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Antiparasitic treatment of cerebral cysticercosis: lessons and experiences from China

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Abstract

Cysticercosis is a tropical disease caused by infection with the larval stage of the pork tapeworm, Taenia solium. Humans and pigs acquire cysticercosis by ingesting T. solium eggs shed in the feces of humans with taeniasis (i.e., infected with an adult intestinal tapeworm). Cerebral cysticercosis occurs when the cysts of T. solium develop within the central nervous system, and it is the primary cause of illness in T. solium infection. Currently, cerebral cysticercosis is endemic worldwide, and it is a leading cause of adult-onset epilepsy in developing countries. However, it is now increasingly detected in developed countries due to the immigration of T. solium carriers from the endemic areas. The antiparasitic treatment of cerebral cysticercosis remains controversial till now. In China, except a few cases who conform to the contraindicated criteria of antiparasitic therapy, most cerebral cysticercosis patients with symptoms and signs are given etiological treatment. This paper reviews the antiparasitic therapy of cerebral cysticercosis in China during the past several decades. Praziquantel treatment with different regimens has been used, and various efficacies are achieved. In the early stage, unsatisfactory therapeutic efficacy was achieved due to small doses and short treatment courses. Afterwards, the therapeutic efficacy became increasingly remarkable in both adults and children with the increases in dosage and courses. Albendazole also presents activity against cysticercosis with slow and moderate action, and it has been widely used in the treatment of the infection. The comparison between praziquantel and albendazole treatments showed that the immediate and short-term effects of albendazole treatment were better than those of praziquantel treatment, but similar mid- and long-term efficacies were observed following albendazole and praziquantel treatments. The combination of albendazole and praziquantel treatments can increase the therapeutic efficacy, and now, from the massive clinical practices, most of Chinese clinical specialists propose the combination therapy of albendazole and praziquantel for cerebral cysticercosis with simultaneous administration of steroids, especially in the first course. In addition, administration of praziquantel at a high dose can become a diagnostic treatment for suspected cerebral cysticercosis and serve as a supplement of the currently available diagnostic methods, such as diagnoses based on the clinical features, immunology, CT and MRI imaging, etc., in some atypical cerebral cysticercosis patients. Praziquantel and albendazole treatments have some adverse reactions, and to control these adverse effects, all the cerebral cysticercosis patients should be treated in hospital. According to the type of cerebral cysticercosis, especially for intracranial hypertension type and meningocephalitis type, the dosages of anti-cysticercus drugs need to follow a gradually increasing pattern. During the period of anti-cysticercosis treatments, steroids and/or dehydrating agents need be administered which can alleviate the intracranial hypertension and so on. Traditional Chinese medicines have been also used in the treatment of cerebral cysticercosis and achieve satisfactory outcomes. However, the compound prescription of traditional Chinese medicines is very complex, and the effective components are not fully clear. Some cerebral cysticercosis patients with very high intracranial tension could not receive antiparasitic treatment immediately, and surgical treatment is required. Chinese surgeons also achieve some successful experiences, but not all the cysticercus can be removed completely during the surgery. Therefore, antiparasitic drugs are still needed after the operation. The rehabilitative treatment is supplementary in the therapy of cerebral cysticercosis. In China, the rehabilitative treatment of cerebral cysticercosis is still at the initial stage. These lessons and experiences in China can be shared with medical staff and researchers from other countries where the disease is endemic.

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Contributors

All authors participated in data collection, analysis, interpretation, and writing of the review.

Conflicts of interest

We declare that we have no conflicts of interest.

Search strategy and selection criteria

Four major Chinese literature databases, namely China National Knowledge Infrastructure, Chinese Biomedical Database, VIP database and Wanfang Database were jointly searched for Chinese language papers and PubMed for English language papers, using the terms “cerebral cysticercosis”, “neurocysticercosis”, “cysticercosis”, “praziquantel”, “albendazole”, “China”, and combinations of these terms. The date of the last search was December 31, 2012. The abstracts of each screened publication were read carefully to identify the studies consistent with the objectives of this review.

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Authors and Affiliations

  1. Jiangsu Institute of Parasitic Diseases, 117 Yangxiang, Meiyuan, Wuxi City, 214064, Jiangsu Province, People’s Republic of China

    Wei Wu, Wei Wang & Yixin Huang

  2. Shandong Institute of Parasitic Diseases, 11 Taibaizhonglu, Jining, 272033, Shandong Province, People’s Republic of China

    Fengju Jia & Yong Huang

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  1. Wei Wu
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  2. Fengju Jia
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  3. Wei Wang
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  4. Yixin Huang
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Correspondence to Yixin Huang or Yong Huang.

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Wei Wu, Fengju Jia and Wei Wang contributed equally to this work.

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Wu, W., Jia, F., Wang, W. et al. Antiparasitic treatment of cerebral cysticercosis: lessons and experiences from China. Parasitol Res 112, 2879–2890 (2013). https://doi.org/10.1007/s00436-013-3459-3

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