Ruth Ann Baird, MD
Sam Wiebe, MD
Joseph R. Zunt, MD,
John J. Halperin, MD,
Gary Gronseth, MD,
Karen L. Roos, MD,
American Academy of Neurology:
Supplemental data at
Evidence-based guideline: Treatment of
Report of the Guideline Development Subcommittee of the
American Academy of Neurology
Objective: To review the evidence base for different treatment strategies in intraparenchymal
neurocysticercosis in adults and children.
Method: 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.
Results: 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.
Recommendations: 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 intraparen-
chymal neurocysticercosis (Level U). Neurology?2013;80:1424–1429
AED 5 antiepileptic drug; CI 5 confidence interval; RCT 5 randomized controlled trial.
Cysticercosis, infection with the larval form of Taenia
solium, is widely prevalent in developing countries of
Africa, Asia, and Latin America. It is considered by the
WHO to be the most common preventable cause of
epilepsy in the developing world, with an estimated 2
million people having epilepsy caused by T solium
infection.1Humans can acquire 2 different forms of
ing T solium cysts or by eating food contaminated with
T solium eggs. Cysts consumed in undercooked meat
mature into adult parasites in the human intestine, at
which time they release eggs and gravid proglottids in
the stool. This form of intestinal infection is called tae-
niasis. When T solium eggs are consumed, through
fecal–oral transmission from another human with tae-
niasis or through autoinfection, they release onco-
spheres into the host’s digestive tract and can then
in end organs. This systemic infection is called cysticer-
cosis. Seeding of larvae in the CNS results in neuro-
cysticercosis. Neurocysticercosis, in turn, may affect the
CNS parenchyma or the CSF space. In this guideline,
we focus solely on parenchymal infections.
Cysticercal cysts evolve through 4 stages, with differ-
ent appearances on neuroimaging—the vesicular stage,
where the cyst contains a living larva; a colloidal stage as
the larva degenerates; a “granulo-nodular” stage as the
membrane of the cyst thickens; and the final stage of
calcification. Only cysts in the vesicular and colloidal
stages contain live larvae2and are amenable to anticy-
sticercal treatment. Encysted larvae can remain asymp-
tomatic for years. When the larvae do elicit a host
immune response, patients can develop brain edema
and, more often, seizures. Optimal treatment of this
From the Departments of Clinical Neurology (R.A.B.) and Neurology and Neurological Surgery (K.L.R.), Indiana University School of Medicine,
Indianapolis; Division of Neurology (S.W.), University of Calgary, Calgary, Canada; Department of Neurology (J.R.Z.), University of Washington,
Seattle; Department of Neurosciences (J.J.H.), Overlook Medical Center, Summit, NJ; Department of Neurology and Medicine (J.J.H.), Mount
Sinai School of Medicine, New York, NY; and Department of Neurology (G.G.), University of Kansas, Kansas City, KS.
Appendices e-1 through e-8 and the e-tables are available as data supplements on the Neurology®website at www.neurology.org.
Accepted for publication by the Guideline Development Subcommittee on July 14, 2012; by the Practice Committee on July 24, 2012; and by the AAN
Board of Directors on December 26, 2012.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
1424 © 2013 American Academy of Neurology
Ruth Ann Baird, Sam Wiebe, Joseph R. Zunt, et al.
Guideline Development Subcommittee of the American Academy of Neurology
Evidence-based guideline: Treatment of parenchymal neurocysticercosis: Report of the
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