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Cysticercosis

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Opinion statement

Cysticercosis, the consequence of ingesting viable eggs of the porcine tapeworm Taenia solium, currently remains one of the most common human parasitic conditions worldwide. Although preventable by the proper disposal of human wastes, cysticercosis of the central nervous system (neurocysticercosis) accounts for a substantial proportion of cases of epilepsy and hydrocephalus among children and adults in many developing countries. Cases also occur in nonendemic regions, reflecting patterns of immigration from highly endemic countries, especially Mexico and other areas of Latin America. Antiparasitic treatment during active infections, using albendazole or praziquantel, can eradicate the parasite, may lower the risk of late complications, and potentially reduces the morbidity of acute disease. Considerable controversy persists regarding the role of antiparasitic therapy in neurocysticercosis, however. Persons with active parenchymal or extraparenchymal disease, defined by the neuroradiographic appearance of lesions, can be treated with albendazole, 15 mg/kg/d divided into two daily doses for 8 days. Patients with parenchymal disease who do not respond to albendazole can receive a second course of albendazole or praziquantel, 50 mg/kg/d divided into three daily doses for 15 days. Concurrent administration of dexamethasone in standard doses is usually required during the first several days of antiparasitic therapy to minimize the inflammation and cerebral edema associated with death of the parasites. Patients with intraventricular cysts and hydrocephalus require shunting and surgical removal of cysticerci. By contrast, persons with inactive lesions and seizures as a consequence of remote infections typically require only symptomatic therapy with standard anticonvulsants.

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References and Recommended Reading

  1. White AC: Neurocysticercosis: a major cause of neurological disease worldwide. Clin Infect Dis 1997, 24:101–105. A well-written, extremely comprehensive review that summarizes the fascinating immunopathogenesis of neurocysticercosis and the current controversies regarding the role of antihelminthic therapy in the treatment of the disorder. If there is time to read but one article regarding neurocysticercosis, this should be the one.

    PubMed  Google Scholar 

  2. Sotelo J: Neurocysticercosis. In Central Nervous System Diseases and Therapy. Edited by Roos K. New York: Marcel Dekker, Inc; 1997:545–572. A thorough review of the condition by a very knowledgeable expert in the diagnosis and treatment of neurocysticercosis.

    Google Scholar 

  3. Lettau LA, Gardner S, Tennis J, et al.: Locally acquired neurocysticercosis—North Carolina, Massachusetts, and South Carolina, 1989–1991. MMWR Morb Mortal Wkly Rep 1992, 41:1–4.

    Google Scholar 

  4. Mitchell WG, Crawford TO: Intraparenchymal cerebral cysticercosis in children: diagnosis and treatment. Pediatrics 1988, 82:76–82.

    PubMed  CAS  Google Scholar 

  5. Scharf D: Neurocysticercosis: two hundred and thirty eight cases from a California hospital. Arch Neurol 1988, 45:777–780.

    PubMed  CAS  Google Scholar 

  6. Sotelo J, Guerrero V, Rubio F: Neurocysticercosis: a new classification based on active and inactive forms. Arch Intern Med 1985, 145:442–445.

    Article  PubMed  CAS  Google Scholar 

  7. Del Brutto OH, Santibanez R, Noboa CA, et al.: Epilepsy due to neurocysticercosis: analysis of 203 patients. Neurology 1992, 42:389–392.

    PubMed  Google Scholar 

  8. Carpio A, Escobar A, Hauser WA: Cysticercosis and epilepsy: a critical review. Epilepsia 1998, 39:1025–1040. A well-written review that emphasizes the importance of neurocysticercosis as a major cause of epilepsy in regions endemic for T. solium. The article contains an excellent summary of the epidemiology of neurocysticercosis and epilepsy and discusses the concept of transitional forms of neurocysticercosis.

    Article  PubMed  CAS  Google Scholar 

  9. Sotelo J, Marin C: Hydrocephalus secondary to cysticercotic arachnoiditis. J Neurosurg 1987, 66:686–689.

    Article  PubMed  CAS  Google Scholar 

  10. Lotz J, Hewlett R, Alheit B, Bowen R: Neurocysticercosis: correlative pathology and MR imaging. Neuroradiology 1988, 30:35–41.

    Article  PubMed  CAS  Google Scholar 

  11. Wilson M, Bryan RT, Fried JA, et al.: Clinical evaluation of the cysticercosis enzyme-linked immunoelectrotransfer blot in patients with neurocysticercosis. J Infect Dis 1991, 164:1007–1009.

    PubMed  CAS  Google Scholar 

  12. St.Geme JW, Maldonado YA, Enzmann D, et al.: Consensus: diagnosis and management of neurocysticercosis in children. Pediatr Infect Dis J 1993, 12:455–461. A summary of expert opinions regarding the treatment of neurocysticercosis presented in a point-counterpoint fashion.

    Article  PubMed  Google Scholar 

  13. Kramer LD: Medical treatment of cysticercosis: ineffective. Arch Neurol 1995, 52:101–102. Together with Del Brutto’s article on pages 102 to 104 of the same issue, which champions the effectiveness of medical treatment, this is another concise point-counterpoint debate regarding the benefits of specific antiparasitic therapy in neurocysticercosis.

    PubMed  CAS  Google Scholar 

  14. Del Brutto OH, Sotelo J, Roman GC: Therapy for neurocysticercosis: a reappraisal. Clin Infect Dis 1993, 17:30–35. Although somewhat older, this article summarizes well the approach to managing neurocysticercosis based on the location of infection.

    Google Scholar 

  15. Evans C, Garcia HH, Gilman RH, Friedland JS: Controversies in the management of cysticercosis. Emerg Infect Dis 1997, 3:403–405.

    Article  PubMed  CAS  Google Scholar 

  16. Schantz PM, Moore AC, Munoz JL, et al.: Neurocysticercosis in an orthodox Jewish community in New York City. N Engl J Med 1992, 327:692–695.

    Article  PubMed  CAS  Google Scholar 

  17. Couldwell WT, Zee CS, Apuzzo MLJ: Definition of the role of contemporary surgical management in cisternal and parenchymal cysticercosis cerebri. Neurosurgery 1991, 28:231–237.

    Article  PubMed  CAS  Google Scholar 

  18. Venkatesan P: Albendazole. J Antimicrob Chemother 1998, 41:145–147. A review of the value of albendazole in the treatment of various parasitic diseases.

    Article  PubMed  CAS  Google Scholar 

  19. Garcia HH, Gilman RH, Horton J, et al.: Albendazole therapy for neurocysticercosis: a prospective doubleblind trial comparing 7 versus 14 days of treatment. Neurology 1997, 48:1421–1427. A recent study of the use of albendazole in patients with active neurocysticercosis, using CT appearance of lesions as a major therapeutic outcome measure. Remarkably, only 38% had “complete cure,” defined as radiographic disappearance of all active lesions at 3 months. Three of 10 patients who had “cure” at 3 months had active lesions detected at the 1-year follow-up.

    PubMed  CAS  Google Scholar 

  20. Baranwal AK, Singhi PD, Khandelwal N, et al.: Albendazole therapy in children with focal seizures and single, small enhancing computerized tomographic lesions: a randomized, placebo-controlled, doubleblind trial. Pediatr Infect Dis J 1998, 17:696–700. This prospective study represents one of the few that have included a placebo control arm. All children received dexamethasone during the first 5 days of therapy. Outcome measures included the CT appearance of lesions and the rates of seizure recurrence. Children who received albendazole had higher rates of lesion resolution (64.5% vs 37.5%; P<0.05) at 3 months and lower rates of recurrent seizures (31.3% vs 12.9%) after 4 weeks, suggesting that albendazole therapy is warranted. Remarkably, nearly 40% of the untreated patients had resolution of lesions at 3 months. One wonders what outcome would be at 1 year of follow-up.

    Article  PubMed  CAS  Google Scholar 

  21. Mehta SS, Hatfield S, Jessen L, Vogel D: Albendazole versus praziquantel for neurocysticercosis. Am J Health Syst Pharm 1998, 55:598–600. An excellent, concise summary of the two currently available drugs used in the treatment of neurocysticercosis. Although efficacy seems nearly equivalent (or slightly in favor of albendazole), the lower cost and cerebrospinal fluid penetration indicate that albendazole should be the drug of choice.

    PubMed  CAS  Google Scholar 

  22. Sotelo J, Escobedo F, Rodriguez-Carbajal J, et al.: Therapy of parenchymal brain cysticercosis with praziquantel. N Engl J Med 1984, 316:1001–1007. One of the first studies to suggest benefit from specific antiparasitic therapy. The study included small numbers, however, did not randomize, and used CT appearance of the lesions as the primary outcome measure.

    Article  Google Scholar 

  23. Vazquez V, Sotelo J: The course of seizures after treatment for cerebral cysticercosis. N Engl J Med 1992, 327:696–701. A subsequent study from the same institution concluded that praziquantel therapy reduced the frequency of seizures 3 years after treatment. The retrospective study design detracts from the power of the observation, however.

    Article  PubMed  CAS  Google Scholar 

  24. Del Brutto OH, Campos X, Sanchez J, Mosquera A: Single day praziquantel versus 1 week albendazole for neurocysticercosis. Neurology 1999, 52:1079–1081. A small-scale study, using CT appearance as the outcome measure, that shows no differences between praziquantel and albendazole in these regimens.

    PubMed  Google Scholar 

  25. Sotelo J, Escobedo R, Penagos P: Albendazole vs. praziquantel for therapy for neurocysticercosis. Arch Neurol 1988, 45:532–533. Another small study that shows no differences between praziquantel and albendazole.

    PubMed  CAS  Google Scholar 

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  1. Division of Pediatric Neurology, Primary Children’s Medical Center, 100 North Medical Drive, Suite 2700, 84113, Salt Lake City, UT, USA

    James F. Bale MD

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  1. James F. Bale MD
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Bale, J.F. Cysticercosis. Curr Treat Options Neurol 2, 355–360 (2000). https://doi.org/10.1007/s11940-000-0052-8

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  • DOI: https://doi.org/10.1007/s11940-000-0052-8

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