eMedicine Specialties > Neurology > Neurological Infections

Neuroimaging in Neurocysticercosis: Follow-up

Author: Arturo Carpio, MD, Director of Epilepsy Center, Professor, Department of Neurology, University of Cuenca School of Medicine, Ecuador; Senior Research Scientist of the GH Sergievsky Center, Columbia University
Coauthor(s): Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Contributor Information and Disclosures

Updated: Jul 10, 2009

Follow-up

Further Inpatient Care

  • Neurosurgical intervention is required only in cases of obstructive hydrocephalus or ventricular or subarachnoid cysticerci.
  • Ophthalmic surgery is recommended in all cases of ocular cysticercosis, because the inflammatory reaction to medical therapy may threaten vision.
  • Isolation is not required for hospitalized patients.

Further Outpatient Care

  • Follow-up CT scan is needed to assess response to medical and surgical treatment.
  • Long-term anticonvulsant therapy is usually not necessary.

Deterrence/Prevention

Family members should be screened for parasitic disease. Attention should be given to personal hygiene.

Complications

  • Intracranial herniation
  • Stroke
  • Status epilepticus
  • Hydrocephalus

Prognosis

  • Prognosis is excellent in almost all cases. Many investigators affirm that most patients with neurocysticercosis (NC) with seizures or epilepsy have a good prognosis. Conversely, in patients with extraparenchymal forms the prognosis is unfavorable, especially those patients with hydrocephalus due to arachnoiditis.
  • Recent prospective cohort studies determined the risk of seizure recurrence after a first seizure due to NC and evaluated risk factors for seizure recurrence, including the influence of antihelminthic treatment.
    • Seventy-seven patients were prospectively followed for over 7 years. Thirty-one patients (40.3%) experienced seizure recurrence.
    • Kaplan-Meier estimated recurrence to be 22% at 6 months, 32% at 12 months, 39% at 24 months, and 49% at 48 and 84 months. Treatment with albendazole did not influence recurrence. No significant differences in the Kaplan-Meier curves of recurrence were present when treatment groups were compared (see Media file 11).
    • The authors concluded that seizure recurrence is high following a first acute symptomatic seizure due to NC, but this risk seems related to persistence of active brain lesions. Recurrence risk is low and in keeping with seizure risk following other brain insults leading to a static encephalopathy in those in whom the neurocysticercosis lesion clears.

Patient Education

  • Education, especially in developing countries, should include the following:
    • Teaching self-diagnosis of taeniasis/cysticercosis; promotion of preventive measures through proper feeding habits
    • Encouragement of general hygiene education
    • Disclosure of relevant information to schools and universities
    • Use of mass media in education
  • Veterinary educational activities should include the following:
    • Advise on farm hygiene and on the importance of meat inspection
    • Development of special educational programs for farmers and workers in the meat industry
  • Ecological and environmental measures include the following:
    • Improvement of sanitation throughout the country, particularly elimination of open-air defecation by farm workers and peasants
    • Improvement of sewage systems
    • Improvement of methods of animal husbandry

Miscellaneous

Special Concerns

  • Cysticercosis is a disease of poverty and social underdevelopment.
  • Human cysticercosis can be prevented by providing proper sanitary facilities and improving health care and socioeconomic status of the people in developing countries.
 


More on Neuroimaging in Neurocysticercosis

Overview: Neuroimaging in Neurocysticercosis
Differential Diagnoses & Workup: Neuroimaging in Neurocysticercosis
Treatment & Medication: Neuroimaging in Neurocysticercosis
Follow-up: Neuroimaging in Neurocysticercosis
Multimedia: Neuroimaging in Neurocysticercosis
References
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References

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Further Reading

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Keywords

neurocysticercosis, pork tapeworm, taeniasis, Taenia solium, T solium, cysticercosis, imaging studies, antihelminthic treatment, parasite, parasitic infection

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Contributor Information and Disclosures

Author

Arturo Carpio, MD, Director of Epilepsy Center, Professor, Department of Neurology, University of Cuenca School of Medicine, Ecuador; Senior Research Scientist of the GH Sergievsky Center, Columbia University
Arturo Carpio, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Coauthor(s)

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

Medical Editor

Joseph F Hulihan, MD, Vice President, Medical Affairs, Ortho-McNeil Janssen Scientific Affairs, LLC
Joseph F Hulihan, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Headache Society, and American Medical Association
Disclosure: Johnson & Johnson Salary Employment; Johnson & Johnson Stock Employment

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Paraplegia Society, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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