Diagnosis and treatment of neurocysticercosis

Abstract

Neurocysticercosis is a parasitic disease caused by the larval (cystic) form of the pork cestode tapeworm, Taenia solium, and is a major cause of acquired seizures and epilepsy worldwide. Development of sensitive and specific diagnostic methods, particularly CT and MRI, has revolutionized our knowledge of the burden of cysticercosis infection and disease, and has led to the development of effective antihelminthic treatments for neurocysticercosis. The importance of calcified granulomas with perilesional edema as foci of seizures and epilepsy in populations where neurocysticercosis is endemic is newly recognized, and indicates that treatment with anti-inflammatory agents could have a role in controlling or preventing epilepsy in these patients. Importantly, neurocysticercosis is one of the few diseases that could potentially be controlled or eliminated-an accomplishment that would prevent millions of cases of epilepsy. This Review examines the rationale for treatment of neurocysticercosis and highlights the essential role of inflammation in the pathogenesis of disease, the exacerbation of symptoms that occurs as a result of antihelminthic treatment, and the limitations of current antihelminthic and anti-inflammatory treatments.

Figures

Figure 1

World map showing the distribution of Taenia solium taeniasis/cysticercosis transmission (Taken from WHO - Control of Neglected Diseases website (http://gamapserver.who.int/mapLibrary/Files/Maps/Global_cysticercosis_2009.png), permission needs to be requested.

Figure 2

Intraparenchymal neurocysticercosis: 2a - viable cysts (magnetic resonance imaging [MRI], T1 protocol), 2b-degenerating cyst (MRI, T1 protocol after contrast injection); 2c - calcified lesions (non contrasted computed tomography [CT] scan); 2d - perilesional edema around a calcified lesion (MRI, FLAIR protocol).

Figure 2

Intraparenchymal neurocysticercosis: 2a - viable cysts (magnetic resonance imaging [MRI], T1 protocol), 2b-degenerating cyst (MRI, T1 protocol after contrast injection); 2c - calcified lesions (non contrasted computed tomography [CT] scan); 2d - perilesional edema around a calcified lesion (MRI, FLAIR protocol).

Figure 2

Intraparenchymal neurocysticercosis: 2a - viable cysts (magnetic resonance imaging [MRI], T1 protocol), 2b-degenerating cyst (MRI, T1 protocol after contrast injection); 2c - calcified lesions (non contrasted computed tomography [CT] scan); 2d - perilesional edema around a calcified lesion (MRI, FLAIR protocol).

Figure 2

Intraparenchymal neurocysticercosis: 2a - viable cysts (magnetic resonance imaging [MRI], T1 protocol), 2b-degenerating cyst (MRI, T1 protocol after contrast injection); 2c - calcified lesions (non contrasted computed tomography [CT] scan); 2d - perilesional edema around a calcified lesion (MRI, FLAIR protocol).

Figure 3

Extraparenchymal neurocysticercosis: 3a - intraventricular cyst (with intraparenchymal degenerating enhancing cysts, on MRI, post-contrast T1 protocol); 2b - subarachnoid NCC in the brain convexity (with also viable and calcified cysts, on non-contrasted CT); 3c - subarachnoid NCC of the Sylvian fissure (MRI, FLAIR protocol); 3d - basal subarachnoid NCC (MRI, post-contrast T1 protocol).

Figure 3

Extraparenchymal neurocysticercosis: 3a - intraventricular cyst (with intraparenchymal degenerating enhancing cysts, on MRI, post-contrast T1 protocol); 2b - subarachnoid NCC in the brain convexity (with also viable and calcified cysts, on non-contrasted CT); 3c - subarachnoid NCC of the Sylvian fissure (MRI, FLAIR protocol); 3d - basal subarachnoid NCC (MRI, post-contrast T1 protocol).

Figure 3

Extraparenchymal neurocysticercosis: 3a - intraventricular cyst (with intraparenchymal degenerating enhancing cysts, on MRI, post-contrast T1 protocol); 2b - subarachnoid NCC in the brain convexity (with also viable and calcified cysts, on non-contrasted CT); 3c - subarachnoid NCC of the Sylvian fissure (MRI, FLAIR protocol); 3d - basal subarachnoid NCC (MRI, post-contrast T1 protocol).

Figure 3

Extraparenchymal neurocysticercosis: 3a - intraventricular cyst (with intraparenchymal degenerating enhancing cysts, on MRI, post-contrast T1 protocol); 2b - subarachnoid NCC in the brain convexity (with also viable and calcified cysts, on non-contrasted CT); 3c - subarachnoid NCC of the Sylvian fissure (MRI, FLAIR protocol); 3d - basal subarachnoid NCC (MRI, post-contrast T1 protocol).