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.

Treatment Approach

The treatment approach for neurocysticercosis can be broken down into several key components:

• Antiparasitic therapy: Albendazole (15 mg/kg/day divided in two doses, maximum 1200 mg daily) for 10-14 days is the recommended first-line treatment, often combined with praziquantel (50 mg/kg/day divided in 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 1-3 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, and treatment effectiveness should be monitored with follow-up neuroimaging at 3-6 months 1.

Special Considerations

In cases with hydrocephalus or large subarachnoid cysts, surgical intervention may be required, and the management of patients with diffuse cerebral edema should be anti-inflammatory therapy such as corticosteroids, whereas hydrocephalus usually requires a surgical approach 1.

Key Recommendations

• For patients with 1–2 viable parenchymal cysticerci, albendazole monotherapy for 10–14 days is recommended compared to either no antiparasitic therapy or combination antiparasitic therapy 1.
• For patients with >2 viable parenchymal cysticerci, albendazole combined with praziquantel for 10–14 days is recommended rather than albendazole monotherapy 1.
• Retreatment with antiparasitic therapy may be necessary for parenchymal cystic lesions persisting for 6 months after the end of the initial course of therapy 1.

From the FDA Drug Label

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

Table 1 AlbendazoleDosage Indication Patient Weight Dose Duration 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)

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 with a dose 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 may be considered to prevent cerebral hypertensive episodes during the first week of treatment 2

From the Research

Treatment Options for Neurocysticercosis

The recommended treatment for neurocysticercosis typically involves the use of antiparasitic drugs, such as albendazole or praziquantel, to eradicate the parasite.

• Albendazole is often considered the first-line treatment due to its efficacy and lower cost compared to praziquantel 3, 4, 5.
• The optimal dosage and duration of albendazole treatment have been studied, with some research suggesting that a short course of 8 days can be highly effective 3, 4.
• Praziquantel is also effective, but its use may be limited by its higher cost and potential for adverse reactions 5, 6.

Administration and Dosage

The administration and dosage of albendazole and praziquantel can vary depending on the specific case and the severity of the disease.

• Albendazole is typically administered at a daily dose of 15 mg/kg of body weight, divided into two daily doses, for 8 days 7.
• Praziquantel is usually given at a daily dose of 50 mg/kg, divided into three daily doses, for 15 days 7.
• Concurrent administration of corticosteroids, such as dexamethasone, may be necessary to minimize inflammation and cerebral edema associated with the death of the parasites 6, 7.

Special Considerations

Certain cases of neurocysticercosis may require special consideration, such as:

• Patients with intraventricular cysts and hydrocephalus, who may require shunting and surgical removal of cysticerci 7.
• Patients with inactive lesions and seizures, who may only require symptomatic therapy with standard anticonvulsants 7.
• Patients with a high parasitic load, who may benefit from concomitant corticosteroid administration to minimize the risk of adverse reactions 6.