Management of neurocysticercosis

Terrence Riley, A. Clinton White

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Neurocysticercosis is a common cause of neurological disease in developing countries and a major cause of epilepsy worldwide. A unique characteristic of human neurocysticercosis is that the living parasite is very well tolerated in human brain, so symptoms and clinical disease primarily result from death of the organism and accompanying inflammatory reaction in the human CNS. Among the diverse clinical manifestations of human neurocysticercosis, seizures are the most common, but other clinical problems occur, depending upon the localisation and viability of the parasite. Although both praziquantel and albendazole are effective agents, there is controversy about their role in several forms of the disease. Systematic reviews have pointed out the limited quality of available data on therapy. At a recent international conference convened to develop guidelines for treatment of this disease, areas of consensus and disagreement on the role of antiparasitic therapy were discussed. It was clear to all that cysticercosis cannot be regarded as a single disorder; treatment needs to be modified based on the location and number of cysticerci and the host response. There was a strong consensus that there is no role for antiparasitic drugs in patients with only calcified lesions. Studies suggest that patients with single enhancing lesions will do well regardless of antiparasitic therapy. Antiparasitic drugs are contraindicated in patients with cerebral oedema (cysticercal encephalitis). Most experts strongly recommend antiparasitic therapy in patients with multiple subarachnoid cysticerci or giant cysticerci. In patients with ventricular cysticerci, endoscopic removal is the preferred therapy. However, recent evidence suggests that placement of a ventricular shunt followed by antiparasitic therapy is an acceptable alternative. Standard treatment for localization-related epilepsy is effective for seizures caused by cysticercosis. In general, seizures are easily controlled in this illness. While many controversies regarding the treatment of patients with neurocysticercosis were not resolved at the international consensus conference, participants did conclude that controlled prospective studies are required to define optimal therapy for the infection and that treatment of infected individuals must be individualised.

Original languageEnglish (US)
Pages (from-to)577-591
Number of pages15
JournalCNS Drugs
Volume17
Issue number8
StatePublished - 2003
Externally publishedYes

Fingerprint

Neurocysticercosis
Antiparasitic Agents
Cysticercus
Therapeutics
Cysticercosis
Seizures
Parasites
Tonic-Clonic Epilepsy
Naphazoline
Praziquantel
Albendazole
Partial Epilepsy
Brain Edema
Encephalitis
Developing Countries

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Neuropsychology and Physiological Psychology
  • Pharmacology

Cite this

Riley, T., & White, A. C. (2003). Management of neurocysticercosis. CNS Drugs, 17(8), 577-591.

Management of neurocysticercosis. / Riley, Terrence; White, A. Clinton.

In: CNS Drugs, Vol. 17, No. 8, 2003, p. 577-591.

Research output: Contribution to journalArticle

Riley, T & White, AC 2003, 'Management of neurocysticercosis', CNS Drugs, vol. 17, no. 8, pp. 577-591.
Riley, Terrence ; White, A. Clinton. / Management of neurocysticercosis. In: CNS Drugs. 2003 ; Vol. 17, No. 8. pp. 577-591.
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