From the Guidelines
Neurocysticercosis diagnosis and treatment involve a combination of antiparasitic drugs, corticosteroids, and surgical interventions. The diagnosis of neurocysticercosis (NCC) is typically made through a combination of clinical presentation, neuroimaging, and serologic testing, including the enzyme-linked immunotransfer blot (EITB) assay 1.
Diagnosis
- Neuroimaging: Computed tomography (CT) and magnetic resonance imaging (MRI) are used to detect lesions, with CT being more sensitive for calcified lesions and MRI being more sensitive for detecting the scolex, edema, and small parenchymal lesions 1.
- Serologic testing: The EITB assay is the test of choice for detecting antibodies against the parasite, with a sensitivity of close to 100% in patients with multiple parenchymal, ventricular, or subarachnoid NCC 1.
Treatment
- Antiparasitic drugs: Albendazole is the preferred antiparasitic drug, and it should be given along with anti-inflammatory drugs, such as corticosteroids 1.
- Corticosteroids: Corticosteroids are used to reduce inflammation and edema, and they should be used cautiously in patients presenting with perilesional edema around a calcified lesion 1.
- Surgical interventions: Surgical interventions, such as neuroendoscopic removal or ventricular shunt placement, may be necessary for certain types of NCC, such as ventricular or subarachnoid NCC 1.
Specific Treatment Recommendations
- Parenchymal NCC: Antiparasitic treatment with albendazole and corticosteroids is recommended for patients with viable cysts, while patients with calcified cysts do not require antiparasitic treatment 1.
- Ventricular NCC: Neuroendoscopic removal or ventricular shunt placement is recommended, followed by antiparasitic treatment with albendazole and corticosteroids 1.
- Subarachnoid NCC: Antiparasitic treatment with albendazole and corticosteroids is recommended, along with ventricular shunt placement if there is hydrocephalus 1. It's worth noting that the treatment of NCC should be individualized, taking into account the location and number of cysts, as well as the patient's overall health and economic situation 1.
From the Research
Diagnosis of Neurocysticercosis
- Neurocysticercosis (NCC) is most accurately diagnosed using clinical neuroimaging, such as CT and MRI scans 2, 3
- Diagnosis is also supported by antibody/antigen detection in the serum and occasionally the cerebrospinal fluid 4, 5
- Neuroimaging remains the main diagnostic test for NCC, despite the introduction of several new immunological tests 4
Treatment of Neurocysticercosis
- Treatment of NCC is individualized and may include antihelmintics, such as albendazole, steroids, symptomatic medicines, or surgery 6, 3
- The use of one or various therapeutic measures depends on the number, location, and biological stage of lesions, as well as the degree of inflammatory response to the parasites 3
- Randomized controlled trials have shown that treatment with cysticidal agents can hasten the resolution of lesions and reduce seizure recurrence in some cases 5
- Corticosteroids and antiparasitic drugs are recommended for viable parenchymal disease and single enhancing lesions, while subarachnoid NCC requires prolonged antiparasitic and anti-inflammatory courses 6
Prevention of Neurocysticercosis
- Prevention of infection depends on communication to the public of the life cycle of the complex zoonosis to promote behavior change, underpinned by practical control measures 2
- Control measures include treatment of human taeniasis and (neuro)cysticercosis with albendazole and praziquantel, surgery where appropriate, and effective vaccination and deworming for pigs supported by meat inspection 2
- Eradication of cysticercosis is an attainable goal by public education and sanitary improvement in endemic areas 3