Neurocysticercosis

Neurocysticercosis – General Information

Neurocysticercosis – Symptoms

Neurocysticercosis – Treatment

The medicines used in Neurocysticercosis treatment are Albendazole and Praziquantel, and are considered also to be the most effective. Other controlled, medical trials have not shown an improvement, an effect in intraparenchymal central nervous system cysticerci. Furthermore, anthelmintic therapy may produce the 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. Albendazole (Valbazen) is a new discovered anti-helminthic medication used for the treatment of Neurocysticercosis. It is given in a dosage of 15 mg per day for four weeks, administered with steroids (to treat inflammation).When dexamethasone is given simultaneously with the drugs, the plasma levels of praziquantel decreases and the levels of albendazole increases.. Comparative studies of praziquantel and albendazole have shown little difference between the two regimens, although the treatment with albendazole improves the patient’s health. Further studies are needed to determine if albendazole is truly more effective than praziquantel.

Praziquantel (Biltricide) is the standard medication in the treatment of Neurocysticercosis. The recommended dosage is 50 mg per kg per day orally for two weeks. Praziquantel increases the number of dead larva by destroying the tegument of the cysticercus, which doesn’t permit the larva to obtain nutrients from cyst fluid. This rapid killing of the larva can increase the inflammatory response and edema around the cysts, and can lead to an increased number of symptoms. Most authorities recommend concomitant administration of corticosteroids with praziquantel. Dexamethasone is the corticosteroid most commonly used for this purpose, but prednisone has also been used. Cysticidal drugs should be used with caution in patients exhibiting multiple lesions as they may exacerbate the inflammation, causing irreversible damage. In such patients steroids are the main treatment. When the patient presents clumps of cysts, intraventricular cysts, optichiasmatic cysts, large cysts, that usually don’t respond to the medication or it can produce a midline shift, surgery can be applied to remove the infected area of cysts. In patients with hydrocephalus, a shunt should be placed before medical management to prevent complications of further ventricular enlargement.

Anticonvulsant therapy should be given during the drug treatment for Neurocysticercosis in order to prevent or decrease the severity and number of seizures. If parenchymal lesions resolve without calcifying the patient remains without seizure, then anticonvulsant therapy may be discontinued after 2 years. If the cysticerci have calcified in the brain, or if there is only one lesion, treatment is not considered beneficial. The most common side effect of the treatment is headache. Cosmetic side effects are much less common when phenytoin is taken at this age than when is taken during childhood, and if the patient has no other adverse effects, such as cognitive problems or gingival hyperplasia, then he should continue taking phenytoin. Other first-line anticonvulsants for partial seizures, such as carbamazepine, are considered to be alternatives. Other adverse effects included a transient loss of seizure control despite medical therapy in patients receiving albendazole and praziquantel; seizure control improved after an increase in the dose of antiepileptic drugs.