Pediatric Neurocysticercosis Follow-up

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

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

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  • 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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