What is the recommended treatment for neurocysticercosis?

From the Guidelines

The recommended treatment for neurocysticercosis typically involves antiparasitic drugs combined with corticosteroids, with the specific treatment approach depending on the number, location, and viability of cysts. The treatment approach for neurocysticercosis can be broken down into several key components:

• Antiparasitic therapy: First-line therapy usually consists of albendazole (15 mg/kg/day divided into two doses, maximum 800 mg daily) for 10-14 days, often combined with praziquantel (50 mg/kg/day divided into three doses) in cases of multiple cysts 1.
• Corticosteroids: Corticosteroids, typically dexamethasone (0.1 mg/kg/day) or prednisone (1 mg/kg/day), should be started 1-2 days before antiparasitic treatment and continued throughout therapy to reduce inflammation and edema caused by dying parasites 1.
• Antiepileptic therapy: Antiepileptic medications like carbamazepine or levetiracetam are necessary if seizures are present 1.
• Surgical intervention: In cases with hydrocephalus or large cysts causing significant mass effect, surgical intervention may be required before medical therapy 1. Some key considerations in the treatment of neurocysticercosis include:
• Monitoring: Treatment effectiveness should be monitored with follow-up neuroimaging at 3-6 months 1.
• Calcified cysts: Some patients with calcified, inactive cysts may only require symptomatic treatment without antiparasitic drugs 1. Overall, the goal of treatment is to target the Taenia solium larvae while managing the inflammatory response that can cause neurological complications during treatment.

From the FDA Drug Label

1.1 Neurocysticercosis Albendazole tablets are indicated for the treatment of parenchymal neurocysticercosis due to active lesions caused by larval forms of the pork tapeworm, Taenia solium.

2.1 Dosage Dosing of albendazole will vary depending upon the indication. Neurocysticercosis 60 kg or greater 400 mg twice daily, with meals 8 to 30 days Less than 60 kg 15 mg/kg/day given in divided doses twice daily with meals (maximum total daily dose 800 mg)

2.2 Concomitant Medication to Avoid Adverse Reactions Patients being treated for neurocysticercosis should receive appropriate steroid and anticonvulsant therapy as required. Oral or intravenous corticosteroids should be considered to prevent cerebral hypertensive episodes during the first week of treatment

The recommended treatment for neurocysticercosis is albendazole tablets, with a dosage of:

• 400 mg twice daily for patients weighing 60 kg or greater, for 8 to 30 days
• 15 mg/kg/day given in divided doses twice daily for patients weighing less than 60 kg, for 8 to 30 days Patients should also receive steroid and anticonvulsant therapy as required, and oral or intravenous corticosteroids should be considered to prevent cerebral hypertensive episodes during the first week of treatment 2

From the Research

Neurocysticercosis Treatment

The recommended treatment for neurocysticercosis depends on the type, location, and stage of the lesions, as well as the patient's symptoms and overall health.

• Medical therapy should be oriented to obtain appropriate symptom control, and the use of antiparasitic agents should be considered 3.
• Antiparasitic treatment is of benefit in most cases of viable and degenerating neurocysticercosis 3.
• Combination therapy with albendazole and praziquantel has been shown to be effective in increasing the parasiticidal effect in patients with multiple brain cysticercosis cysts without increased side-effects 4.
• The choice of antiparasitic drug is still guided by collateral factors, including drug availability and costs 5.

Treatment Guidelines

• WHO 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 6.
• Subarachnoid neurocysticercosis is associated with a high fatality rate unless optimally treated, and advances in treatment include the use of prolonged antiparasitic and anti-inflammatory courses 6.
• Emerging data support the safety and efficacy of minimally invasive surgery in ventricular cases 6.

Incidence Data

• Accurate incidence data for neurocysticercosis in the United States are not available, but estimates range from 0·2 to 0·6 cases per 100 000 general population and 1·5-5·8 cases per 100 000 Hispanics 7.
• It is estimated that between 1320 and 5050 new cases of neurocysticercosis occur every year in the United States 7.