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Pediatric Neurocysticercosis Treatment & Management

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

Medical Care

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.[30]

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.[31]

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.[32]

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.[33]

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Surgical Care

Neurosurgery has limited role in the management of neurocysticercosis.[34] 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.

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Consultations

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.
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Diet

See the list below:

  • Avoid reinfection and reingestion of ova from the original source.
  • No other specific diet is necessary.
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Activity

See the list below:

  • No activity restrictions are necessary.
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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.

References
  1. Prasad KN, Prasad A, Verma A, Singh AK. Human cysticercosis and Indian scenario: a review. J Biosci. 2008 Nov. 33(4):571-82. [Medline].

  2. Serpa JA, Yancey LS, White AC Jr. Advances in the diagnosis and management of neurocysticercosis. Expert Rev Anti Infect Ther. 2006 Dec. 4(6):1051-61. [Medline].

  3. Shandera WX, Kass JS. Neurocysticercosis: current knowledge and advances. Curr Neurol Neurosci Rep. 2006 Nov. 6(6):453-9. [Medline].

  4. Singhi P, Singhi S. Neurocysticercosis in children. J Child Neurol. 2004 Jul. 19(7):482-92. [Medline].

  5. Sinha S, Sharma BS. Neurocysticercosis: A review of current status and management. J Clin Neurosci. 2009 Apr 24. [Medline].

  6. Singhi P. Neurocysticercosis. Ther Adv Neurol Disord. 2011 Mar. 4(2):67-81. [Medline]. [Full Text].

  7. Serpa JA, Graviss EA, Kass JS, White AC Jr. Neurocysticercosis in Houston, Texas: an update. Medicine (Baltimore). 2011 Jan. 90(1):81-6. [Medline].

  8. Sorvillo F, Wilkins P, Shafir S, Eberhard M. Public health implications of cysticercosis acquired in the United States. Emerg Infect Dis. 2011 Jan. 17(1):1-6. [Medline].

  9. Zee CS, Go JL, Kim PE, DiGiorgio CM. Imaging of neurocysticercosis. Neuroimaging Clin N Am. 2000 May. 10(2):391-407. [Medline].

  10. Wallin MT, Kurtzke JF. Neurocysticercosis in the United States: review of an important emerging infection. Neurology. 2004 Nov 9. 63(9):1559-64. [Medline].

  11. Garcia HH, Del Brutto OH,. Neurocysticercosis: updated concepts about an old disease. Lancet Neurol. 2005 Oct. 4(10):653-61. [Medline].

  12. Chaoshuang L, Zhixin Z, Xiaohong W, Zhanlian H, Zhiliang G. Clinical analysis of 52 cases of neurocysticercosis. Trop Doct. 2008 Jul. 38(3):192-4. [Medline].

  13. Jung H, Cardenas G, Sciutto E, Fleury A. Medical treatment for neurocysticercosis: drugs, indications and perspectives. Curr Top Med Chem. 2008. 8(5):424-33. [Medline].

  14. Ruiz-Garcia M, Gonzalez-Astiazaran A, Rueda-Franco F. Neurocysticercosis in children. Clinical experience in 122 patients. Childs Nerv Syst. 1997 Nov-Dec. 13(11-12):608-12. [Medline].

  15. Talukdar B, Saxena A, Popli VK. Neurocysticercosis in children: clinical characteristics and outcome. Ann Trop Paediatr. 2002 Dec. 22(4):333-9. [Medline].

  16. Carabin H, Ndimubanzi PC, Budke CM, Nguyen H, Qian Y, Cowan LD, et al. Clinical manifestations associated with neurocysticercosis: a systematic review. PLoS Negl Trop Dis. 2011 May. 5(5):e1152. [Medline]. [Full Text].

  17. Rosenfeld EA, Byrd SE, Shulman ST. Neurocysticercosis among children in Chicago. Clin Infect Dis. 1996 Aug. 23(2):262-8. [Medline].

  18. Michelet L, Fleury A, Sciutto E, Kendjo E, Fragoso G, Paris L, et al. Human neurocysticercosis: comparison of different diagnostic tests using cerebrospinal fluid. J Clin Microbiol. 2011 Jan. 49(1):195-200. [Medline]. [Full Text].

  19. Garg RK, Sinha MK. Multiple ring-enhancing lesions of the brain. J Postgrad Med. 2010 Oct-Dec. 56(4):307-16. [Medline].

  20. Fleury A, Hernandez M, Avila M, et al. Detection of HP10 antigen in serum for diagnosis and follow-up of subarachnoidal and intraventricular human neurocysticercosis. J Neurol Neurosurg Psychiatry. 2007 Sep. 78(9):970-4. [Medline].

  21. Almeida CR, Ojopi EP, Nunes CM, et al. Taenia solium DNA is present in the cerebrospinal fluid of neurocysticercosis patients and can be used for diagnosis. Eur Arch Psychiatry Clin Neurosci. 2006 Aug. 256(5):307-10. [Medline].

  22. Rodriguez S, Dorny P, Tsang VC, Pretell EJ, Brandt J, Lescano AG. Detection of Taenia solium antigens and anti-T. solium antibodies in paired serum and cerebrospinal fluid samples from patients with intraparenchymal or extraparenchymal neurocysticercosis. J Infect Dis. 2009 May 1. 199(9):1345-52. [Medline].

  23. Balaji J, D M. Clinical and Radiological Profile of Neurocysticercosis in South Indian Children. Indian J Pediatr. 2011 Mar 12. [Medline].

  24. Figueroa JJ, Davis LE, Magalhaes A. Extraparenchymal neurocysticercosis in albuquerque, New Mexico. J Neuroimaging. 2011 Jan. 21(1):38-43. [Medline].

  25. Odermatt P, Preux PM, Druet-Cabanac M. Treatment of neurocysticercosis: a randomised controlled trial. J Neurol Neurosurg Psychiatry. 2008 Sep. 79(9):978. [Medline].

  26. Thussu A, Chattopadhyay A, Sawhney IM, Khandelwal N. Albendazole therapy for single small enhancing CT lesions (SSECTL) in the brain in epilepsy. J Neurol Neurosurg Psychiatry. 2008 Mar. 79(3):272-5. [Medline].

  27. Carpio A, Kelvin EA, Bagiella E, Leslie D, Leon P, Andrews H. Effects of albendazole treatment on neurocysticercosis: a randomised controlled trial. J Neurol Neurosurg Psychiatry. 2008 Sep. 79(9):1050-5. [Medline].

  28. Ramirez-Zamora A, Alarcon T. Management of neurocysticercosis. Neurol Res. 2010 Apr. 32(3):229-37. [Medline].

  29. Abba K, Ramaratnam S, Ranganathan LN. Anthelmintics for people with neurocysticercosis. Cochrane Database Syst Rev. 2010 Jan 20. CD000215. [Medline].

  30. Garcia HH, Gonzales I, Lescano AG, Bustos JA, Zimic M, Escalante D, et al. Efficacy of combined antiparasitic therapy with praziquantel and albendazole for neurocysticercosis: a double-blind, randomised controlled trial. Lancet Infect Dis. 2014 Aug. 14(8):687-95. [Medline]. [Full Text].

  31. Del Brutto OH, Roos KL, Coffey CS, García HH. Meta-analysis: Cysticidal drugs for neurocysticercosis: albendazole and praziquantel. Ann Intern Med. 2006 Jul 4. 145(1):43-51. [Medline].

  32. Kaur S, Singhi P, Singhi S, Khandelwal N. Combination therapy with albendazole and praziquantel versus albendazole alone in children with seizures and single lesion neurocysticercosis: a randomized, placebo-controlled double blind trial. Pediatr Infect Dis J. 2009 May. 28(5):403-6. [Medline].

  33. Matthaiou DK, Panos G, Adamidi ES, Falagas ME. Albendazole versus praziquantel in the treatment of neurocysticercosis: a meta-analysis of comparative trials. PLoS Negl Trop Dis. 2008 Mar 12. 2(3):e194. [Medline]. [Full Text].

  34. Rajshekhar V. Surgical management of neurocysticercosis. Int J Surg. 2010. 8(2):100-4. [Medline].

  35. Kelvin EA, Carpio A, Bagiella E, Leslie D, Leon P, Andrews H, et al. Seizure in people with newly diagnosed active or transitional neurocysticercosis. Seizure. 2011 Mar. 20(2):119-25. [Medline]. [Full Text].

  36. Viola GM, White AC Jr, Serpa JA. Hemorrhagic cerebrovascular events and neurocysticercosis: a case report and review of the literature. Am J Trop Med Hyg. 2011 Mar. 84(3):402-5. [Medline]. [Full Text].

  37. Li J, Zhang WB, Wilson M, et al. A novel recombinant antigen for immunodiagnosis of human cystic echinococcosis. J Infect Dis. 2003 Dec 15. 188(12):1952-61. [Medline].

 
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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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