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Review
. 2002 Oct;15(4):747-56.
doi: 10.1128/CMR.15.4.747-756.2002.

Current consensus guidelines for treatment of neurocysticercosis

Hector H García  1 , Carlton A W Evans, Theodore E Nash, Osvaldo M Takayanagui, A Clinton White Jr, David Botero, Vedantam Rajshekhar, Victor C W Tsang, Peter M Schantz, James C Allan, Ana Flisser, Dolores Correa, Elsa Sarti, Jon S Friedland, S Manuel Martinez, Armando E Gonzalez, Robert H Gilman, Oscar H Del Brutto
Affiliations
Review

Current consensus guidelines for treatment of neurocysticercosis

Hector H García et al. Clin Microbiol Rev. 2002 Oct.

Abstract

Taenia solium neurocysticercosis is a common cause of epileptic seizures and other neurological morbidity in most developing countries. It is also an increasingly common diagnosis in industrialized countries because of immigration from areas where it is endemic. Its clinical manifestations are highly variable and depend on the number, stage, and size of the lesions and the host's immune response. In part due to this variability, major discrepancies exist in the treatment of neurocysticercosis. A panel of experts in taeniasis/cysticercosis discussed the evidence on treatment of neurocysticercosis for each clinical presentation, and we present the panel's consensus and areas of disagreement. Overall, four general recommendations were made: (i) individualize therapeutic decisions, including whether to use antiparasitic drugs, based on the number, location, and viability of the parasites within the nervous system; (ii) actively manage growing cysticerci either with antiparasitic drugs or surgical excision; (iii) prioritize the management of intracranial hypertension secondary to neurocysticercosis before considering any other form of therapy; and (iv) manage seizures as done for seizures due to other causes of secondary seizures (remote symptomatic seizures) because they are due to an organic focus that has been present for a long time.

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Figures

FIG. 1.
FIG. 1.
Life cycle of T. solium.
FIG.2-9.
FIG.2-9.
Viable cysts (contrasted MRI; Fig. 2), cyst with perilesional contrast enhancement (contrasted MRI; Fig. 3), enhancing lesion (contrasted MRI; Fig. 4), calcifications (noncontrasted CT; Fig. 5), giant cyst (contrasted CT; Fig. 6), cysticercotic encephalitis (contrasted MRI; Fig. 7), basal subarachnoid cysticercosis (contrasted MRI; Fig. 8), and IV ventricle ependymitis (contrasted MRI; Fig. 9).
FIG.2-9.
FIG.2-9.
Viable cysts (contrasted MRI; Fig. 2), cyst with perilesional contrast enhancement (contrasted MRI; Fig. 3), enhancing lesion (contrasted MRI; Fig. 4), calcifications (noncontrasted CT; Fig. 5), giant cyst (contrasted CT; Fig. 6), cysticercotic encephalitis (contrasted MRI; Fig. 7), basal subarachnoid cysticercosis (contrasted MRI; Fig. 8), and IV ventricle ependymitis (contrasted MRI; Fig. 9).
FIG.2-9.
FIG.2-9.
Viable cysts (contrasted MRI; Fig. 2), cyst with perilesional contrast enhancement (contrasted MRI; Fig. 3), enhancing lesion (contrasted MRI; Fig. 4), calcifications (noncontrasted CT; Fig. 5), giant cyst (contrasted CT; Fig. 6), cysticercotic encephalitis (contrasted MRI; Fig. 7), basal subarachnoid cysticercosis (contrasted MRI; Fig. 8), and IV ventricle ependymitis (contrasted MRI; Fig. 9).
FIG.2-9.
FIG.2-9.
Viable cysts (contrasted MRI; Fig. 2), cyst with perilesional contrast enhancement (contrasted MRI; Fig. 3), enhancing lesion (contrasted MRI; Fig. 4), calcifications (noncontrasted CT; Fig. 5), giant cyst (contrasted CT; Fig. 6), cysticercotic encephalitis (contrasted MRI; Fig. 7), basal subarachnoid cysticercosis (contrasted MRI; Fig. 8), and IV ventricle ependymitis (contrasted MRI; Fig. 9).
FIG.2-9.
FIG.2-9.
Viable cysts (contrasted MRI; Fig. 2), cyst with perilesional contrast enhancement (contrasted MRI; Fig. 3), enhancing lesion (contrasted MRI; Fig. 4), calcifications (noncontrasted CT; Fig. 5), giant cyst (contrasted CT; Fig. 6), cysticercotic encephalitis (contrasted MRI; Fig. 7), basal subarachnoid cysticercosis (contrasted MRI; Fig. 8), and IV ventricle ependymitis (contrasted MRI; Fig. 9).
FIG.2-9.
FIG.2-9.
Viable cysts (contrasted MRI; Fig. 2), cyst with perilesional contrast enhancement (contrasted MRI; Fig. 3), enhancing lesion (contrasted MRI; Fig. 4), calcifications (noncontrasted CT; Fig. 5), giant cyst (contrasted CT; Fig. 6), cysticercotic encephalitis (contrasted MRI; Fig. 7), basal subarachnoid cysticercosis (contrasted MRI; Fig. 8), and IV ventricle ependymitis (contrasted MRI; Fig. 9).
FIG.2-9.
FIG.2-9.
Viable cysts (contrasted MRI; Fig. 2), cyst with perilesional contrast enhancement (contrasted MRI; Fig. 3), enhancing lesion (contrasted MRI; Fig. 4), calcifications (noncontrasted CT; Fig. 5), giant cyst (contrasted CT; Fig. 6), cysticercotic encephalitis (contrasted MRI; Fig. 7), basal subarachnoid cysticercosis (contrasted MRI; Fig. 8), and IV ventricle ependymitis (contrasted MRI; Fig. 9).
FIG.2-9.
FIG.2-9.
Viable cysts (contrasted MRI; Fig. 2), cyst with perilesional contrast enhancement (contrasted MRI; Fig. 3), enhancing lesion (contrasted MRI; Fig. 4), calcifications (noncontrasted CT; Fig. 5), giant cyst (contrasted CT; Fig. 6), cysticercotic encephalitis (contrasted MRI; Fig. 7), basal subarachnoid cysticercosis (contrasted MRI; Fig. 8), and IV ventricle ependymitis (contrasted MRI; Fig. 9).
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