TABLE 4.

Guidelines for use of antiparasitic treatment in neurocysticercosisa

TypeInfection burdenRecommendationsEvidence
Parenchymal neurocysticercosis
    Viable (live cysts)Mild (1 to 5 cysts)(a) Antiparasitic treatment, with steroidsII-3
(b) Antiparasitic treatment; steroids used only if side effects related to therapy appearII-3
(c) No antiparasitic treatment; neuroimaging follow-upII-3
Moderate (more than 5 cysts)Consensus: antiparasitic treatment with steroidsII-3
Heavy (more than 100 cysts)(a) Antiparasitic treatment with high-dose steroidsIII
(b) Chronic steroid management; no antiparasitic treatment; neuroimaging follow-upIII
    Enhancing lesions (degenerating cysts)Mild or moderate(a) No antiparasitic treatment; neuroimaging follow-upI
(b) Antiparasitic treatment with steroidsII-3
(c) Antiparasitic treatment; steroids only if side effects developII-3
Heavy (cysticercotic encephalitis)Consensus: no antiparasitic treatment; high-dose steroids and osmotic diureticsIII
    Calcified cysticerciAny numberConsensus: no antiparasitic treatment
Extraparenchymal neurocysticercosis
    Ventricular cysticercosisConsensus: neuroendoscopic removal, when available. If not available:III
(a) CSF diversion followed by antiparasitic treatment, with steroidsIII
(b) open surgery (mainly for ventricle cysts)III
    Subarachnoid cysts, including giant cysts or racemose cysticercosis, and chronic meningitisConsensus: antiparasitic treatment with steroids, ventricular shunt if there is hydrocephalusII-3
    Hydrocephalus with no visible cysts on neuroimagingConsensus: ventricular shunt; no antiparasitic treatmentIII
Spinal cysticercosis, intra- or extramedullarybConsensus: primarily surgical; anecdotal reports of successful use of albendazole with steroidsIII
Ophthalmic cysticercosisbConsensus: surgical resection of cystscII-3
  • a Levels of recommendations (a, b, and c) and quality of evidence (101) are defined in the text.

  • b Given the rarity of these presentations, treatment was discussed based on the published literature (22, 27).

  • c Experience in the use of albendazole with methylprednisolone for treatment of retinal cysticercosis and as a presurgical treatment for intravitreal cysticercosis has been published (7) but not yet replicated.