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Pediatric Neurocysticercosis

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Abstract

Neurocysticercosis is the most common helminth infection of nervous system in humans caused by the encysted larvae of Taenia solium. It is a major cause of epilepsy in tropical areas and the most common cause of focal-onset seizures in North Indian children. Children with neurocysticercosis have pleomorphic manifestations depending on the location, number and viability of the cysts and host response. In endemic areas, neurocysticercosis should be clinically suspected in any child with recent-onset seizures, headache or focal motor deficits where there is no other suggestion of an underlying neurological disorder. Diagnosis of neurocysticercosis is essentially based on neuroimaging; visualization of a scolex is diagnostic. Management includes use of cysticidal drugs usually albendazole, which seems to be effective for lesion resolution and seizure remission, use of steroids and anti-epileptic drugs. Single lesions portend good prognosis with resolution of lesions in >60% of the cases within 6 mo and good seizure control. Prognosis is guarded in cysticercus encephalitis, racemose and extraparenchymal neurocysticercosis.

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Article 09 July 2018

Ricardo Santos de Oliveira, Dinark Conceição Viana, … José Francisco Manganelli Salomão

References

  1. Relationship between epilepsy and tropical diseases. Commission on tropical diseases of the international league against epilepsy. Epilepsia. 1994;35:89–93.

    Article  Google Scholar 

  2. Singhi P, Ray M, Singhi S, Khandelwal N. Clinical spectrum of 500 children with neurocysticercosis and response to albendazole therapy. J Child Neurol. 2000;15:207–13.

    Article  PubMed  CAS  Google Scholar 

  3. Ndimubanzi PC, Carabin H, Budke CM, et al. A systematic review of the frequency of neurocyticercosis with a focus on people with epilepsy. PLoS Negl Trop Dis. 2010;4:e870.

    Article  PubMed  PubMed Central  Google Scholar 

  4. WHO. Accelerating work to overcome the global impact of neglected tropical diseases. A roadmap for impementation. Switzerland: World Health Organization; 2012.

  5. Del Brutto OH, Garcia HH. Neurocysticercosis in nonendemic countries: time for a reappraisal. Neuroepidemiology. 2012;39:145–6.

    Article  PubMed  Google Scholar 

  6. Serpa JA, White AC Jr. Neurocysticercosis in the United States. Pathog Glob Health. 2012;106:256–60.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mafojane NA, Appleton CC, Krecek RC, Michael LM, Willingham AL 3rd. The current status of neurocysticercosis in eastern and southern Africa. Acta Trop. 2003;87:25–33.

    Article  PubMed  CAS  Google Scholar 

  8. Praet N, Speybroeck N, Manzanedo R, et al. The disease burden of Taenia solium cysticercosis in Cameroon. PLoS Negl Trop Dis. 2009;3:e406.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Montano SM, Villaran MV, Ylquimiche L, et al. Neurocysticercosis: association between seizures, serology, and brain CT in rural Peru. Neurology. 2005;65:229–33.

    Article  PubMed  CAS  Google Scholar 

  10. Medina MT, Aguilar-Estrada RL, Alvarez A, et al. Reduction in rate of epilepsy from neurocysticercosis by community interventions: the Salama, Honduras study. Epilepsia. 2011;52:1177–85.

  11. Fleury A, Hernandez M, Fragoso G, Parkhouse RM, Harrison LJ, Sciutto E. Detection of secreted cysticercal antigen: a useful tool in the diagnosis of inflammatory neurocysticercosis. Trans R Soc Trop Med Hyg. 2003;97:542–6.

    Article  PubMed  CAS  Google Scholar 

  12. Khurana S, Aggarwal A, Malla N. Prevalence of anti-cysticercus antibodies in slum, rural and urban populations in and around union territory, Chandigarh. Indian J Pathol Microbiol. 2006;49:51–3.

    PubMed  Google Scholar 

  13. Sahu PS, Patro S, Jena PK, Swain SK, Das BK. Imaging and serological-evidence of neurocysticercosis among patients with seizures in Odisha, an unexplored eastern coastal province in India. J Clin Diagn Res. 2015;9:DC06–10.

    PubMed  PubMed Central  Google Scholar 

  14. Cherian A, Syam UK, Sreevidya D, et al. Low seroprevalence of systemic cysticercosis among patients with epilepsy in Kerala--South India. J Infect Public Health. 2014;7:271–6.

    Article  PubMed  Google Scholar 

  15. Parija SC, Balamurungan N, Sahu PS, Subbaiah SP. Cysticercus antibodies and antigens in serum from blood donors from Pondicherry, India. Rev Inst Med Trop Sao Paulo. 2005;47:227–30.

    Article  PubMed  Google Scholar 

  16. Prasad KN, Prasad A, Gupta RK, et al. Neurocysticercosis in patients with active epilepsy from the pig farming community of Lucknow district, north India. Trans R Soc Trop Med Hyg. 2009;103:144–50.

    Article  PubMed  Google Scholar 

  17. Prasad KN, Verma A, Srivastava S, Gupta RK, Pandey CM, Paliwal VK. An epidemiological study of asymptomatic neurocysticercosis in a pig farming community in northern India. Trans R Soc Trop Med Hyg. 2011;105:531–6.

    Article  PubMed  Google Scholar 

  18. Singh G, Bawa J, Chinna D, et al. Association between epilepsy and cysticercosis and toxocariasis: a population-based case-control study in a slum in India. Epilepsia. 2012;53:2203–8.

    Article  PubMed  Google Scholar 

  19. Singhi P, Singhi S. Neurocysticercosis in children. J Child Neurol. 2004;19:482–92.

    Article  PubMed  Google Scholar 

  20. Ito A, Putra MI, Subahar R, et al. Dogs as alternative intermediate hosts of Taenia solium in Papua (Irian Jaya), Indonesia confirmed by highly specific ELISA and immunoblot using native and recombinant antigens and mitochondrial DNA analysis. J Helminthol. 2002;76:311–4.

    Article  PubMed  CAS  Google Scholar 

  21. Mahanty S, Garcia HH. Cysticercosis and neurocysticercosis as pathogens affecting the nervous system. Prog Neurobiol. 2010;91:172–84.

    Article  PubMed  CAS  Google Scholar 

  22. Alvarez JI, Rivera J, Teale JM. Differential release and phagocytosis of tegument glycoconjugates in neurocysticercosis: implications for immune evasion strategies. PLoS Negl Trop Dis. 2008;2:e218.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Verma A, Prasad KN, Gupta RK, et al. Toll-like receptor 4 polymorphism and its association with symptomatic neurocysticercosis. J Infect Dis. 2010;202:1219–25.

    Article  PubMed  CAS  Google Scholar 

  24. Cooke JC, Gelman JS, Harper RW. Echocardiologists' role in the deployment of the Amplatzer atrial septal occluder device in adults. J Am Soc Echocardiogr. 2001;14:588–94.

    Article  PubMed  CAS  Google Scholar 

  25. Rathore C, Thomas B, Kesavadas C, Radhakrishnan K. Calcified neurocysticercosis lesions and hippocampal sclerosis: potential dual pathology? Epilepsia. 2012;53:e60–2.

    Article  PubMed  Google Scholar 

  26. Morales NM, Agapejev S, Morales RR, Padula NA, Lima MM. Clinical aspects of neurocysticercosis in children. Pediatr Neurol. 2000;22:287–91.

    Article  PubMed  CAS  Google Scholar 

  27. Singhi P, Saini AG, Sankhyan N. Amaurosis fugax caused by neurocysticercosis. Pediatr Infect Dis J. 2014;33:427.

    Article  PubMed  Google Scholar 

  28. Singhi P. Neurocysticercosis. Ther Adv Neurol Disord. 2011;4:67–81.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Saini AG, Vyas S, Singhi P. Racemose neurocysticercosis. J Infect Public Health. 2017. https://doi.org/10.1016/j.jiph.2016.11.019.

  30. Singhi P, Saini AG. Pediatric neurocysticercosis: current challenges and future prospects. Pediatr Health Med Ther. 2016;7:5–16.

    Article  Google Scholar 

  31. Singhi P, Singhi S. Neurocysticercosis in children. Indian J Pediatr. 2009;76:537–45.

    Article  PubMed  Google Scholar 

  32. Del Brutto OH, Wadia NH, Dumas M, Cruz M, Tsang VC, Schantz PM. Proposal of diagnostic criteria for human cysticercosis and neurocysticercosis. J Neurol Sci. 1996;142:1–6.

    Article  PubMed  Google Scholar 

  33. Del Brutto OH. Diagnostic criteria for neurocysticercosis, revisited. Pathog Glob Health. 2012;106:299–304.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Singhi PD, Baranwal AK. Single small enhancing computed tomographic lesion in Indian children--I: evolution of current concepts. J Trop Pediatr. 2001;47:204–7.

    Article  PubMed  CAS  Google Scholar 

  35. do Amaral LL, Ferreira RM, da Rocha AJ, Ferreira NP. Neurocysticercosis: evaluation with advanced magnetic resonance techniques and atypical forms. Top Magn Reson Imaging. 2005;16:127–44.

    Article  PubMed  Google Scholar 

  36. Singhi PD, Baranwal AK. Single small enhancing computed tomographic lesions in indian children--II. Clinical features, pathology, radiology and management. J Trop Pediatr. 2001;47:266–70.

    Article  PubMed  CAS  Google Scholar 

  37. Pretell EJ, Martinot C Jr, Garcia HH, Alvarado M, Bustos JA, Martinot C. Differential diagnosis between cerebral tuberculosis and neurocysticercosis by magnetic resonance spectroscopy. J Comput Assist Tomogr. 2005;29:112–4.

    Article  PubMed  Google Scholar 

  38. Rajshekhar V, Haran RP, Prakash GS, Chandy MJ. Differentiating solitary small cysticercus granulomas and tuberculomas in patients with epilepsy. Clinical and computerized tomographic criteria. J Neurosurg. 1993;78:402–7.

    Article  PubMed  CAS  Google Scholar 

  39. Atluri SR, Singhi P, Khandelwal N, Malla N. Evaluation of excretory secretory and 10-30 kDa antigens of Taenia solium cysticerci by EITB assay for the diagnosis of neurocysticercosis. Parasite Immunol. 2009;31:151–5.

    Article  PubMed  CAS  Google Scholar 

  40. Sahu PS, Parija SC, Jayachandran S. Antibody specific to 43kDa excretory-secretory antigenic peptide of Taenia solium metacestode as a potential diagnostic marker in human neurocysticercosis. Acta Trop. 2010;115:257–61.

    Article  PubMed  CAS  Google Scholar 

  41. Atluri SR, Singhi P, Khandelwal N, Malla N. Neurocysticercosis immunodiagnosis using Taenia solium cysticerci crude soluble extract, excretory secretory and lower molecular mass antigens in serum and urine samples of Indian children. Acta Trop. 2009;110:22–7.

    Article  PubMed  Google Scholar 

  42. Sahu PS, Parija S, Kumar D, Jayachandran S, Narayan S. Comparative profile of circulating antigenic peptides in CSF, serum & urine from patients with neurocysticercosis diagnosed by immunoblotting. Parasite Immunol. 2014;36:509–21.

    Article  PubMed  CAS  Google Scholar 

  43. 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;164:1007–9.

    Article  PubMed  CAS  Google Scholar 

  44. Mandal J, Singhi PD, Khandelwal N, Malla N. Evaluation of ELISA and dot blots for the serodiagnosis of neurocysticercosis, in children found to have single or multiple enhancing lesions in computerized tomographic scans of the brain. Ann Trop Med Parasitol. 2006;100:39–48.

    Article  PubMed  CAS  Google Scholar 

  45. Rodriguez S, Dorny P, Tsang VC, et al. Detection of Taenia solium antigens and anti-T. solium antibodies in paired serum and cerebrospinal fluid samples from patients with intraparenchymal or extraparenchymal neurocysticercosis. J Infect Dis. 2009;199:1345–52.

  46. Noh J, Rodriguez S, Lee YM, et al. Recombinant protein- and synthetic peptide-based immunoblot test for diagnosis of neurocysticercosis. J Clin Microbiol. 2014;52:1429–34.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Garcia HH, Gilman RH, Catacora M, Verastegui M, Gonzalez AE, Tsang VC. Serologic evolution of neurocysticercosis patients after antiparasitic therapy. Cysticercosis working group in Peru. J Infect Dis. 1997;175:486–9.

  48. Camargo JA, Bertolucci PH. Quantification of Fas protein in CSF of patients with neurocysticercosis. Arq Neuropsiquiatr. 2012;70:262–6.

    Article  PubMed  Google Scholar 

  49. Camargo JA, Bertolucci PH. Quantification of amino acid neurotransmitters in cerebrospinal fluid of patients with neurocysticercosis. Open Neurol J. 2015;9:15–20.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  50. Otte WM, Singla M, Sander JW, Singh G. Drug therapy for solitary cysticercus granuloma: a systematic review and meta-analysis. Neurology. 2013;80:152–62.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  51. Kaur S, Singhi P, Singhi S, Khandelwal N. Combination therapy with albendazole and praziquantel versus albendazole alone in children with seizures and single lesion neurocysticercosis: a randomized, placebo-controlled double blind trial. Pediatr Infect Dis J. 2009;28:403–6.

    Article  PubMed  Google Scholar 

  52. Baird RA, Wiebe S, Zunt JR, Halperin JJ, Gronseth G, Roos KL. Evidence-based guideline: treatment of parenchymal neurocysticercosis: report of the guideline development subcommittee of the American Academy of neurology. Neurology. 2013;80:1424–9.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Singhi P, Dayal D, Khandelwal N. One week versus four weeks of albendazole therapy for neurocysticercosis in children: a randomized, placebo-controlled double blind trial. Pediatr Infect Dis J. 2003;22:268–72.

    PubMed  Google Scholar 

  54. Garcia HH, Evans CA, Nash TE, et al. Current consensus guidelines for treatment of neurocysticercosis. Clin Microbiol Rev. 2002;15:747–56.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Singhi P, Jain V, Khandelwal N. Corticosteroids versus albendazole for treatment of single small enhancing computed tomographic lesions in children with neurocysticercosis. J Child Neurol. 2004;19:323–7.

    Article  PubMed  Google Scholar 

  56. Singhi PD, Dinakaran J, Khandelwal N, Singhi SC. One vs. two years of anti-epileptic therapy in children with single small enhancing CT lesions. J Trop Pediatr. 2003;49:274–8.

    Article  PubMed  Google Scholar 

  57. Ash A, Okello A, Khamlome B, Inthavong P, Allen J, Thompson RC. Controlling Taenia solium and soil transmitted helminths in a northern Lao PDR village: impact of a triple dose albendazole regime. Acta Trop. 2015; https://doi.org/10.1016/j.actatropica.2015.05.018.

  58. O'Neal SE, Moyano LM, Ayvar V, et al. Ring-screening to control endemic transmission of Taenia solium. PLoS Negl Trop Dis. 2014;8:e3125.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Panic G, Duthaler U, Speich B, Keiser J. Repurposing drugs for the treatment and control of helminth infections. Int J Parasitol Drugs Drug Resist. 2014;4:185–200.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Devi R, Jain A, Hurkat P, Jain SK. Dual drug delivery using lactic acid conjugated SLN for effective management of neurocysticercosis. Pharm Res. 2015;32:3137–48.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Pediatric Neurology and Neurodevelopment Unit, Medanta, The Medicity, Gurgaon, Haryana, India

    Pratibha Singhi

  2. Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Arushi Gahlot Saini

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  1. Pratibha Singhi
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  2. Arushi Gahlot Saini
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PS: Revision of the draft and final approval of the manuscript; AGS: Drafted the manuscript and reviewed the literature. PS will act as guarantor for this paper.

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Correspondence to Pratibha Singhi.

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Singhi, P., Saini, A.G. Pediatric Neurocysticercosis. Indian J Pediatr 86, 76–82 (2019). https://doi.org/10.1007/s12098-017-2460-8

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