Medication Summary
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Anthelmintics
Class Summary
Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.
Albendazole (Albenza)
Broad-spectrum agent that chemically belongs to benzimidazole group. Has been used to treat enterobiasis, ascariasis, trichuriasis, strongyloidiasis, and hookworm infections, but in US, approved only for use in hydatid disease and neurocysticercosis. Inhibits parasite's ability to assemble tubulin dimers into tubulin polymers, thus arresting microtubule formation. This affects several aspects of parasite's life, including larval development, carbohydrate transport, and enzyme function, as well as maintenance of parasite integument and digestive system.
Praziquantel (Biltricide)
Effective against various trematodes and cestodes including Schistosoma species and tapeworms. Works by increasing parasite's cell membrane permeability. Results in loss of intracellular calcium, massive muscle contractions, and spastic paralysis of parasites, as well as damage to schistosome tegument, followed by attachment of phagocytes to parasite.
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Neuroimaging in neurocysticercosis. CT scans showing different phases of neurocysticercosis. Top left: CT scan showing many calcifications and active cysts with scolices in both hemispheres. Top right: T1-weighted MRI showing 2 active cysts with the scolex in their interior (vesicular phase). Bottom left: Postcontrast CT scan showing a ring-enhancing cyst (colloidal phase) on left. Bottom right: Proton density-weighted MRI showing a thick capsule with adjacent scolex and perilesional edema (colloidal phase).
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Neuroimaging in neurocysticercosis. Natural history of neurocysticercosis. Top left: This CT scan shows a large occipital active cyst (vesicle phase), many calcifications, and small cortical cysts. Top right: After 18 months, the occipital cyst has been replaced by a calcification and the remaining cysts have disappeared. Bottom left: A single parietal nodular-enhancing lesion (transitional, nodular-granular phase) is shown. Bottom right: Six months later, the lesion has disappeared.
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Neuroimaging in neurocysticercosis. Noncontrast and contrast-enhanced CT scan of neurocysticercosis. Left: Normal noncontrast CT scan. Right: After administration of the contrast medium, the CT scan of the same patient shows a single parietal nodular-enhancing lesion (transitional, nodular phase).
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Neuroimaging in neurocysticercosis. Cysticercotic encephalitis. Left: Contrast-enhanced CT scan showing multiple, small, nodular, and annular areas of abnormal enhancement in brain parenchyma. Right: Gadolinium-enhanced T1-weighted MRI showing hyperintense lesions.
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Neuroimaging in neurocysticercosis. Cysticercus cellulosae in neurocysticercosis.
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Treatment of Neurocysticercosis
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Neuroimaging in neurocysticercosis. Cysticercus cellulosae showing the invaginated scolex in neurocysticercosis.
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Neuroimaging in neurocysticercosis. Subcortical parenchymatous cysticercosis
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Neuroimaging in neurocysticercosis. Inflammatory reaction in parenchymatous cysticercosis.
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Neuroimaging in neurocysticercosis. Antiepileptic treatment for patients with first seizure due to neurocysticercosis.
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Neuroimaging in neurocysticercosis. Probability of seizure recurrence (Kaplan-Meier curve) after a first seizure in patients with NC as function of cysticidal treatment.
