Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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)

View full drug information

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)

View full drug information

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.

Nash TE, Garcia HH. Diagnosis and treatment of neurocysticercosis. Nat Rev Neurol. 2011 Sep 13. 7(10):584-94. [QxMD MEDLINE Link].
Del Brutto OH. Neurocysticercosis. Neurohospitalist. 2014 Oct. 4(4):205-12. [QxMD MEDLINE Link]. [Full Text].
Del Brutto OH. Neurocysticercosis. Handb Clin Neurol. 2014. 121:1445-59. [QxMD MEDLINE Link].
Roy B, Verma S, Awasthi R, Rathore RK, Venkatesan R, Yoganathan SA, et al. Correlation of phase values with CT Hounsfield and R2* values in calcified neurocysticercosis. J Magn Reson Imaging. 2011 Nov. 34(5):1060-4. [QxMD MEDLINE Link].
Saenz B, Ruiz-Garcia M, Jimenez E, Hernandez-Aguilar J, Suastegui R, Larralde C. Neurocysticercosis: clinical, radiologic, and inflammatory differences between children and adults. Pediatr Infect Dis J. 2006 Sep. 25(9):801-3. [QxMD MEDLINE Link].
Shrestha B, Mainali P, Sayami S, Shrestha OK. Clinico-radiological Aspects of Neurocysticercosis in Pediatric Population in a Tertiary Hospital. JNMA J Nepal Med Assoc. 2013 Jul-Sep. 52(191):483-8. [QxMD MEDLINE Link].
Hernández RD, Durán BB, Lujambio PS. Magnetic resonance imaging in neurocysticercosis. Top Magn Reson Imaging. 2014 Jun. 23(3):191-8. [QxMD MEDLINE Link].
Das K, Mondal GP, Banerjee M, Mukherjee BB, Singh OP. Role of antiparasitic therapy for seizures and resolution of lesions in neurocysticercosis patients: an 8 year randomised study. J Clin Neurosci. 2007 Dec. 14(12):1172-7. [QxMD MEDLINE Link].
Gogia S, Talukdar B, Choudhury V, Arora BS. Neurocysticercosis in children: clinical findings and response to albendazole therapy in a randomized, double-blind, placebo-controlled trial in newly diagnosed cases. Trans R Soc Trop Med Hyg. 2003 Jul-Aug. 97(4):416-21. [QxMD MEDLINE Link].
Del Brutto OH, Roos KL, Coffey CS, García HH. Meta-analysis: Cysticidal drugs for neurocysticercosis: albendazole and praziquantel. Ann Intern Med. 2006 Jul 4. 145(1):43-51. [QxMD MEDLINE Link].
Garcia HH, Pretell EJ, Gilman RH, Martinez SM, Moulton LH, Del Brutto OH. A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N Engl J Med. 2004 Jan 15. 350(3):249-58. [QxMD MEDLINE Link].
Carpio A, Kelvin EA, Bagiella E, Leslie D, Leon P, Andrews H. Effects of albendazole treatment on neurocysticercosis: a randomised controlled trial. J Neurol Neurosurg Psychiatry. 2008 Sep. 79(9):1050-5. [QxMD MEDLINE Link].
Caplan LR. How to manage patients with neurocysticercosis. Eur Neurol. 1997. 37(2):124. [QxMD MEDLINE Link].
Carpio A. Neurocysticercosis: an update. Lancet Infect Dis. 2002 Dec. 2(12):751-62. [QxMD MEDLINE Link].
Carpio A, Escobar A, Hauser WA. Cysticercosis and epilepsy: a critical review. Epilepsia. 1998 Oct. 39(10):1025-40. [QxMD MEDLINE Link].
Carpio A, Hauser WA. Prognosis for seizure recurrence in patients with newly diagnosed neurocysticercosis. Neurology. 2002 Dec 10. 59(11):1730-4. [QxMD MEDLINE Link].
Carpio A, Hauser WA. Neurocysticercosis and epilepsy. Singh G, Prabhakar S, eds. Taenia Solium Cysticercosis. Oxon, UK: CABI Publishing; 2002. 211-20.
Carpio A, Placencia M, Santillan F. A proposal for classification of neurocysticercosis. Can J Neurol Sci. 1994 Feb. 21(1):43-7. [QxMD MEDLINE Link].
Carpio A, Santillan F, Leon P. Is the course of neurocysticercosis modified by treatment with antihelminthic agents?. Arch Intern Med. 1995 Oct 9. 155(18):1982-8. [QxMD MEDLINE Link].
Correa D, Medina-Escutia, E. Host-parasite immune relationship in Taenia solium taeniosis and cysticercosis. Garcia HH, Martinez, SM eds. Taenia solium Taeniasis/Cysticercosis. 1999. 15-24.
Davis L. Neurocysticercosis and seizures: Avoiding the cost of antihelminthic treatment. Neurology. 2002. 59:1669-71.
Dixon HBF, Lipscomb FM. Cysticercosis: an analysis and follow up of 450 cases. Med Res Council Special Reports. 1961. 299:1-58.
Escobar A. The pathology of neurocysticercosis. Cysticercosis of Central Nervous System. 1983:27-54.
Estanol B, Corona T, Abad P. A prognostic classification of cerebral cysticercosis: therapeutic implications. J Neurol Neurosurg Psychiatry. 1986 Oct. 49(10):1131-4. [QxMD MEDLINE Link].
Flisser A, Correa D, Evans CAW. Taenia solium cysticercosis: New revisited immunological aspects. Singh G, Prabhakar S, eds. Taenia Solium Cysticercosis. Oxon, UK: CABI Publish; 2002. 24-44.
Garcia HH, Martinez M, Gilman R. Diagnosis of cysticercosis in endemic regions. The Cysticercosis Working Group in Peru. Lancet. 1991 Aug 31. 338(8766):549-51. [QxMD MEDLINE Link].
Garg K, Singh K, Misra S. Single-enhancing lesions in Indians patients with seizures: a review. Epilepsy Res. 2002. 59:1730-1734.
Garg RK, Kar AM, Jain S. Failure of albendazole therapy in two common types of parenchymal neurocysticercosis. J Assoc Physicians India. 1995 Oct. 43(10):706-7. [QxMD MEDLINE Link].
Goodman KA, Ballagh SA, Carpio A. Case-control study of seropositivity for cysticercosis in Cuenca, Ecuador. Am J Trop Med Hyg. 1999 Jan. 60(1):70-4. [QxMD MEDLINE Link].
Kramer LD. Medical treatment of cysticercosis--ineffective. Arch Neurol. 1995 Jan. 52(1):101-2. [QxMD MEDLINE Link].
Kramer LD, Locke GE, Byrd SE. Cerebral cysticercosis: documentation of natural history with CT [published erratum appears in Radiology 1989 Oct;173(1):286]. Radiology. 1989 May. 171(2):459-62. [QxMD MEDLINE Link].
Manreza ML. Neurocysticercosis in children. Trends in Pediatric Neurology. 1993. 295-8.
Martinez HR, Rangel-Guerra R, Arredondo-Estrada JH. Medical and surgical treatment in neurocysticercosis a magnetic resonance study of 161 cases. J Neurol Sci. 1995 May. 130(1):25-34. [QxMD MEDLINE Link].
McCormick GF, Zee CS, Heiden J. Cysticercosis cerebri. Review of 127 cases. Arch Neurol. 1982 Sep. 39(9):534-9. [QxMD MEDLINE Link].
Mitchell WG, Crawford TO. Intraparenchymal cerebral cysticercosis in children: diagnosis and treatment. Pediatrics. 1988 Jul. 82(1):76-82. [QxMD MEDLINE Link].
Padma MV, Behari M, Misra NK. Albendazole in single CT ring lesions in epilepsy. Neurology. 1994 Jul. 44(7):1344-6. [QxMD MEDLINE Link].
Pal DK, Carpio A, Sander JW. Neurocysticercosis and epilepsy in developing countries. J Neurol Neurosurg Psychiatry. 2000 Feb. 68(2):137-43. [QxMD MEDLINE Link].
Ramos-Kuri M, Montoya RM, Padilla A. Immunodiagnosis of neurocysticercosis. Disappointing performance of serology (enzyme-linked immunosorbent assay) in an unbiased sample of neurological patients. Arch Neurol. 1992 Jun. 49(6):633-6. [QxMD MEDLINE Link].
Schantz PM. Cysticercosis in non-endemic countries: the example of United States. Teniasis/Cysticercosis por T. solium. 1996. 277-86.
Singhal BS, Salinas RA. Controversies in the Drug Treatment of Neurocysticercosis. Singh G, Prabhakar S, eds. Taenia Solium Cysticercosis. Oxon, UK: CABI Publish; 2002. 713-43.
Suss RA, Maravilla KR, Thompson J. MR imaging of intracranial cysticercosis: comparison with CT and anatomopathologic features. AJNR Am J Neuroradiol. 1986 Mar-Apr. 7(2):235-42. [QxMD MEDLINE Link].
Teitelbaum GP, Otto RJ, Watanabe AT. MR imaging of neurocysticercosis. AJNR. 1989. 10:709-18.
Tsang VC, Brand JA, Boyer AE. An enzyme-linked immunoelectrotransfer blot assay and glycoprotein antigens for diagnosing human cysticercosis (Taenia solium). J Infect Dis. 1989 Jan. 159(1):100-2. [QxMD MEDLINE Link].
White AC, Garcia HH. Recent Developments in the Epidemiology, Diagnosis, Treatment, and Prevention of Neurocysticercosis. Curr Infect Dis Rep. 1999 Dec. 1(5):434-440. [QxMD MEDLINE Link].
Xiao ZX, Zhao CY, Liu YP. [Albendazole treatment in cerebral cysticercosis]. Chung Hua Nei Ko Tsa Chih. 1986 Feb. 25(2):100-2, 127. [QxMD MEDLINE Link].
Zee CS, Segall HD, Destian S. MRI of intraventricular cysticercosis: surgical implications. J Comput Assist Tomogr. 1993 Nov-Dec. 17(6):932-9. [QxMD MEDLINE Link].

Media Gallery

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).
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.
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).
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.
Neuroimaging in neurocysticercosis. Cysticercus cellulosae in neurocysticercosis.
Treatment of Neurocysticercosis
Neuroimaging in neurocysticercosis. Cysticercus cellulosae showing the invaginated scolex in neurocysticercosis.
Neuroimaging in neurocysticercosis. Subcortical parenchymatous cysticercosis
Neuroimaging in neurocysticercosis. Inflammatory reaction in parenchymatous cysticercosis.
Neuroimaging in neurocysticercosis. Antiepileptic treatment for patients with first seizure due to neurocysticercosis.
Neuroimaging in neurocysticercosis. Probability of seizure recurrence (Kaplan-Meier curve) after a first seizure in patients with NC as function of cysticidal treatment.

of 11

Author

Arturo Carpio, MD Professor, University of Cuenca School of Medicine, Ecuador; Senior Research Scientist, GH Sergievsky Center, Columbia University

Arturo Carpio, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Coauthor(s)

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL Co-Founder and Former Chief Publishing Officer, eMedicine and eMedicine Health, Founding Editor-in-Chief, eMedicine Neurology; Founder and Former Chairman and CEO, Pearlsreview; Founder and CEO/CMO, PHLT Consultants; Former Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association for Physician Leadership

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Florian P Thomas, MD, PhD, MA, MS Chair, Neuroscience Institute and Department of Neurology, Director, Hereditary Neuropathy Center, Co-Director, Center for Memory Loss and Brain Health, Co-Director, ALS Center, Hackensack University Medical Center; Associate Dean of Faculty, Founding Chair and Professor, Department of Neurology, Hackensack Meridian School of Medicine

Florian P Thomas, MD, PhD, MA, MS is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Neurology, American Neurological Association, Consortium of Multiple Sclerosis Centers, National Multiple Sclerosis Society, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Adjunct Associate Professor of Neurology, University of Missouri-Columbia School of Medicine; Medical Director of St Mary's Stroke Program, SSM Neurosciences Institute, SSM Health

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Sections Neuroimaging in Neurocysticercosis
Overview
Presentation
- History
- Physical
- Causes
- Complications
- Show All
DDx
Workup
Treatment
Medication
Media Gallery
References

Neuroimaging in Neurocysticercosis Medication

Medication Summary

Anthelmintics

Class Summary

Albendazole (Albenza)

Albendazole (Albenza)

Praziquantel (Biltricide)

Praziquantel (Biltricide)

Neuroimaging in Neurocysticercosis Medication

Medication Summary

Anthelmintics

Class Summary

Albendazole (Albenza)

Albendazole (Albenza)

Praziquantel (Biltricide)

Praziquantel (Biltricide)

References

Tables

Contributor Information and Disclosures

What would you like to print?