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Clinical Microbiology Reviews, October 2002, p. 747-756, Vol. 15, No. 4
0893-8512/02/$04.00+0     DOI: 10.1128/CMR.15.4.747-756.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Current Consensus Guidelines for Treatment of Neurocysticercosis

Hector H. García,1,2* Carlton A. W. Evans,3,4 Theodore E. Nash,5 Osvaldo M. Takayanagui,6 A. Clinton White Jr.,7 David Botero,8 Vedantam Rajshekhar,9 Victor C. W. Tsang,10 Peter M. Schantz,10 James C. Allan,11 Ana Flisser,12 Dolores Correa,13 Elsa Sarti,14 Jon S. Friedland,4 S. Manuel Martinez,1 Armando E. Gonzalez,15 Robert H. Gilman,1,2,16 and Oscar H. Del Brutto17

Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas,1 Departments of Microbiology and Pathology, Universidad Peruana Cayetano Heredia,2 School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru,15 University of Cambridge Clinical School, Cambridge,3 Imperial College of Science, Technology and Medicine,4 Department of Biological Sciences, University of Salford, and Pfizer Inc., Sandwich, United Kingdom,11 Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda,5 Department of International Health, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland,16 Department of Neurology, School of Medicine of Ribeirao Preto, Universidade de Sao Paulo, Ribeirão Preto, Brazil,6 Infectious Disease Section, Department of Medicine, Baylor College of Medicine, Houston, Texas,7 Instituto Colombiano de Medicina Tropical, Medellín, Colombia,8 Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, India,9 Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia,10 School of Medicine, Universidad Nacional Autonoma de Mexico,12 Instituto Nacional de Pediatria, Secretaría de Salud,13 Instituto Nacional de Diagnóstico y Referencia Epidemiológicos, Secretaría de Salud, Mexico D.F., Mexico,14 Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador,17

Taenia solium neurocysticercosis is a common cause of epileptic seizures and other neurological morbidity in most developing countries. It is also an increasingly common diagnosis in industrialized countries because of immigration from areas where it is endemic. Its clinical manifestations are highly variable and depend on the number, stage, and size of the lesions and the host's immune response. In part due to this variability, major discrepancies exist in the treatment of neurocysticercosis. A panel of experts in taeniasis/cysticercosis discussed the evidence on treatment of neurocysticercosis for each clinical presentation, and we present the panel's consensus and areas of disagreement. Overall, four general recommendations were made: (i) individualize therapeutic decisions, including whether to use antiparasitic drugs, based on the number, location, and viability of the parasites within the nervous system; (ii) actively manage growing cysticerci either with antiparasitic drugs or surgical excision; (iii) prioritize the management of intracranial hypertension secondary to neurocysticercosis before considering any other form of therapy; and (iv) manage seizures as done for seizures due to other causes of secondary seizures (remote symptomatic seizures) because they are due to an organic focus that has been present for a long time.

* Corresponding author. Mailing address: Cysticercosis Unit, Instituto de Ciencias Neurológicas, Jr. Ancash 1271, Barrios Altos, Lima 1, Peru. Phone: 511 3287360. Fax: 511 3287382. E-mail: hgarcia{at}terra.com.pe.

Clinical Microbiology Reviews, October 2002, p. 747-756, Vol. 15, No. 4
0893-8512/02/$04.00+0     DOI: 10.1128/CMR.15.4.747-756.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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