Corticosteroids versus albendazole for treatment of single small enhancing computed tomographic lesions in children with neurocysticercosis

Cysticercosis: Recent Advances in Diagnosis and Management of Neurocysticercosis

Neurocysticercosis, caused by infection with the pork tapeworm Taenia solium, is increasingly recognized as a cause of neurologic disease worldwide. Because the clinical presentation is nonspecific, diagnosis has been difficult. Advances in imaging studies and serodiagnostic techniques are facilitating the diagnosis of neurocysticercosis and tapeworm carriers. Neurocysticercosis represents a spectrum of disease. Seizures are the main clinical manifestation in parenchymal neurocysticercosis. Recent studies emphasize that such seizures are the result of the host inflammatory response, even in patients who only have calcifications with no viable cysticerci. Controlled clinical trials have demonstrated that antiparasitic drugs can decrease the number of generalized seizures, although the benefit is small and confined to a subgroup of patients. Corticosteroids can also decrease seizure frequency. Case studies have demonstrated that endoscopic surgery appears to be the optimal approach to ventricular cysts. Recombinant vaccines are being developed and may prove important in disease control.

Neurocysticercosis in children

Neurocysticercosis is a major cause of neurologic disease worldwide. The clinical presentations are pleomorphic depending on the stage and location of cysts in the nervous system. Most children (> 80%) present with seizures, particularly partial seizures; headache and vomiting are seen in about a third of cases. Diagnosis is made by either computed tomography (CT) or magnetic resonance imaging. Single enhancing lesions are the most common finding. Visualization of a scolex confirms the diagnosis. Some cases have multiple cysts; the "starry-sky" appearance in cases with innumerable cysts is characteristic. Most children require anticonvulsants. Corticosteroids are indicated in those with cerebral edema. The efficacy of cysticidal therapy continues to be debated. Controlled studies suggest that cysticidal therapy helps in increased and faster resolution of CT lesions, but there is no conclusive evidence that it improves long-term seizure control. The prognosis in cases with single lesions is good; seizure control is achieved with a single anticonvulsant, and the recurrence rate is low. Children with multiple lesions have recurrent seizures. Extraparenchymal neurocysticercosis is rare in children and carries a poor prognosis. Neurocysticercosis must be considered in the differential diagnosis of seizures and a wide variety of neurologic disorders, particularly in endemic areas.