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Treatment of cysticercosis

INTRODUCTION

Cysticercosis is caused by the larval stage (metacestode) of the pork tapeworm Taenia solium. Clinical syndromes related to this parasite are divided into neurocysticercosis (NCC) and extraneural cysticercosis. Neurocysticercosis, in turn, is divided into parenchymal and extraparenchymal forms. The most common presentation of parenchymal NCC is seizures, whereas extraparenchymal NCC typically presents with hydrocephalus. Treatment must be individualized based on the manifestations of disease.

The treatment of cysticercosis will be reviewed here. The epidemiology, transmission, prevention, clinical features and diagnosis of cysticercosis and the life cycle of T. solium are discussed in separately. (See "Epidemiology, transmission and prevention of cysticercosis" and "Clinical manifestations and diagnosis of cysticercosis".)

PRINCIPLES OF THERAPY

The initial approach to patients with clinical manifestations of neurocysticercosis (NCC) should focus on management of symptoms such as seizure control with antiepileptics and treatment of increased intracranial pressure, if present. Subsequently a determination should be made regarding the role of antiparasitic and anti-inflammatory therapy.

Antiepileptic therapy — Antiepileptics should be administered to patients with NCC who present with seizures. Most reports in the literature on management of seizure due to NCC describe use of phenytoin or carbamazepine. Newer therapies (eg, levitiracetam or topiramate) are likely to be at least as effective, perhaps better tolerated, although more costly [1]. (See "Initial treatment of epilepsy in adults".)

Antiepileptic therapy may also be appropriate for patients who do not present with seizures but who are at high risk for seizures. The risk of seizures appears to be highest in the setting of multiple lesions, particularly when the lesions are degenerating and are surrounded by inflammation [2-6]. Calcified, inactive lesions can also serve as foci for seizures but in an otherwise asymptomatic patient are not generally considered an indication for prophylactic antiepileptic drug therapy.
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