Evidence-based guideline: Treatment of parenchymal neurocysticercosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology

Neurology (Impact Factor: 8.29). 04/2013; 80(15):1424-1429. DOI: 10.1212/WNL.0b013e31828c2f3e


To review the evidence base for different treatment strategies in intraparenchymal neurocysticercosis in adults and children.

A literature search of Medline, EMBASE, LILACS, and the Cochrane Database from 1980 to 2008, updated in 2012, resulted in the identification of 10 Class I or Class II trials of cysticidal drugs administered with or without corticosteroids in the treatment of neurocysticercosis.

The available data demonstrate that albendazole therapy, administered with or without corticosteroids, is probably effective in decreasing both long-term seizure frequency and the number of cysts demonstrable radiologically in adults and children with neurocysticercosis, and is well-tolerated. There is insufficient information to assess the efficacy of praziquantel.

Albendazole plus either dexamethasone or prednisolone should be considered for adults and children with neurocysticercosis, both to decrease the number of active lesions on brain imaging studies (Level B) and to reduce long-term seizure frequency (Level B). The evidence is insufficient to support or refute the use of steroid treatment alone in patients with intraparenchymal neurocysticercosis (Level U).

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    • "Both diagnosis and prognosis of neurocysticercosis cases depend heavily on parasite location. When parasites are located intraparenchymally or in the subarachnoid space of the convexity, diagnosis is relatively straightforward by using computed tomography or Magnetic Resonance Imaging (MRI) and prognosis is generally good, since cestocidal drugs (albendazole or praziquantel ) are useful in most cases (Baird et al., 2013). The occurrence of seizures is the most common symptom. "
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    ABSTRACT: Imagenological diagnosis of subarachnoid neurocysticercosis is usually difficult when classical magnetic resonance imaging (MRI) sequences are used. The purpose of this study was to evaluate the advantages of 3D MRI sequences [Fast Imaging Employing Steady-state Acquisition (FIESTA) and Spoiled Gradient Recalled Echo (SPGR)] with respect to classical sequences [Fluid Attenuation Inversion Recovery (FLAIR) and T1] in visualizing Taenia solium cyst in these locations. Forty-seven T. solium cysts located in the basal cisterns of the subarachnoid space were diagnosed in eighteen Mexican patients. A pre-treatment MRI was performed on all patients, and all four sequences (FIESTA, FLAIR, T1 SPGR, and T2) were evaluated independently by two neuroradiologists. The sensitivity of each sequence to detect the parasite membrane and scolex was evaluated, along with its capacity to detect differences in signal intensity between cerebrospinal fluid (CSF) and cysts. FIESTA sequences allowed the visualization of cyst membrane in 87.2% of the parasites evaluated, FLAIR in 38.3%, SPGR in 23.4%, and T2 in 17.0%. The superiority of FIESTA sequences over the other three imaging methods was statistically significant (P<0.001). Scolices were detected by FIESTA twice as much as the other sequences did, although this difference was not significant (P>0.05). Differences in signal intensity between CSF and parasite cysts were significant in FIESTA (P<0.0001), SPGR (P<0.0001), and FLAIR (P=0.005) sequences. For the first time, the usefulness of 3D MRI sequences to diagnose T. solium cysts located in the basal cisterns of the subarachnoid space was demonstrated. The routine use of these sequences could favor an earlier diagnosis and greatly improve the prognosis of patients affected by this severe form of the disease. Copyright © 2015. Published by Elsevier B.V.
    Acta tropica 08/2015; 152. DOI:10.1016/j.actatropica.2015.08.017 · 2.27 Impact Factor
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    ABSTRACT: SUMMARY This personal review focuses on ways to approach and overcome some of the more common issues encountered while studying cestode zoonoses. The information presented here is based on the author's own experiences with immunological and molecular approaches for the detection of these parasites. There are many incongruities between immunological and molecular studies due to biased work. Nothing is perfect. Indirect approaches using either immunological, or even molecular tools, are limited without confirmation from direct evidence of infection. The dilemma of whether developing countries should develop their own diagnostic tests or rely on commercially available kits is also discussed.
    Parasitology 06/2013; 140(13):1-15. DOI:10.1017/S0031182013000966 · 2.56 Impact Factor
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    ABSTRACT: Neurocysticercosis (NCC) is a parasitic infection of the central nervous system caused by larvae of Taenia solium. It represents the most common cause of neurological disease in children living in developing countries. In recent years, NCC is increasingly being diagnosed also in high-socioeconomic countries, mainly due to the high rate of immigration. We describe a case of a 14-year-old Ecuadorian boy living in Italy, who experienced a generalized tonic-clonic seizure and was diagnosed with NCC. The boy was successfully managed with anticonvulsant, anticysticercal and anti-inflammatory treatment. With the present case we would like to emphasize the importance of considering NCC as a possible cause of non febrile seizures in children living in developed countries, particularly in those immigrated from an endemic region or had a long-term stay in an area of high prevalence.
    Asian Pacific Journal of Tropical Disease 08/2013; DOI:10.1016/S2222-1808(13)60078-X
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