Treatment of Neurocysticercosis / Cysticercosis of Brain / Pork Tapeworm
Neurocysticercosis is treated with cysticidal drugs and it is given under a cover of steroids.
Controversy exists as to the treatment of neurocysticercosis with cysticidal drugs, as there is insufficient evidence to establish that medical treatment is preferable to symptomatic management followed by normal death of the parasites. When treated with cysticidal drugs, there may be an aggravation of symptoms. Hence it is recommended that cysticidal treatment be given under cover of steroids.
Albendazole and Praziquantel are both effective in treatment. Albendazole is the drug of choice as it is less expensive and when co administered with a steroid (to treat inflammation) results in increased absorption of albendazole, whereas in the case of Praziquantel, the concomitant use of steroid decreases plasma levels. Both drugs are given with fatty meal. Treatment should be conducted in hospital as within a week of treatment inflammatory reactions to the dying parasite, such as may be manifested as headache, vomiting, mental changes and convulsions may be manifested.
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 mainstay of treatment.
Anti-cysticercal medications: Praziquantel and Albendazole
Anticonvulsant / Anti-epileptic medications should be given during the drug treatment to prevent or decrease the severity and number of seizures.
If parenchymal lesions resolve without calcifying and patient remains seizure free, then anticonvulsant therapy may be discontinued after 2 years.
The First Line / classical anticonvulsant medications include: Phenytoin Carbamazepine, Phenobarbitals.
Second line / Newer medicines: Valproic acid, Lamotrigine, Levetiracetam, Zonisamide.
Additionally, Glucocorticoid Therapy: Dexamethasone
Diuretics: Mannitol, Furosemide
No treatment at all in some cases.
Endoscopic surgery, for the removal of cysticercus, is the preferred approach for patients with obstructive hydrocephalus.
Complications:
Complications and sequelae of Neurocysticercosis includes:
- Fits
- Myositis
- Aseptic meningitis
- Intracranial space-occupying lesion
- Intracranial calcification
- Oligoclonal bands (CSF)
- Hydrocephalus
- Raised intracranial pressure
