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Neuroimaging in Neurocysticercosis Medication

  • Author: Arturo Carpio, MD; Chief Editor: Niranjan N Singh, MD, DM  more...
 
Updated: Nov 12, 2014
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Anthelmintics

Class Summary

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.

Albendazole (Albenza)

 

Broad-spectrum agent that chemically belongs to benzimidazole group. Has been used to treat enterobiasis, ascariasis, trichuriasis, strongyloidiasis, and hookworm infections, but in US, approved only for use in hydatid disease and neurocysticercosis. Inhibits parasite's ability to assemble tubulin dimers into tubulin polymers, thus arresting microtubule formation. This affects several aspects of parasite's life, including larval development, carbohydrate transport, and enzyme function, as well as maintenance of parasite integument and digestive system.

Praziquantel (Biltricide)

 

Effective against various trematodes and cestodes including Schistosoma species and tapeworms. Works by increasing parasite's cell membrane permeability. Results in loss of intracellular calcium, massive muscle contractions, and spastic paralysis of parasites, as well as damage to schistosome tegument, followed by attachment of phagocytes to parasite.

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Contributor Information and Disclosures
Author

Arturo Carpio, MD Professor, University of Cuenca School of Medicine, Ecuador; Senior Research Scientist, 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 Lorenzo, MD, MHA, CPE Founding Editor-in-Chief, eMedicine Neurology; Founder and CEO/CMO, PHLT Consultants; Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, MHA, CPE is a member of the following medical societies: Alpha Omega Alpha, American Association for Physician Leadership, American Academy of Neurology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Florian P Thomas, MD, PhD, Drmed, MA, MS Director, National MS Society Multiple Sclerosis Center; Professor and Director, Clinical Research Unit, Department of Neurology, Adjunct Professor of Physical Therapy, Associate Professor, Institute for Molecular Virology, St Louis University School of Medicine; Editor-in-Chief, Journal of Spinal Cord Medicine

Florian P Thomas, MD, PhD, Drmed, MA, MS is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Neurology, American Neurological Association, Consortium of Multiple Sclerosis Centers, National Multiple Sclerosis Society, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Niranjan N Singh, MD, DM Associate Professor of Neurology, University of Missouri-Columbia School of Medicine

Niranjan N Singh, MD, DM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

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Neuroimaging in neurocysticercosis. CT scans showing different phases of neurocysticercosis. Top left: CT scan showing many calcifications and active cysts with scolices in both hemispheres. Top right: T1-weighted MRI showing 2 active cysts with the scolex in their interior (vesicular phase). Bottom left: Postcontrast CT scan showing a ring-enhancing cyst (colloidal phase) on left. Bottom right: Proton density-weighted MRI showing a thick capsule with adjacent scolex and perilesional edema (colloidal phase).
Neuroimaging in neurocysticercosis. Natural history of neurocysticercosis. Top left: This CT scan shows a large occipital active cyst (vesicle phase), many calcifications, and small cortical cysts. Top right: After 18 months, the occipital cyst has been replaced by a calcification and the remaining cysts have disappeared. Bottom left: A single parietal nodular-enhancing lesion (transitional, nodular-granular phase) is shown. Bottom right: Six months later, the lesion has disappeared.
Neuroimaging in neurocysticercosis. Noncontrast and contrast-enhanced CT scan of neurocysticercosis. Left: Normal noncontrast CT scan. Right: After administration of the contrast medium, the CT scan of the same patient shows a single parietal nodular-enhancing lesion (transitional, nodular phase).
Neuroimaging in neurocysticercosis. Cysticercotic encephalitis. Left: Contrast-enhanced CT scan showing multiple, small, nodular, and annular areas of abnormal enhancement in brain parenchyma. Right: Gadolinium-enhanced T1-weighted MRI showing hyperintense lesions.
Neuroimaging in neurocysticercosis. Cysticercus cellulosae in neurocysticercosis.
Treatment of Neurocysticercosis
Neuroimaging in neurocysticercosis. Cysticercus cellulosae showing the invaginated scolex in neurocysticercosis.
Neuroimaging in neurocysticercosis. Subcortical parenchymatous cysticercosis
Neuroimaging in neurocysticercosis. Inflammatory reaction in parenchymatous cysticercosis.
Neuroimaging in neurocysticercosis. Antiepileptic treatment for patients with first seizure due to neurocysticercosis.
Neuroimaging in neurocysticercosis. Probability of seizure recurrence (Kaplan-Meier curve) after a first seizure in patients with NC as function of cysticidal treatment.
 
 
 
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