A Proposal for Classification of Neurocysticercosis

Neurology: Clinical Practice, 2013

Neurocysticercosis is the most common parasitic brain disease worldwide. Its clinical heterogeneity is related to localization, number and stage of evolution of the parasites, sex, age, and intensity of the host brain inflammatory reaction. In addition to the localization of the parasite, inflammation is the main phenomenon responsible of symptomatology. Acute symptomatic seizures are the most common symptom in patients with parenchymal parasites, but most do not evolve into epilepsy. Neurocysticercosis diagnosis is based mainly on neuroimaging. New imaging techniques have improved detection of the scolex and visualization of cysts in the extraparenchymal spaces. Immunologic testing can be useful, particularly when imaging is equivocal. Based on disappearance of parasites, antihelminthic drugs as currently used are effective in approximately one-third of patients with parenchymal viable cysts.

Medical Journal Armed Forces India, 1998

Neurocysticercosis is the most common parasitic disease affecting the human central nervous system, with protean clinical manifestations. During the last 17 years, 153 cases of neurocysticercosis were histopathologically diagnosed on surgically resected and autopsied material. Variable number of cysts, from a solitary one to multiple were found invading different parts of the neuraxis (118 cases). These cestode larval forms had a prediliction for locating in the cerebral grey matter (98 cases), followed by subcortical nuclear area (12), cerebral ventricles and subarachnoid cisterns (26 cases). Patients harbouring parenchymal cysts manifested predominantly with seizures and encephalitis (113 cases) whereas those with ventricular and/or cisternal cysts presented with features of chronic meningitis and hydrocephalus. The unusual clinical presentations were psychiatric symptoms with behavioural abnormalities and stroke in the young as a result of cysticercal meningitis with associated arteritis. Primary cysticercal abscess in the brain parenchyma was an interesting pathological feature noted in 3 cases. In the endemic areas, the coexistence of neurocysticercosis appears to enhance the morbidity and mortality due to Japanese encephalitis (31 cases). The surface glycoprotein of the cysticercal cyst has been identified to be the antigenic component to which the host immune system responds by forming antibody in the CSF.

Neurosurgical Focus, 2002

In the neurosurgical services in many developing countries, treatment of neurocysticercosis (NCC) accounts for greater than 10% of brain surgical procedures and approximately 15% of neurological consultations. In these areas brain cysticercosis is the leading cause of hydrocephalus in adults and the first cause of late-onset epilepsy. During the last two decades, successful medical treatment has been established. Additionally, neuroimaging and immunological studies have clearly defined the topography, pathophysiological mechanisms, and biological status of these lesions. Thus, selection of cases for medical or surgical treatment has improved; in a significant number of cases, both interventions are required. New therapies with either albendazole or praziquantel have respectively reduced to 8 days and to 1 day the course of anticysticidal therapy, which now is fast, effective, inexpensive, atoxic, and convenient, particularly in endemic areas where most patients belong to the lower s...

Neurology, 2002

Neurocysticercosis is the most common helminthic infection of the CNS but its diagnosis remains difficult. Clinical manifestations are nonspecific, most neuroimaging findings are not pathognomonic, and some serologic tests have low sensitivity and specificity. The authors provide diagnostic criteria for neurocysticercosis based on objective clinical, imaging, immunologic, and epidemiologic data. These include four categories of criteria stratified on the basis of their diagnostic strength, including the following: 1) absolute-histologic demonstration of the parasite from biopsy of a brain or spinal cord lesion, cystic lesions showing the scolex on CT or MRI, and direct visualization of subretinal parasites by funduscopic examination; 2) major-lesions highly suggestive of neurocysticercosis on neuroimaging studies, positive serum enzyme-linked immunoelectrotransfer blot for the detection of anticysticercal antibodies, resolution of intracranial cystic lesions after therapy with albendazole or praziquantel, and spontaneous resolution of small single enhancing lesions; 3) minor-lesions compatible with neurocysticercosis on neuroimaging studies, clinical manifestations suggestive of neurocysticercosis, positive CSF enzyme-linked immunosorbent assay for detection of anticysticercal antibodies or cysticercal antigens, and cysticercosis outside the CNS; and 4) epidemiologic-evidence of a household contact with Taenia solium infection, individuals coming from or living in an area where cysticercosis is endemic, and history of frequent travel to disease-endemic areas. Interpretation of these criteria permits two degrees of diagnostic certainty: 1) definitive diagnosis, in patients who have one

Expert review of neurotherapeutics, 2018

Neurocysticercosis (NC) is a neglected disease that contributes substantially to neurological morbidity/mortality in lower-income countries and increasingly among high-income countries due to migration. Many advances have been made in understanding NC, but unanswered questions remain Areas covered: This review discusses the epidemiology, pathophysiology, immunology, diagnosis, treatment, and eradication of NC. Expert commentary: The global NC prevalence remains unknown and needs proper ascertainment. Further understanding of the pathophysiology of extraparenchymally located cysts is needed to improve management. The role of inflammation, which is required for parasite death and reabsorption, but may lead to severe complications, must be better understood. Valid screening tools including immunological and molecular tests need to be developed to reduce the reliance on neuroimaging which is not usually accessible in endemic areas. Prognosis for people with parenchymal NC is generally g...

2013

Neurocysticercosis, the infection of central nervous system caused by the larval form of the tapeworm Taenia solium, is the most common parasitic disease of the central nervous system and the most common cause of acquired epilepsy worldwide .Neurocysticercosis (NCC) is infestation of human central nervous system with tissue cysts of pork tapeworm.Human beings acquire cysticercosis through faecaloral contamination or poor hygiene practices . Clinical presentation of NCC can be variable. This has primarily been a disease that remains endemic in southIndia(India).It is a disease of low-socioeconomic countries but increasing trend seen towards developed nations due to migration . Seizures are the commonest presentation of NCC [50-80%] (1,2). Various types of seizures have been described among patients with NCC including generalized, focal and rarely myoclonus and acquired epileptic aphasia. In general, it seems that about half the cases have partial seizures and the other half generaliz...

Current Opinion in Infectious Diseases, 2011

Purpose of review-Taenia solium neurocysticercosis has been long recognized as an important cause of neurological morbidity in most of the world. Unwarranted generalization of diagnostic and treatment recommendations made it difficult to assess individual prognosis and responses for each type of NCC. Understanding of the main clinical presentations (dependent on number, location, size and stage of parasites, as well as on the immune response of the host) allows a better view of treatment options and expected outcomes. Recent findings-Current treatment options are still limited and involve symptomatic agents, antiparasitic agents or surgery. The importance of adequate symptomatic management, the potential for improved antiparasitic treatment regimes, in particular combination therapy, and the increasingly important role of minimally invasive neurosurgery are also revised in this manuscript. -Treatment decisions in NCC should be individualized in relation to the type of NCC. Initial measures should focus on symptomatic management to later consider antiparasitic therapy when appropriate. Appropiate patient categorization, new antiparasitic regimes and minimally invasive surgery are improving the prognosis of patients with NCC.

International Journal of Current Research and Academic Review, 2017

Article Info Neurocysticercosis (NCC) is a major cause of neurological morbidity in the world. The diagnosis of NCC is challenging in endemic and resource-limited countries where laboratory and imaging techniques are not available. Clinical manifestations are nonspecific, most neuroimaging findings are non-pathognomonic, and some serologic tests have low sensitivity or specificity. The treatment of the NCC includes cysticidal drugs (e.g., albendazole and praziquantel), and neurosurgical procedure, depending upon the situation. Currently, there are several diagnostic and management issues which remain unresolved. This review will help to look the recently going diagnostic procedures and the medical management of the disease.

Research and Reports in Tropical Medicine, 2021

Neurocysticercosis (NCC) causes significant neurological morbidity around the world, and is the most common preventable factor for epilepsy in adults. It is endemic in most developing countries, and also diagnosed with some frequency in industrialized countries because of travel and migration. The clinical manifestations of NCC are extremely variable and may include almost any neurological symptom, depending on the number of lesions, location, size and evolutive stage of the infecting parasitic larvae and the immune response of the host. Thus, the diagnosis of NCC relies mostly on neuroimaging and immunological tests. Despite being a disease with a known etiology, the lack of specificity of clinical manifestations and auxiliary examinations makes its diagnosis difficult. In an attempt for developing a standard diagnosis approach, a chart of diagnostic criteria for NCC was initially published in 1996, and revised in 2001 and 2017. This chart of diagnostic criteria systematized the di...

The Lancet Neurology, 2005