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Pediatric Neurocysticercosis Follow-up

  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Russell W Steele, MD  more...
 
Updated: Mar 03, 2015
 

Further Outpatient Care

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  • Children who have single nonviable lesions and do not require antihelminthic treatment can be managed safely on an outpatient basis. Most children can be managed as outpatients, especially in the United States where cases are often simple neurocysticercosis.
  • Arrange neurologic follow-up care to manage seizures and any sequelae.
  • Perform a follow-up MRI in 3-6 months or sooner if symptoms worsen or recur.
  • If a child who was admitted for antihelminthic treatment is doing well after 72 hours and follow-up care is assured, the child can be discharged to finish therapy at home.
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Further Inpatient Care

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  • Indications for admission in patients with neurocysticercosis include the following:
    • Children who need antihelminthic therapy for active or multiple cysts (hospitalize for first 72 h of therapy)
    • Signs of increased intracranial pressure or apparent need for corticosteroid treatment
    • Recalcitrant seizures
    • Hydrocephalus, possibly requiring an intraventricular shunt
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Inpatient & Outpatient Medications

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  • Anticonvulsants, with carbamazepine and phenytoin as first-choice treatments
  • Antihelminthics
    • Antihelminthic medication is controversial. Reserve such treatment for certain cases.
    • When antihelminthics are used, albendazole is preferable to praziquantel.
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Transfer

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  • Arrange transfer if the facility is unable to provide neurologic or neurosurgical care deemed necessary.
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Deterrence/Prevention

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  • Prevention of exposure to infected ova in the home and community is the most effective preventative measure.
  • Examine stools from contacts using 3 consecutive daily specimens. If positive, contacts should receive single doses of praziquantel (10 mg/kg) or albendazole (400 mg).
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Complications

See the list below:

  • Seizures[35]
  • Death
  • Hydrocephalus
  • Recalcitrant seizure disorder[36]
  • Cerebrovascular accidents
  • Motor and speech delay
  • Blindness
  • Dementia
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Prognosis

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  • In cases with single lesions, prognosis is excellent. In those with multiple lesions, especially extraparenchymal, prognosis can be poor.
  • Treatment with antihelminthics results in complete resolution or significant regression in 80-90% of patients. Most children with calcified single lesions that do not require antihelminthic treatment have spontaneous resolution in 2-9 months, usually within 3 months.
  • Usually, seizures are easy to control, and most children can be weaned from their anticonvulsants within 1-2 years. Most children remain free of seizures.
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Patient Education

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  • Educate patients and their families regarding prevention.
  • Emphasize improvement in sanitation, separation of pigs from humans, and food preparation hygiene in endemic areas.
  • For excellent patient education resources, please see eMedicineHealth's Infections Center.
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Contributor Information and Disclosures
Author

Vinod K Dhawan, MD, FACP, FRCPC, FIDSA Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Infectious Diseases, Rancho Los Amigos National Rehabilitation Center

Vinod K Dhawan, MD, FACP, FRCPC, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Pfizer Inc for speaking and teaching.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Ashir Kumar, MD, MBBS FAAP, Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS is a member of the following medical societies: Infectious Diseases Society of America, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Acknowledgements

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose. Eric HW Kossoff, MD Assistant Professor, Departments of Pediatrics and Neurology, Associate Director of Pediatric Neurology Residency Program, Johns Hopkins School of Medicine

Eric HW Kossoff, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society

Disclosure: Nothing to disclose.

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Case 1: Coronal image MRI of a 6-year-old boy from Peru with single right frontal cyst.
Case 1: Axial image MRI of a 6-year-old boy from Peru with single right frontal cyst.
Case 2: MRI of a 40-year-old patient with a single parietal calcified cyst.
Case 2: CT scan of a 40-year-old patient with a single parietal calcified cyst.
Case 3: MRI of a 47-year-old man with 2 right parietal cysts, one with edema.
Case 3: MRI of a 47-year-old man with 2 right parietal cysts, one with edema, after the larger cyst had involuted.
Case 4: CT scan of 28-year-old woman with occipital headaches and diplopia; imaging reveals a superior cerebellar cyst, mild ventricular dilatation, and old calcifications in the right insular region. Image courtesy of Gholam Motamedi, MD.
Case 4: MRI of 28-year-old woman with occipital headaches and diplopia; MRI discerns prepontine and suprasellar lesions, as well as the superior cerebellar cyst. Image courtesy of Gholam Motamedi, MD.
MRI of multiple cysts. Image courtesy of the Centers for Disease Control and Prevention.
MRI of an 87-year-old patient from Europe with bitemporal lesions found incidentally. Image courtesy of Jon Poling, MD.
Two parietal lesions observed on autopsy specimen.
MRI of a 40-year-old woman with severe epilepsy and a left temporal single cyst.
MRI of a 21-year-old woman with left temporal lobe epilepsy and a single cyst.
 
 
 
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