Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Diagnosis and treatment of neurocysticercosis

Nature Reviews Neurology volume 7, pages 584–594 (2011)Cite this article

Subjects

Abstract

Neurocysticercosis is a parasitic disease caused by the larval (cystic) form of the pork cestode tapeworm, Taenia solium, and is a major cause of acquired seizures and epilepsy worldwide. Development of sensitive and specific diagnostic methods, particularly CT and MRI, has revolutionized our knowledge of the burden of cysticercosis infection and disease, and has led to the development of effective antihelminthic treatments for neurocysticercosis. The importance of calcified granulomas with perilesional edema as foci of seizures and epilepsy in populations where neurocysticercosis is endemic is newly recognized, and indicates that treatment with anti-inflammatory agents could have a role in controlling or preventing epilepsy in these patients. Importantly, neurocysticercosis is one of the few diseases that could potentially be controlled or eliminated—an accomplishment that would prevent millions of cases of epilepsy. This Review examines the rationale for treatment of neurocysticercosis and highlights the essential role of inflammation in the pathogenesis of disease, the exacerbation of symptoms that occurs as a result of antihelminthic treatment, and the limitations of current antihelminthic and anti-inflammatory treatments.

Key Points

  • Taenia solium neurocysticercosis is a common cause of seizure disorders worldwide

  • Intraparenchymal neurocysticercosis is mostly associated with seizures; extraparenchymal neurocysticercosis can cause mass effects and hydrocephalus, and has a poor prognosis

  • Management of patients with neurocysticercosis commonly involves antiepileptic drugs and steroids to treat the neurological and inflammatory symptoms, plus antihelminthic drugs to kill any viable parasites (in most cases)

  • Most treatment recommendations for neurocysticercosis are based on expert opinion or anecdotal evidence; only a few controlled studies of antihelminthic drugs or steroids exist

  • Neurocysticercosis could provide a useful model to study susceptibility to and pathogenesis of epilepsy

  • Neurocysticercosis is a preventable, and probably eradicable, cause of seizures and epilepsy

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2: World map showing the distribution of taeniasis and Taenia solium cysticercosis in humans.
Figure 3: Intraparenchymal neurocysticercosis.
Figure 4: Extraparenchymal neurocysticercosis.

Similar content being viewed by others

References

  1. [No authors listed] Relationship between epilepsy and tropical diseases. Commission on Tropical Diseases of the International League Against Epilepsy. Epilepsia 35, 89–93 (1994).

  2. Garcia, H. H. & Del Brutto, O. H. Neurocysticercosis: updated concepts about an old disease. Lancet Neurol. 4, 653–661 (2005).

    PubMed  Google Scholar 

  3. Ndimubanzi, P. C. et al. A systematic review of the frequency of neurocyticercosis with a focus on people with epilepsy. PLoS Negl. Trop. Dis. 4, e870 (2010).

    PubMed  PubMed Central  Google Scholar 

  4. Montano, S. M. et al. Neurocysticercosis: association between seizures, serology, and brain CT in rural Peru. Neurology 65, 229–233 (2005).

    CAS  PubMed  Google Scholar 

  5. Villaran, M. V. et al. Epilepsy and neurocysticercosis: an incidence study in a Peruvian rural population. Neuroepidemiology 33, 25–31 (2009).

    PubMed  PubMed Central  Google Scholar 

  6. Medina, M. T. et al. Prevalence, incidence, and etiology of epilepsies in rural Honduras: the Salama Study. Epilepsia 46, 124–131 (2005).

    PubMed  Google Scholar 

  7. Del Brutto, O. H. et al. Epilepsy and neurocysticercosis in Atahualpa: a door-to-door survey in rural coastal Ecuador. Epilepsia 46, 583–587 (2005).

    PubMed  Google Scholar 

  8. Budke, C. M., White, A. C. Jr & Garcia, H. H. Zoonotic larval cestode infections: neglected, neglected tropical diseases? PLoS Negl. Trop. Dis. 93, 211–221 (2009).

    Google Scholar 

  9. Rajshekhar, V., Joshi, D. D, Doanh, N. Q, van De, N. & Xiaonon, Z. Taenia solium taeniosis/cysticercosis in Asia: epidemiology, impact and issues. Acta Trop. 87, 53–60 (2003).

    PubMed  Google Scholar 

  10. Del Brutto, O. H., Sotelo, J. & Roman, G. C. Neurocysticercosis: a Clinical Handbook (Swets & Zeitliger, Lisse) (1998).

    Google Scholar 

  11. Schantz, P. M., Wilkins, P. P. & Tsang, V. C. W. in Emerging Infections 2 Ch. 2 (eds Scheld, W. M. et al.) 213–241 (American Society for Microbiology, Washington DC, 1998).

    Google Scholar 

  12. Quet, F. et al. Meta-analysis of the association between cysticercosis and epilepsy in Africa. Epilepsia 51, 830–837 (2010).

    PubMed  Google Scholar 

  13. Praet, N. et al. The disease burden of Taenia solium cysticercosis in Cameroon. PLoS Negl. Trop. Dis. 3, e406 (2009).

    PubMed  PubMed Central  Google Scholar 

  14. Winkler, A. S. et al. Epilepsy and neurocysticercosis in rural Tanzania—an imaging study. Epilepsia 50, 987–993 (2009).

    PubMed  Google Scholar 

  15. Winkler, A. S., Willingham, A. L. 3rd, Sikasunge, C. S. & Schmutzhard, E. Epilepsy and neurocysticercosis in sub-Saharan Africa. Wien. Klin. Wochenschr. 121 (Suppl. 3), 3–12 (2009).

    PubMed  Google Scholar 

  16. Serpa, J. A., Graviss, E. A., Kass, J. S. & White, A. C. Neurocysticercosis in Houston, Texas: an update. Medicine (Baltimore) 90, 81–86 (2010).

    Google Scholar 

  17. Sorvillo, F., Wilkins, P., Shafir, S. & Eberhard, M. Public health implications of cysticercosis acquired in the United States. Emerg. Infect. Dis. 17, 1–6 (2010).

    Google Scholar 

  18. Raffaldi, I. et al. An uncommon cause of seizures in children living in developed countries: neurocysticercosis—a case report. Ital. J. Pediatr. 37, 9 (2010).

    Google Scholar 

  19. Croker, C., Reporter, R. & Mascola, L. Use of statewide hospital discharge data to evaluate the economic burden of neurocysticercosis in Los Angeles County (1991–2008). Am. J. Trop. Med. Hyg. 83, 106–110 (2010).

    PubMed  PubMed Central  Google Scholar 

  20. Gilman, R. H., Del Brutto, O. H., Garcia, H. H. & Martinez, M. Prevalence of taeniosis among patients with neurocysticercosis is related to severity of infection. The Cysticercosis Working Group in Peru. Neurology 55, 1062 (2000).

    CAS  PubMed  Google Scholar 

  21. Sarti Gutierrez, E., Schantz, P. M., Aguilera, J. & Lopez, A. Epidemiologic observations on porcine cysticercosis in a rural community of Michoacan State, Mexico. Vet. Parasitol. 41, 195–201 (1992).

    CAS  PubMed  Google Scholar 

  22. Lescano, A. G. et al. Taenia solium cysticercosis hotspots surrounding tapeworm carriers: clustering on human seroprevalence but not on seizures. PLoS Negl. Trop. Dis. 3, e371 (2009).

    PubMed  PubMed Central  Google Scholar 

  23. Nash, T. E. et al. Treatment of neurocysticercosis: current status and future research needs. Neurology 67, 1120–1127 (2006).

    CAS  PubMed  Google Scholar 

  24. Garcia, H. H. et al. Neurocysticercosis: unraveling the nature of the single cysticercal granuloma. Neurology 75, 654–658 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Verma, A. et al. Toll-like receptor 4 polymorphism and its association with symptomatic neurocysticercosis. J. Infect. Dis. 202, 1219–1225 (2010).

    CAS  PubMed  Google Scholar 

  26. Lobato, R. D. et al. Hydrocephalus in cerebral cysticercosis. Pathogenic and therapeutic considerations. J. Neurosurg. 55, 786–793 (1981).

    CAS  PubMed  Google Scholar 

  27. Carabin, H. et al. Clinical manifestations associated with neurocysticercosis: a systematic review. PLoS Negl. Trop. Dis. 5, e1152 (2011).

    PubMed  PubMed Central  Google Scholar 

  28. Antoniuk, S. et al. Neurocysticercosis in children: clinical study and follow-up of 112 patients. Rev. Neurol. 42 (Suppl. 3), S97–S101 (2006).

    PubMed  Google Scholar 

  29. Morales, N. M., Agapejev, S., Morales, R. R, Padula, N. A. & Lima, M. M. Clinical aspects of neurocysticercosis in children. Pediatr. Neurol. 22, 287–291 (2000).

    CAS  PubMed  Google Scholar 

  30. Escobar, A. The pathology of neurocysticercosis in Cysticercosis of the Central Nervous System (eds Palacios, E. et al) 27–54 (Thomas, C. C., Springfield, 1983).

    Google Scholar 

  31. Evans, C. A. W. The immunology of the host–parasite relationship in Taenia solium Cysticercosis: Implications for Prevention and Therapy in Taenia solium Taeniasis/Cysticercosis 2nd edn (eds Garcia, H. H. & Martinez, S. M) 25–37 (Editorial Universo, Lima, (1999).

    Google Scholar 

  32. Nash, T. E. et al. Calcific neurocysticercosis and epileptogenesis. Neurology 62, 1934–1938 (2004).

    CAS  PubMed  Google Scholar 

  33. Rajshekhar, V. & Chandy, M. J. (Eds) Solitary Cysticercus Granuloma: the Disappearing Lesion (Orient Longman, Chennai, 2000).

    Google Scholar 

  34. Singh, G. & Murthy, J. M. Solitary cysticercus granuloma—treatment with albendazole: what is the optimal duration? Neurol. India 58, 507–508 (2010).

    PubMed  Google Scholar 

  35. Rajshekhar, V., Haran, R. P., Prakash, G. S. & Chandy, M. J. Differentiating solitary small cysticercus granulomas and tuberculomas in patients with epilepsy. Clinical and computerized tomographic criteria. J. Neurosurg. 78, 402–407 (1993).

    CAS  PubMed  Google Scholar 

  36. Sharma, P., Garg, R. K., Verma, R., Singh, M. K. & Shukla, R. Risk of seizure recurrence in patients of new-onset partial seizure having a solitary cysticercus granuloma of brain or normal neuroimaging. J. Neurol. Sci. 301, 21–26 (2010).

    PubMed  Google Scholar 

  37. Kramer, L. D., Locke, G. E., Byrd, S. E. & Daryabagi, J. Cerebral cysticercosis: documentation of natural history with CT. Radiology 171, 459–462 (1989).

    CAS  PubMed  Google Scholar 

  38. Nash, T. E. & Patronas, N. J. Edema associated with calcified lesions in neurocysticercosis. Neurology 53, 777–781 (1999).

    CAS  PubMed  Google Scholar 

  39. Sheth, T. N., Pilon, L., Keystone, J. & Kucharczyk, W. Persistent MR contrast enhancement of calcified neurocysticercosis lesions. AJNR Am. J. Neuroradiol. 19, 79–82 (1998).

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Ooi, W. W. et al. A calcified Taenia solium granuloma associated with recurrent perilesional edema causing refractory seizures: histopathological features. Am. J. Trop. Med. Hyg. (in press).

  41. Nash, T. E., Pretell, J. & Garcia, H. H. Calcified cysticerci provoke perilesional edema and seizures. Clin. Infect. Dis. 33, 1649–1653 (2001).

    CAS  PubMed  Google Scholar 

  42. Nash, T. E. et al. Perilesional brain oedema and seizure activity in patients with calcified neurocysticercosis: a prospective cohort and nested case–control study. Lancet Neurol. 7, 1099–1105 (2008).

    PubMed  PubMed Central  Google Scholar 

  43. Pradhan, S., Kathuria, M. K. & Gupta, R. K. Perilesional gliosis and seizure outcome: a study based on magnetization transfer magnetic resonance imaging in patients with neurocysticercosis. Ann. Neurol. 48, 181–187 (2000).

    CAS  PubMed  Google Scholar 

  44. Gupta, R. K., Kathuria, M. K. & Pradhan, S. Magnetisation transfer magnetic resonance imaging demonstration of perilesional gliosis—relation with epilepsy in treated or healed neurocysticercosis. Lancet 354, 44–45 (1999).

    CAS  PubMed  Google Scholar 

  45. Escobar, A. et al. The pathology of neurocysticercosis in Taenia Solium Cysticercosis: From Basic To Clinical Science Ch. 30 (eds Singh, G. & Prabhakar, S) 289–305 (Centre for Agricultural Bioscience International, Wallingford, 2002).

    Google Scholar 

  46. Henneberg, R. Die tierischen parasiten des zentralnervensystem in Handbuch der Neurologie Vol. 3 (ed. Lewandowsky, M) 643–712 (Springer, Berlin, 1912).

    Google Scholar 

  47. Rabiela-Cervantes, M. T. R. et al. Anatomopathological aspects of human brain cysticercosis in Cysticercosis: Present State of Knowledge and Perspectives (eds Flisser, A. et al) 179–200 (Academic, New York, 1982).

    Google Scholar 

  48. Marquez-Monter, H. Cysticercosis in Pathology of Protozoal and Helminthic Diseases (ed. Marcial-Rojas, R) 592–617 (Williams & Wilkins, Philadelphia, 1971).

    Google Scholar 

  49. Figueroa, J. J., Davis, L. E. & Magalhaes, A. Extraparenchymal neurocysticercosis in Albuquerque, New Mexico. J. Neuroimaging 21, 38–43 (2010).

    Google Scholar 

  50. Bandres, J. C., White, A. C. Jr, Samo, T. Murphy, E. C. & Harris, R. L. Extraparenchymal neurocysticercosis: report of five cases and review of management. Clin. Infect. Dis. 15, 799–811 (1992).

    CAS  PubMed  Google Scholar 

  51. Proano, J. V. et al. Medical treatment for neurocysticercosis characterized by giant subarachnoid cysts. N. Engl. J. Med. 345, 879–885 (2001).

    CAS  PubMed  Google Scholar 

  52. Bickerstaff, E. R., Cloake, P. C., Hughes, B. & Smith, W. T. The racemose form of cerebral cysticercosis. Brain 75, 1–16 (1952).

    CAS  PubMed  Google Scholar 

  53. Cardenas, G., Jung, H., Rios, C., Fleury, A. & Soto-Hernandez, J. L. Severe cysticercal meningitis: clinical and imaging characteristics. Am. J. Trop. Med. Hyg. 82, 121–125 (2010).

    PubMed  PubMed Central  Google Scholar 

  54. Canelas, H. M. Ricciardi-Cruz, O. & Escalante, O. A. Cysticercosis of the nervous system: less frequent clinical forms. III. Spinal cord forms. Arq. Neuropsiquiatr. 21, 77–86 (1963).

    CAS  PubMed  Google Scholar 

  55. Boulos, M. I., Aviv, R. I. & Lee, L. Spinal neurocysticercosis manifesting as recurrent aseptic meningitis. Can. J. Neurol. Sci. 37, 878–880 (2010).

    PubMed  Google Scholar 

  56. Del Brutto, O. H. et al. Proposed diagnostic criteria for neurocysticercosis. Neurology 57, 177–183 (2001).

    CAS  PubMed  Google Scholar 

  57. Schantz, P. M. et al. Neurocysticercosis in an Orthodox Jewish community in New York City. N. Engl. J. Med. 327, 692–695 (1992).

    CAS  PubMed  Google Scholar 

  58. Del Brutto, O. H. et al. Epilepsy due to neurocysticercosis: analysis of 203 patients. Neurology 42, 389–392 (1992).

    CAS  PubMed  Google Scholar 

  59. Cruz, M. E., Cruz, I., Preux, P. M., Schantz, P. & Dumas, M. Headache and cysticercosis in Ecuador, South America. Headache 35, 93–97 (1995).

    CAS  PubMed  Google Scholar 

  60. Ciampi de Andrade, D. et al. Cognitive impairment and dementia in neurocysticercosis: a cross-sectional controlled study. Neurology 74, 1288–1295 (2010).

    CAS  PubMed  Google Scholar 

  61. Garcia, H. H. & Del Brutto, O. H. Imaging findings in neurocysticercosis. Acta Trop. 87, 71–78 (2003).

    PubMed  Google Scholar 

  62. George, U., Bansal, G. & Rathore, S. MR spectroscopy aids diagnosis in subarachnoid space cysticercosis. Neurol. India 58, 957–958 (2010).

    PubMed  Google Scholar 

  63. Dumas, J. L. et al. Parenchymal neurocysticercosis: follow up and staging by MRI. Neuroradiology 39, 12–16 (1997).

    CAS  PubMed  Google Scholar 

  64. Wilson, M. et al. Clinical evaluation of the cysticercosis enzyme-linked immunoelectrotransfer blot in patients with neurocysticercosis. J. Infect. Dis. 164, 1007–1009 (1991).

    CAS  PubMed  Google Scholar 

  65. Scheel, C. M. et al. Serodiagnosis of neurocysticercosis using synthetic 8-kD proteins: comparison of assay formats. Am. J. Trop. Med. Hyg. 73, 771–776 (2005).

    CAS  PubMed  Google Scholar 

  66. Greene, R. M., Hancock, K., Wilkins, P. P. & Tsang, V. C. Taenia solium: molecular cloning and serologic evaluation of 14- and 18-kDa related, diagnostic antigens. J. Parasitol. 86, 1001–1007 (2000).

    CAS  PubMed  Google Scholar 

  67. Handali, S. et al. Porcine antibody responses to Taenia solium antigens rGp50 and sTs18var1. Am. J. Trop. Med. Hyg. 71, 322–326 (2004).

    PubMed  Google Scholar 

  68. Handali, S. et al. Development and evaluation of a magnetic immunochromatographic test to detect Taenia solium, which causes taeniasis and neurocysticercosis in humans. Clin. Vaccine Immunol. 17, 631–637 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Handali, S. et al. Multiantigen print immunoassay for comparison of diagnostic antigens for Taenia solium cysticercosis and taeniasis. Clin. Vaccine Immunol. 17, 68–72 (2010).

    CAS  PubMed  Google Scholar 

  70. Garcia, H. H. et al. Strategies for the elimination of taeniasis/cysticercosis. J. Neurol. Sci. 262, 153–157 (2007).

    PubMed  Google Scholar 

  71. Diaz, F. et al. Epidemiology of taeniasis and cysticercosis in a Peruvian village. The Cysticercosis Working Group in Peru. Am. J. Epidemiol. 135, 875–882 (1992).

    CAS  PubMed  Google Scholar 

  72. Diaz, J. F. et al. Immunodiagnosis of human cysticercosis (Taenia solium): a field comparison of an antibody-enzyme-linked immunosorbent assay (ELISA), an antigen-ELISA, and an enzyme-linked immunoelectrotransfer blot (EITB) assay in Peru. The Cysticercosis Working Group in Peru (CWG). Am. J. Trop. Med. Hyg. 46, 610–615 (1992).

    CAS  PubMed  Google Scholar 

  73. Rodriguez, S. et al. Detection of Taenia solium antigens and anti-T. solium antibodies in paired serum and cerebrospinal fluid samples from patients with intraparenchymal or extraparenchymal neurocysticercosis. J. Infect. Dis. 199, 1345–1352 (2009).

    PubMed  Google Scholar 

  74. Bobes, R. J. et al. Subarachnoidal and intraventricular human neurocysticercosis: application of an antigen detection assay for the diagnosis and follow-up. Trop. Med. Int. Health 11, 943–950 (2006).

    PubMed  Google Scholar 

  75. Zamora, H. et al. Drop in antigen levels following successful treatment of subarachnoid neurocysticercosis. Am. J. Trop. Med. Hyg. 73, S41 (2005).

    Google Scholar 

  76. Sinha, S. & Sharma, B. S. Neurocysticercosis: a review of current status and management. J. Clin. Neurosci. 16, 867–876 (2009).

    PubMed  Google Scholar 

  77. Garcia, H. H. et al. Current consensus guidelines for treatment of neurocysticercosis. Clin. Microbiol. Rev. 15, 747–756 (2002).

    PubMed  PubMed Central  Google Scholar 

  78. Singh, G. et al. A diagnostic and therapeutic scheme for a solitary cysticercus granuloma. Neurology 75, 2236–2245 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  79. Bittencourt, P. R. et al. Phenytoin and carbamazepine decrease oral bioavailability of praziquantel. Neurology 42, 492–495 (1992).

    CAS  PubMed  Google Scholar 

  80. Garcia, H. H. et al. Pharmacokinetics of combined treatment with praziquantel and albendazole in neurocysticercosis. Br. J. Clin. Pharmacol. 72, 77–84 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  81. Mall, R. K., Agarwal, A., Garg, R. K., Kar, A. M. & Shukla, R. Short course of prednisolone in Indian patients with solitary cysticercus granuloma and new-onset seizures. Epilepsia 44, 1397–1401 (2003).

    CAS  PubMed  Google Scholar 

  82. Mitre, E., Talaat, K. R., Sperling, M. R. & Nash, T. E. Methotrexate as a corticosteroid-sparing agent in complicated neurocysticercosis. Clin. Infect. Dis. 44, 549–553 (2007).

    CAS  PubMed  Google Scholar 

  83. Del Brutto, O. H., Roos, K. L., Coffey, C. S. & Garcia, H. H. Meta-analysis: cysticidal drugs for neurocysticercosis: albendazole and praziquantel. Ann. Intern. Med. 145, 43–51 (2006).

    CAS  PubMed  Google Scholar 

  84. Carpio, A., Santillian, F., Leon, P., Flores, C. & Hauser, W. A. Is the course of neurocysticercosis modified by treatment with antihelminthic agents? Arch. Intern. Med. 155, 1982–1988 (1995).

    CAS  PubMed  Google Scholar 

  85. Carpio, A. et al. Effects of albendazole treatment on neurocysticercosis: a randomised controlled trial. J. Neurol. Neurosurg. Psychiatry 79, 1050–1055 (2008).

    CAS  PubMed  Google Scholar 

  86. Gonzalez, A. E. et al. Time–response curve of oxfendazole in the treatment of swine cysticercosis. Am. J. Trop. Med. Hyg. 59, 832–836 (1998).

    CAS  PubMed  Google Scholar 

  87. Del Brutto, O. H. Medical treatment of cysticercosis—effective. Arch. Neurol. 52, 102–104 (1995).

    CAS  PubMed  Google Scholar 

  88. Garcia, H. H. et al. A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N. Engl. J. Med. 350, 249–258 (2004).

    CAS  PubMed  Google Scholar 

  89. Vazquez, V. & Sotelo, J. The course of seizures after treatment for cerebral cysticercosis. N. Engl. J. Med. 327, 696–701 (1992).

    CAS  PubMed  Google Scholar 

  90. Baranwal, A. K., Singhi, P. D., Khandelwal, N. & Singhi, S. C. Albendazole therapy in children with focal seizures and single small enhancing computerized tomographic lesions: a randomized, placebo-controlled, double blind trial. Pediatr. Infect. Dis. J. 17, 696–700 (1998).

    CAS  PubMed  Google Scholar 

  91. Kaur, M., Mahajan, R. C. & Malla, N. Diagnostic accuracy of rapid enzyme linked immunosorbent assay for the diagnosis of human hydatidosis. Indian J. Med. Res. 110, 18–21 (1999).

    CAS  PubMed  Google Scholar 

  92. Kaur, P., Jost, R., Sivasithamparam, K. & Barbetti, M. J. Comparison of 1 week versus 4 weeks of albendazole therapy in single small enhancing computed tomography lesion. Neurol. India 58, 560–564 (2010).

    PubMed  Google Scholar 

  93. Goel, D., Mittal, M., Bansal, K. K. & Singhal, A. Natural history of solitary cerebral cysticercosis cases after albendazole therapy: a longitudinal follow-up study from India. Acta Neurol. Scand. 121, 204–208 (2010).

    CAS  PubMed  Google Scholar 

  94. Padma, M. V., Behari, M. Misra, N. K. & Ahuja, G. K. Albendazole in single CT ring lesions in epilepsy. Neurology 44, 1344–1346 (1994).

    CAS  PubMed  Google Scholar 

  95. Rajshekhar, V. Albendazole therapy in patients with solitary cerebral cysticercus granuloma. Is it effective? J. Neurol. Neurosurg. Psychiatry 79, 238–239 (2008).

    PubMed  Google Scholar 

  96. Sotelo, J. et al. Comparison of therapeutic regimen of anticysticercal drugs for parenchymal brain cysticercosis. J. Neurol. 237, 69–72 (1990).

    CAS  PubMed  Google Scholar 

  97. Corona, T., Lugo, R., Medina, R. & Sotelo, J. Single-day praziquantel therapy for neurocysticercosis. N. Engl. J. Med. 334, 125 (1996).

    CAS  PubMed  Google Scholar 

  98. Pretell, E. J. et al. The Cysticercosis Working Group in Peru: failure of one-day praziquantel treatment in patients with multiple neurocysticercosis lesions. Clin. Neurol. Neurosurg. 103, 175–177 (2001).

    CAS  PubMed  Google Scholar 

  99. Castro, N. et al. Population pharmacokinetics of albendazole in patients with neurocysticercosis. Int. J. Clin. Pharmacol. Ther. 47, 679–685 (2009).

    CAS  PubMed  Google Scholar 

  100. Jung, H. & Gonzalez, D. Pharmacology of antycisticercal therapy in Taenia Solium Cysticercosis: from Basic to Clinical Science (eds Singh, G. & Prabhakar, S.) 363–374 (Centre for Agricultural Bioscience International, Wallingford, 2002).

    Google Scholar 

  101. Guo, D. M., Xie, S. P. & Jia, J. P. Therapeutic efficacy of praziquantel, albendazole and a combination of the two drugs in cysticercosis. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 21, 187–188 (2003).

    PubMed  Google Scholar 

  102. Kaur, S., Singhi, P. Singhi, S. & Khandewal, 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. 28 403–406 (2009).

    PubMed  Google Scholar 

  103. Bittencourt, P. R. et al. High-dose praziquantel for neurocysticercosis: efficacy and tolerability. Eur. Neurol. 30, 229–234 (1990).

    CAS  PubMed  Google Scholar 

  104. Bittencourt, P. R., Gracia, C. M., Gorz, A. M. & Oliveira, T. V. High-dose praziquantel for neurocysticercosis: serum and CSF concentrations. Acta Neurol. Scand. 82, 28–33 (1990).

    CAS  PubMed  Google Scholar 

  105. Overbosch, D. et al. Penetration of praziquantel into cerebrospinal fluid and cysticerci in human cysticercosis. Eur. J. Clin. Pharmacol. 33, 287–292 (1987).

    CAS  PubMed  Google Scholar 

  106. Yee, T., Barakos, J. A. & Knight, R. T. High-dose praziquantel with cimetidine for refractory neurocysticercosis: a case report with clinical and MRI follow-up. West. J. Med. 170, 112–115 (1999).

    CAS  PubMed  PubMed Central  Google Scholar 

  107. Lima, R. M. et al. Albendazole–praziquantel interaction in healthy volunteers: kinetic disposition, metabolism and enantioselectivity. Br. J. Clin. Pharmacol. 71, 528–535 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  108. Agapejev, S., Da Silva, M. D. & Ueda, A. K. Severe forms of neurocysticercosis: treatment with albendazole. Arq. Neuropsiquiatr. 54, 82–93 (1996).

    CAS  PubMed  Google Scholar 

  109. Cardenas, G. et al. Subarachnoidal neurocysticercosis non-responsive to cysticidal drugs: a case series. BMC Neurol. 10, 16 (2010).

    PubMed  PubMed Central  Google Scholar 

  110. Gongora-Rivera, F. et al. Albendazole trial at 15 or 30 mg/kg/day for subarachnoid and intraventricular cysticercosis. Neurology 66, 436–438 (2006).

    CAS  PubMed  Google Scholar 

  111. Rajshekhar, V. Surgical management of neurocysticercosis. Int. J. Surg. 8, 100–104 (2010).

    PubMed  Google Scholar 

  112. Torres-Corzo, J. G. et al. Endoscopic management of hydrocephalus due to neurocysticercosis. Clin. Neurol. Neurosurg. 112, 11–16 (2010).

    PubMed  Google Scholar 

  113. Jimenez-Vazquez, O. H. & Nagore, N. Cisternal neurocysticercosis. Br. J. Neurosurg. 22, 774–775 (2008).

    CAS  PubMed  Google Scholar 

  114. Jimenez-Vazquez, O. H. & Nagore, N. Role of neuroendoscopy in the treatment of large viable cysticerci in the brain parenchyma. Br. J. Neurosurg. 22, 682–683 (2008).

    CAS  PubMed  Google Scholar 

  115. Bergsneider, M. Endoscopic removal of cysticercal cysts within the fourth ventricle. Technical note. J. Neurosurg. 91, 340–345 (1999).

    CAS  PubMed  Google Scholar 

  116. Bergsneider, M., Holly, L. T., Lee, J. H., King, W. A. & Frazee, J. G. Endoscopic management of cysticercal cysts within the lateral and third ventricles. J. Neurosurg. 92, 14–23 (2000).

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported in part by the Intramural Research Program of the National Institutes of Health, National Institutes of Allergy and Infection Diseases. H. H. Garcia is a Wellcome Trust International Senior Research Fellow.

Author information

Authors and Affiliations

  1. Gastrointestinal Parasites Section, Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Building 4, Room B1-01, Bethesda, 20892, MD, USA

    Theodore E. Nash

  2. Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Jr Ancash 1271, Lima, Perú

    Hector H. Garcia

Authors
  1. Theodore E. Nash
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hector H. Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

T. E. Nash and H. H. Garcia contibuted equally to researching the data for the article, discussion of the article content, writing the article and reviewing and/or editing the manuscript before submission.

Corresponding author

Correspondence to Hector H. Garcia.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nash, T., Garcia, H. Diagnosis and treatment of neurocysticercosis. Nat Rev Neurol 7, 584–594 (2011). https://doi.org/10.1038/nrneurol.2011.135

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrneurol.2011.135

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing