eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Neurocysticercosis: Follow-up

Author: Vinod K Dhawan, MD, FACP, FRCP(C), Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Professor of Medicine, Charles Drew University of Medicine and Science; Chief, Division of Infectious Diseases, MLK-Harbor Hospital
Coauthor(s): Eric HW Kossoff, MD, Assistant Professor, Departments of Pediatrics and Neurology, Associate Director of Pediatric Neurology Residency Program, Johns Hopkins School of Medicine
Contributor Information and Disclosures

Updated: Sep 14, 2009

Follow-up

Further Inpatient Care

  • 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

Further Outpatient Care

  • 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.

Inpatient & Outpatient Medications

  • 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.

Transfer

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

Deterrence/Prevention

  • 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).

Complications

  • Death
  • Hydrocephalus
  • Recalcitrant seizure disorder
  • Hemiparesis
  • Motor and speech delay
  • Blindness
  • Dementia

Prognosis

  • 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.

Patient Education

  • 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 eMedicine's Infections Center and Parasites and Worms Center.

Miscellaneous

Medicolegal Pitfalls

  • Failing to recognize early signs of increased intracranial pressure
  • Failing to recognize hydrocephalus
  • Initiation of antihelminthic therapy as an outpatient
  • Progression to neurosurgical removal of the cyst without prior medical management

Special Concerns

  • Identification of the source of infection and prevention of further exposure is paramount to the care of neurocysticercosis.
  • Cases do not need to be reported to the CDC unless local transmission is suspected. In this case, the Division of Parasitic Diseases at the CDC can be contacted through state and local health departments. More information is available at the CDC Web site.
  • In 1997, a study by Del Brutto et al found an association between neurocysticercosis and cerebral gliomas in adults, possibly because of astrocytic gliosis that surrounds the cyst.15 Further study and evaluation are needed.
 


More on Neurocysticercosis

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

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Further Reading

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Keywords

cysticercosis, taeniasis, tapeworm diseases, parasite, parasitic infection, tapeworm, tapeworm infection, larval infection, hydrocephalus, treatment, diagnosis

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Contributor Information and Disclosures

Author

Vinod K Dhawan, MD, FACP, FRCP(C), Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Professor of Medicine, Charles Drew University of Medicine and Science; Chief, Division of Infectious Diseases, MLK-Harbor Hospital
Vinod K Dhawan, MD, FACP, FRCP(C) is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Royal College of Physicians and Surgeons of Canada
Disclosure: Pfizer Inc None None

Coauthor(s)

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.

Medical Editor

Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital
Ashir Kumar, MBBS, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School 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.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
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, and Southern Medical Association
Disclosure: None None None

 
 
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