Pediatric Neurocysticercosis Treatment & Management
- Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Russell W Steele, MD more...
Drug therapy for parenchymal neurocysticercosis with praziquantel or albendazole has been somewhat controversial due to the conflicting results of several small studies. However, more recent randomized controlled trials have documented some benefit of antihelminthic therapy.[25, 26, 27] Patients in the treatment arm showed faster resolution of the active (viable) cysts. Treatment of calcified cysts is, however, not beneficial.[28, 29]
A double-blind randomized controlled trial aimed to establish whether combination of praziquantel and albendazole would increase cysticidal efficacy and whether complete cyst resolution results in fewer seizures. The study concluded that combination of albendazole plus praziquantel increases the parasiticidal effect in patients with multiple brain cysticercosis cysts without increased side-effects. The authors further concluded that a more efficacious parasiticidal regime without increased treatment-associated side-effects should improve the treatment and long term prognosis of patients with neurocysticercosis.
Drug therapy for intraventricular cysts may prove efficacious and is currently recommended by most experts. A meta-analysis of cysticidal drug therapy with albendazole and praziquantel concluded that drug therapy results in better resolution of colloidal and vesicular cysticerci, lower risk for recurrence of seizures in patients with colloidal cysticerci, and a reduction in the rate of generalized seizures in patients with vesicular cysticerci.
In a recent trial, combination therapy with albendazole and praziquantel was statistically comparable with sole therapy with albendazole alone in eradicating lesions and preventing seizures.
Anthelmintic therapy may exacerbate obstruction of CSF flow, precipitating hydrocephalus. Inflammatory response associated with drug therapy may impair vision in ocular disease and may increase the risk of paralysis with spinal cord lesions. Concomitant use of corticosteroids mitigates this inflammatory response. Corticosteroid therapy lowers serum praziquantel levels but variably increases the serum levels of albendazole and its active metabolites in some patients. For this reason, many experts prefer albendazole over praziquentel for treatment of neurocysticercosis.
Neurosurgery has limited role in the management of neurocysticercosis. Resolution of lesions with medical management alone is superior and should be attempted first. Neurosurgical intervention may be indicated for cases of cysts that have failed to resolve with antihelminthic treatment and are causing severe neurologic sequelae.
In general, indications of surgery include cysts that compress the brain and cranial nerves locally, intracranial hypertension or edema refractory to medical treatment, intraventricular cysts, spinal cysts with cord or root compression, and ocular cysts.
Recently, endoscopic approaches for ventricular cysts have been developed and are now the treatment of choice for ventricular cysts with hydrocephalus.
Shunting may be indicated if cysts have led to hydrocephalus.
See the list below:
Consult a neurologist for management of seizures, increased intracranial pressure, and any other neurologic sequelae of this disease.
Consult an infectious disease specialist for help with a questionable diagnosis, eradication of the organism, and public health issues.
Consult an ophthalmologist to examine the child for any signs of subretinal cysts.
Consult a neurosurgeon if a biopsy or resection is called for or if the child requires shunting because of hydrocephalus.
See the list below:
Avoid reinfection and reingestion of ova from the original source.
No other specific diet is necessary.
See the list below:
No activity restrictions are necessary.
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