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Treatment of neurocysticercosis : Current status and future research needs
T. E. Nash, G. Singh, A. C. White, et al. Neurology 2006;67;1120 DOI 10.1212/01.wnl.0000238514.51747.3a This information is current as of February 21, 2011

The online version of this article, along with updated information and services, is located on the World Wide Web at:http://www.neurology.org/content/67/7/1120.full.html

Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright © 2006 by AAN Enterprises, Inc. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.

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CME

Treatment ofneurocysticercosis
Current status and future research needs
T.E. Nash, MD; G. Singh, MD; A.C. White, MD; V. Rajshekhar, MCh; J.A. Loeb, MD, PhD; J.V. Proano, MD; O.M. Takayanagui, MD; A.E. Gonzalez, DVM, PhD; J.A. Butman, MD, PhD; ˜ C. DeGiorgio, MD; O.H. Del Brutto, MD; A. Delgado-Escueta, MD, PhD; C.A.W. Evans, MD, PhD; R.H. Gilman, MD, DTMH; S.M. Martinez, MD; M.T. Medina, MD; E.J. Pretell, MD; J.Teale, PhD; and H.H. Garcia, MD, PhD

Abstract—Here we put forward a roadmap that summarizes important questions that need to be answered to determine more effective and safer treatments. A key concept in management of neurocysticercosis is the understanding that infection and disease due to neurocysticercosis are variable and thus different clinical approaches and treatments are required. Despiterecent advances, treatments remain either suboptimal or based on poorly controlled or anecdotal experience. A better understanding of basic pathophysiologic mechanisms including parasite survival and evolution, nature of the inflammatory response, and the genesis of seizures, epilepsy, and mechanisms of anthelmintic action should lead to improved therapies.
NEUROLOGY 2006;67:1120–1127Cysticercosis, the most common cause of adult-onset epilepsy in the developing world,1-3 is due to infection with the cystic larval form of the tapeworm Taenia solium. The intestinal dwelling tapeworm stage develops following the ingestion of raw or poorly cooked pork containing cystic larvae. The tapeworm releases infectious ova into the feces. When ingested by freeroaming pigs, the ova release theinvasive larvae, which migrate and develop into cystic larvae in the muscles, brain, and other tissues of the pig. Like the pig, humans also develop larval cysts in their tissue after accidental ingestion of ova. Most of the symptoms and disease in humans result from infection of the CNS by larval cysts. Presenting symptoms and signs can be particularly varied due to differences in location, number ofcysts, and associated inflammation.1,4

Treatment of neurocysticercosis (NCC) is controversial.1,4-9 There are limited natural history studies of most types of NCC so that the benefits of treatments, until most recently, have not been based on optimally designed studies. Despite this imperfect supporting information, clinical observations indicate that treatment approaches and requirements differamong the forms or types of NCC. Factors considered in deciding treatments include the anatomic location of cysts, the stage of evolution of the cysts, number of cysts, the degree of associated inflammation, size, and severity of symptoms. Frequently, the presence of multiple cysts in different anatomic locations and in varying stages of evolution further complicates treatment decisions.Determining effective treatments is complicated by the fact that cysticidal treatment itself initiates a host in-

From the Laboratory of Parasitic Diseases (T.E.N.), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD; Dayanand Medical College and Hospital (G.S.), Ludhiana, Punjab, India; Infectious Disease Section (A.C.W.), Department of Medicine, Baylor College of Medicine,...