Treatment of Parenchymal Neurocysticercosis: A New Evidence-Based Guideline

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Treatment of Parenchymal Neurocysticercosis: A New Evidence-Based Guideline

Albendazole with steroids is the treatment of choice for parenchymal neurocysticercosis.

Neurocysticercosis is infection of the central nervous system by Taenia solium cysts. It is the most common parasitic brain disease worldwide and the most common cause of epilepsy in the developing world. Clinically, it can cause a great variety of symptoms, including seizures, headaches, dizziness, focal neurologic deficits, psychiatric symptoms, and severe intracranial hypertension.

To develop this evidence-based guideline for the treatment of parenchymal neurocysticercosis, the authors conducted an English- and Spanish-language literature search of medical databases from 1980 to January 2012. They identified 10 Class I or Class II trials of cysticidal drugs administered, with or without steroids, to treat neurocysticercosis. The authors came to the following conclusions:

  • Available data demonstrate that albendazole therapy, administered with or without steroids, probably decreases both long-term seizure frequency and the number of cysts seen radiologically. The drug is well tolerated. Albendazole plus steroids should be considered for adults or children with neurocysticercosis to decrease the number of active lesions (Level B) and to reduce long-term seizure frequency (Level B).
  • The evidence is not sufficient to support or refute the use of steroid treatment alone in patients with intraparenchymal neurocysticercosis. (Level U)
  • Evidence is lacking to judge the optimal timing of steroid treatment or the use of antiepileptic drugs.

Comment: Although large, double-blind, randomized trials are still needed, antiparasitic drugs such as albendazole are recommended for neurocysticercosis. The response to antihelminthic drugs is heterogeneous; some parasites are eradicated while others resist treatment. Soon, the genome for Taenia solium will be sequenced (Parasitol Int 2006; 55:S127), and this should improve our knowledge of mechanisms of pathogenesis and the role of genetics in disease heterogeneity.

€” Jaime Toro, MD

Published in Journal Watch Neurology April 30, 2013


Baird RA et al. Evidence-based guideline: Treatment of parenchymal neurocysticercosis. Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013 Apr 9; 80:1424. [Free full-text Neurology PDF | PubMed ® abstract]

Copyright © 2013. Massachusetts Medical Society. All rights reserved.

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