Managing neurocysticercosis: challenges and solutions
What is it about?
Taenia solium neurocysticercosis (NCC) is a major cause of neurological morbidity in the world. Variability in the neuropathology and clinical presentation of NCC often make it difficult to diagnose and manage. Diagnosis of NCC can be challenging especially in endemic and resource-limited countries where laboratory and imaging techniques are often lacking. NCC management can also be challenging as current treatment options are limited and involve symptomatic agents, antiparasitic agents, or surgery. Although antiparasitic treatment probably reduces the number of active lesions and long-term seizure frequency, its efficacy is limited and strategies to improve treatment regimens are warranted. Treatment decisions should be individualized in relation to the type of NCC. Initial measures should focus on symptomatic management, with antiparasitic therapy only to be considered later on, when appropriate. Symptomatic treatment remains the cornerstone in NCC management which should not only focuses on epilepsy, but also on other manifestations that cause considerable burden (recurrent headaches, cognitive decline). Accurate patients' categorization, better antiparasitic regimens, and definition of new clinical outcomes for trials on NCC could improve management quality and prognosis of NCC. Prevention strategies targeting tapeworm carriers and infected pigs are yielding good results in local models. If local elimination of transmission is confirmed and replicated, this will open the door to cysticercosis eradication efforts worldwide.
Why is it important?
Neurocysticercosis is a public health problem in most developing countries and is reported with some frequency in industrialized countries due to immigration. Populations facing poverty and lack of health care facilities in endemic countries are more concerned. These conditions make accurate diagnosis of NCC very challenging in the absence of neuroimaging methods or appropriate immunologic tests. Treatment of NCC is mostly symptomatic
The following have contributed to this page: Dr Yannick F Fogang, NDIAYE Mansour, and Abdoul Aziz Savadogo