Neuroimaging in Neurocysticercosis Follow-up

Updated: Oct 05, 2016
  • Author: Arturo Carpio, MD; Chief Editor: Niranjan N Singh, MD, DM  more...
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Follow-up

Further Outpatient Care

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  • Follow-up CT scan is needed to assess response to medical and surgical treatment.
  • Long-term anticonvulsant therapy is usually not necessary.
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Further Inpatient Care

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  • Neurosurgical intervention is required only in cases of obstructive hydrocephalus or ventricular or subarachnoid cysticerci.
  • Ophthalmic surgery is recommended in all cases of ocular cysticercosis, because the inflammatory reaction to medical therapy may threaten vision.
  • Isolation is not required for hospitalized patients.
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Deterrence/Prevention

Family members should be screened for parasitic disease. Attention should be given to personal hygiene.

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Complications

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  • Intracranial herniation
  • Stroke
  • Status epilepticus
  • Hydrocephalus
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Prognosis

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  • Prognosis is excellent in almost all cases. Many investigators affirm that most patients with neurocysticercosis (NC) with seizures or epilepsy have a good prognosis. Conversely, in patients with extraparenchymal forms the prognosis is unfavorable, especially those patients with hydrocephalus due to arachnoiditis.
  • Recent prospective cohort studies determined the risk of seizure recurrence after a first seizure due to NC and evaluated risk factors for seizure recurrence, including the influence of antihelminthic treatment.
    • Seventy-seven patients were prospectively followed for over 7 years. Thirty-one patients (40.3%) experienced seizure recurrence.
    • Kaplan-Meier estimated recurrence to be 22% at 6 months, 32% at 12 months, 39% at 24 months, and 49% at 48 and 84 months. Treatment with albendazole did not influence recurrence. No significant differences in the Kaplan-Meier curves of recurrence were present when treatment groups were compared (see the image below).
      Neuroimaging in neurocysticercosis. Probability of Neuroimaging in neurocysticercosis. Probability of seizure recurrence (Kaplan-Meier curve) after a first seizure in patients with NC as function of cysticidal treatment.
    • The authors concluded that seizure recurrence is high following a first acute symptomatic seizure due to NC, but this risk seems related to persistence of active brain lesions. Recurrence risk is low and in keeping with seizure risk following other brain insults leading to a static encephalopathy in those in whom the neurocysticercosis lesion clears.
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Patient Education

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  • Education, especially in developing countries, should include the following:
    • Teaching self-diagnosis of taeniasis/cysticercosis; promotion of preventive measures through proper feeding habits
    • Encouragement of general hygiene education
    • Disclosure of relevant information to schools and universities
    • Use of mass media in education
  • Veterinary educational activities should include the following:
    • Advise on farm hygiene and on the importance of meat inspection
    • Development of special educational programs for farmers and workers in the meat industry
  • Ecological and environmental measures include the following:
    • Improvement of sanitation throughout the country, particularly elimination of open-air defecation by farm workers and peasants
    • Improvement of sewage systems
    • Improvement of methods of animal husbandry
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