Current Consensus Guidelines for Treatment of Neurocysticercosis

Abstract

Cysticercosis, the infection caused by the larval stage of the tapeworm Taenia solium, is the most common parasitic disease of the nervous system in humans and the single most common cause of acquired epileptic seizures in the developing world, where prevalence rates of active epilepsy are twice those in developed countries. Before the introduction of modern neuroimaging diagnostic techniques, knowledge of the natural history of human disease was limited and largely based on cases diagnosed either by the presence of subcutaneous nodules, by plain X-rays showing calcifications in the brain or soft tissues, by surgery of cases with intracranial hypertension, or from necropsy data. The image of an aggressive, lethal disease arose from this clearly biased (towards more severe infestations) group of cases. During the last two decades, the introduction of computed tomography (CT) and later magnetic resonance Imaging (MRI) permitted the identification of mild cases with only a few parenchymal cysts, and the terms benign and malign cysticercosis were coined. Later, studies in India showed that a vast majority of single enhancing lesions, until then attributed to tuberculosis, were in fact degenerating cysticerci. The introduction of praziquantel and albendazole as specific antiparasitic agents was enthusiastically adopted by any segments of the medical community. The value of these gents has been questioned by some authors and an intense controversy still exists. Unfortunately, this has led to confusion and poorly informed decisions in clinical management, especially in areas where neurocysticercosis is not a daily diagnosis. At a recent meeting on cysticercosis held in Lima, Peru, a panel of experts in different aspects of the disease reached a consensus as to the minimal treatment guidelines for neurocysticercosis. Effort was made to identify about which types of neurocysticercosis there was agreement and a uniformly accepted approach. The panel also attempted to define the range of therapeutic approaches for those forms for which there was no consensos.