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Treatment of cysticercosis

A Clinton White, Jr, MD, FACP, FIDSA
Section Editor
Peter F Weller, MD, MACP
Deputy Editor
Elinor L Baron, MD, DTMH


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 detail separately. (See "Epidemiology, transmission, and prevention of cysticercosis" and "Clinical manifestations and diagnosis of cysticercosis".)


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 antiinflammatory 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, levetiracetam 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 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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Literature review current through: Nov 2017. | This topic last updated: Dec 16, 2016.
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  1. Kaushal S, Rani A, Chopra SC, Singh G. Safety and efficacy of clobazam versus phenytoin-sodium in the antiepileptic drug treatment of solitary cysticercus granulomas. Neurol India 2006; 54:157.
  2. Garcia HH, Pretell EJ, Gilman RH, et al. A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N Engl J Med 2004; 350:249.
  3. Del Brutto OH. Prognostic factors for seizure recurrence after withdrawal of antiepileptic drugs in patients with neurocysticercosis. Neurology 1994; 44:1706.
  4. Carpio A, Hauser WA. Prognosis for seizure recurrence in patients with newly diagnosed neurocysticercosis. Neurology 2002; 59:1730.
  5. Rajshekhar V, Jeyaseelan L. Seizure outcome in patients with a solitary cerebral cysticercus granuloma. Neurology 2004; 62:2236.
  6. Verma A, Misra S. Outcome of short-term antiepileptic treatment in patients with solitary cerebral cysticercus granuloma. Acta Neurol Scand 2006; 113:174.
  7. Nash TE, Pretell EJ, Lescano AG, et al. Perilesional brain oedema and seizure activity in patients with calcified neurocysticercosis: a prospective cohort and nested case-control study. Lancet Neurol 2008; 7:1099.
  8. Garcia HH, Nash TE, Del Brutto OH. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol 2014; 13:1202.
  9. Webb CM, White AC Jr. Update on the Diagnosis and Management of Neurocysticercosis. Curr Infect Dis Rep 2016; 18:44.
  10. García HH, Evans CA, Nash TE, et al. Current consensus guidelines for treatment of neurocysticercosis. Clin Microbiol Rev 2002; 15:747.
  11. Baird RA, Wiebe S, Zunt JR, et al. Evidence-based guideline: treatment of parenchymal neurocysticercosis: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013; 80:1424.
  12. Göngora-Rivera F, Soto-Hernández JL, González Esquivel D, et al. Albendazole trial at 15 or 30 mg/kg/day for subarachnoid and intraventricular cysticercosis. Neurology 2006; 66:436.
  13. Carpio A, Kelvin EA, Bagiella E, et al. Effects of albendazole treatment on neurocysticercosis: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2008; 79:1050.
  14. Jung H, Hurtado M, Medina MT, et al. Dexamethasone increases plasma levels of albendazole. J Neurol 1990; 237:279.
  15. Sotelo J, Jung H. Pharmacokinetic optimisation of the treatment of neurocysticercosis. Clin Pharmacokinet 1998; 34:503.
  16. Del Brutto OH, Roos KL, Coffey CS, García HH. Meta-analysis: Cysticidal drugs for neurocysticercosis: albendazole and praziquantel. Ann Intern Med 2006; 145:43.
  17. Singh G, Rajshekhar V, Murthy JM, et al. A diagnostic and therapeutic scheme for a solitary cysticercus granuloma. Neurology 2010; 75:2236.
  18. Otte WM, Singla M, Sander JW, Singh G. Drug therapy for solitary cysticercus granuloma: a systematic review and meta-analysis. Neurology 2013; 80:152.
  19. Singhi P, Dayal D, Khandelwal N. One week versus four weeks of albendazole therapy for neurocysticercosis in children: a randomized, placebo-controlled double blind trial. Pediatr Infect Dis J 2003; 22:268.
  20. Bustos JA, Pretell EJ, Llanos-Zavalaga F, et al. Efficacy of a 3-day course of albendazole treatment in patients with a single neurocysticercosis cyst. Clin Neurol Neurosurg 2006; 108:193.
  21. Proaño JV, Madrazo I, Avelar F, et al. Medical treatment for neurocysticercosis characterized by giant subarachnoid cysts. N Engl J Med 2001; 345:879.
  22. Garcia HH, Lescano AG, Lanchote VL, et al. Pharmacokinetics of combined treatment with praziquantel and albendazole in neurocysticercosis. Br J Clin Pharmacol 2011; 72:77.
  23. Kaur S, Singhi P, Singhi S, Khandelwal N. Combination therapy with albendazole and praziquantel versus albendazole alone in children with seizures and single lesion neurocysticercosis: a randomized, placebo-controlled double blind trial. Pediatr Infect Dis J 2009; 28:403.
  24. Garcia HH, Gonzales I, Lescano AG, et al. Efficacy of combined antiparasitic therapy with praziquantel and albendazole for neurocysticercosis: a double-blind, randomised controlled trial. Lancet Infect Dis 2014; 14:687.
  25. Yee T, Barakos JA, Knight RT. High-dose praziquantel with cimetidine for refractory neurocysticercosis: a case report with clinical and MRI follow-up. West J Med 1999; 170:112.
  26. Garcia HH. Antiparasitic drugs in neurocysticercosis: albendazole or praziquantel? Expert Rev Anti Infect Ther 2008; 6:295.
  27. Mall RK, Agarwal A, Garg RK, et al. Short course of prednisolone in Indian patients with solitary cysticercus granuloma and new-onset seizures. Epilepsia 2003; 44:1397.
  28. Nash TE, Singh G, White AC, et al. Treatment of neurocysticercosis: current status and future research needs. Neurology 2006; 67:1120.
  29. Prakash S, Garg RK, Kar AM, et al. Intravenous methyl prednisolone in patients with solitary cysticercus granuloma: a random evaluation. Seizure 2006; 15:328.
  30. Garg RK, Potluri N, Kar AM, et al. Short course of prednisolone in patients with solitary cysticercus granuloma: a double blind placebo controlled study. J Infect 2006; 53:65.
  31. Kishore D, Misra S. Short course of oral prednisolone on disappearance of lesion and seizure recurrence in patients of solitary cysticercal granuloma with single small enhancing CT lesion: an open label randomized prospective study. J Assoc Physicians India 2007; 55:419.
  32. Mitre E, Talaat KR, Sperling MR, Nash TE. Methotrexate as a corticosteroid-sparing agent in complicated neurocysticercosis. Clin Infect Dis 2007; 44:549.
  33. Garcia HH, Gonzales I, Lescano AG, et al. Enhanced steroid dosing reduces seizures during antiparasitic treatment for cysticercosis and early after. Epilepsia 2014; 55:1452.
  34. Rangel-Castilla L, Serpa JA, Gopinath SP, et al. Contemporary neurosurgical approaches to neurocysticercosis. Am J Trop Med Hyg 2009; 80:373.
  35. Vedantam A, Daniels B, Lam S. Intraventricular Cyst Causing Acute Obstructive Hydrocephalus: Neurocysticercosis Managed With Neuroendoscopy. Pediatr Neurol 2016; 55:71.
  36. Sotelo J, Marin C. Hydrocephalus secondary to cysticercotic arachnoiditis. A long-term follow-up review of 92 cases. J Neurosurg 1987; 66:686.
  37. Kelley R, Duong DH, Locke GE. Characteristics of ventricular shunt malfunctions among patients with neurocysticercosis. Neurosurgery 2002; 50:757.
  38. Colli BO, Carlotti CG Jr, Assirati JA Jr, et al. Surgical treatment of cerebral cysticercosis: long-term results and prognostic factors. Neurosurg Focus 2002; 12:e3.
  39. Singhi P, Jain V, Khandelwal N. Corticosteroids versus albendazole for treatment of single small enhancing computed tomographic lesions in children with neurocysticercosis. J Child Neurol 2004; 19:323.
  40. Thussu A, Chattopadhyay A, Sawhney IM, Khandelwal N. Albendazole therapy for single small enhancing CT lesions (SSECTL) in the brain in epilepsy. J Neurol Neurosurg Psychiatry 2008; 79:272.
  41. Abba K, Ramaratnam S, Ranganathan LN. Anthelmintics for people with neurocysticercosis. Cochrane Database Syst Rev 2010; :CD000215.
  42. Garcia HH, Lescano AG, Gonzales I, et al. Cysticidal Efficacy of Combined Treatment With Praziquantel and Albendazole for Parenchymal Brain Cysticercosis. Clin Infect Dis 2016; 62:1375.
  43. Das K, Mondal GP, Banerjee M, et al. Role of antiparasitic therapy for seizures and resolution of lesions in neurocysticercosis patients: an 8 year randomised study. J Clin Neurosci 2007; 14:1172.
  44. Thomson AJ. Neurocysticercosis--experience at the teaching hospitals of the University of Cape Town. S Afr Med J 1993; 83:332.
  45. Rangel R, Torres B, Del Bruto O, Sotelo J. Cysticercotic encephalitis: a severe form in young females. Am J Trop Med Hyg 1987; 36:387.
  46. Nash TE, Del Brutto OH, Butman JA, et al. Calcific neurocysticercosis and epileptogenesis. Neurology 2004; 62:1934.
  47. Rajshekhar V, Raghava MV, Prabhakaran V, et al. Active epilepsy as an index of burden of neurocysticercosis in Vellore district, India. Neurology 2006; 67:2135.
  48. Garcia-Noval J, Moreno E, de Mata F, et al. An epidemiological study of epilepsy and epileptic seizures in two rural Guatemalan communities. Ann Trop Med Parasitol 2001; 95:167.
  49. Garcia HH, Coyle CM, White AC Jr. Cysticercosis. In: Tropical Infectious Diseases: Principles, Pathogens and Practice, 3rd ed, Guerrant RL, Walker DH, Weller PF (Eds), Saunders Elsevier, Philadelphia 2011. p.815.
  50. Garcia HH, Del Brutto OH, Nash TE, et al. New concepts in the diagnosis and management of neurocysticercosis (Taenia solium). Am J Trop Med Hyg 2005; 72:3.
  51. Garcia HH, Del Brutto OH, Cysticercosis Working Group in Peru. Neurocysticercosis: updated concepts about an old disease. Lancet Neurol 2005; 4:653.
  52. Gravori T, Steineke T, Bergsneider M. Endoscopic removal of cisternal neurocysticercal cysts. Technical note. Neurosurg Focus 2002; 12:e7.
  53. Bergsneider M, Holly LT, Lee JH, et al. Endoscopic management of cysticercal cysts within the lateral and third ventricles. J Neurosurg 2000; 92:14.
  54. Psarros TG, Krumerman J, Coimbra C. Endoscopic management of supratentorial ventricular neurocysticercosis: case series and review of the literature. Minim Invasive Neurosurg 2003; 46:331.
  55. Husain M, Jha DK, Rastogi M, et al. Neuro-endoscopic management of intraventricular neurocysticercosis (NCC). Acta Neurochir (Wien) 2007; 149:341.
  56. Suri A, Goel RK, Ahmad FU, et al. Endoscopic excision of intraventricular neurocysticercosis in children: a series of six cases and review. Childs Nerv Syst 2008; 24:281.
  57. Zymberg ST, Paiva Neto MA, Gorgulho AA, Cavalheiro S. Endoscopic approach to fourth ventricle cysticercosis. Arq Neuropsiquiatr 2003; 61:204.
  58. Torres-Corzo J, Rodriguez-della Vecchia R, Rangel-Castilla L. Bruns syndrome caused by intraventricular neurocysticercosis treated using flexible endoscopy. J Neurosurg 2006; 104:746.
  59. Husain M, Rastogi M, Jha DK, et al. Endoscopic transaqueductal removal of fourth ventricular neurocysticercosis with an angiographic catheter. Neurosurgery 2007; 60:249.
  60. Bergsneider M, Nieto JH. Endoscopic management of intraventricular cysticercosis. In: Taenia solium cysticercosis: from basic to clinical science, Singh G, Prabhakar S (Eds), CABI Publishing, Oxford 2002. p.399.
  61. Psarros TG, Coimbra C. Endoscopic third ventriculostomy for patients with hydrocephalus and fourth ventricular cysticercosis: a review of five cases. Minim Invasive Neurosurg 2004; 47:346.
  62. Lapergue B, Hosseini H, Liance M, et al. Hydrocephalus and racemose cysticercosis: surgical alternative by endoscopic third ventriculostomy. Neurochirurgie 2005; 51:481.
  63. Sharma T, Sinha S, Shah N, et al. Intraocular cysticercosis: clinical characteristics and visual outcome after vitreoretinal surgery. Ophthalmology 2003; 110:996.
  64. Murthy R, Samant M. Extraocular muscle cysticercosis: clinical features and management outcome. Strabismus 2008; 16:97.
  65. Sundaram PM, Jayakumar N, Noronha V. Extraocular muscle cysticercosis - a clinical challenge to the ophthalmologists. Orbit 2004; 23:255.
  66. Bandres JC, White AC Jr, Samo T, et al. Extraparenchymal neurocysticercosis: report of five cases and review of management. Clin Infect Dis 1992; 15:799.
  67. White AC Jr. New developments in the management of neurocysticercosis. J Infect Dis 2009; 199:1261.