...herapy Anti-parasitic drugs should be used...
...ble Cysts Monotherapy with albendazole (15 mg/...
>2 Viable CystsAlbendazole (15mg/kg/d in 2 daily...
...y therapyCorticosteroids should be used wh...
...herapyAnti-epileptic drugs should be use...
...le Enhancing Lesion due to NCC...
...nti-parasitic therapyAlbendazole (15...
...ti-inflammatory therapyCorticosteroids...
...ic therapyAntiepileptic drugs should be used...
...nchymal Neurocysticercosis with or withou...
...ti-parasitic therapyAnti-parasitic trea...
...i-epileptic therapyTreatment with anti...
...y therapyCorticosteroids should NOT be rout...
...ticercal encephalitis (with diffuse cerebral ed...
...anti-parasitic drugs; treat diffuse ce...
a Two well-designed ran...
...mendations for Therapy of Extraparenchymal Neu...
...r (lateral or 3rd Ventricle) (IVN)Removal of...
...aventricular (fourth ventricle...
...her endoscopic or microsurgical cy...
...iversion via a ventriculoperitoneal...
...lar – when surgical removal not feasible (...
...nt anti-parasitic and anti-inflamm...
...rgical management of hydrocephalusInitial manag...
...hnoidᵈ (SAN)...
...arasitic therapyᵉSubarachnoid cysts do not re...
...matory therapyConcomitant administ...
...ic surgical approach often requires ventri...
Figure 1. Endemicity of Taenia solium
...Endemicity of Taenia solium...