Recent developments in the epidemiology, diagnosis, treatment, and prevention of neurocysticercosis

Neuroimaging studies have revealed that neurocysticercosis is a major cause of neurologic disease in most developing countries and is an emerging disease in industrialized areas. Patients with neurocysticercosis present mainly with seizures (parenchymal form) or intracranial hypertension (ventricular/subarachnoid forms). Management should be based on a thorough understanding of the pathogenesis and natural history of infection. Symptoms of active parenchymal neurocysticercosis result from the host inflammatory response to the dying metacestode form. Careful use of anticonvulsants will result in an excellent clinical outcome. The anthelminthic drugs albendazole and praziquantel are effective in killing the cysts, but their long-term effect on prognosis is unproven. Patients with obstructive hydrocephalus from ventricular cysts should be managed surgically by cerebrospinal fluid diversion or cyst removal. Treatment with antiparasitic drugs (especially albendazole) and corticosteroids may decrease the incidence of shunt failure. Current efforts at control of the disease include mass human or porcine chemotherapy in endemic zones and vaccination.