Optimal Treatment for Subarachnoid Neurocysticercosis: Closer, but Not There yet

White, A. Clinton; Fleury, Agnès

doi:10.4269/ajtmh.19-0754

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…The high rate of recurrences despite total cyst degeneration but with persisting CSF abnormalities suggest use of MRI as a sole indicator of treatment efficacy is often misleading (32). Although it has been suggested repeated short courses of treatment are effective and lead to inactive disease (33) there are no published reports of long-term follow up and clinical outcomes. Many patients with SUBNCC referred for treatment give a history of repeated failed courses of treatment of 8-30 days duration (11) suggesting prolonged treatment courses are required to prevent parasite regrowth and recurrence.…”

Section: Prolonged Treatments Lead To Excellent Clinical Outcomesmentioning

confidence: 99%

Subarachnoid neurocysticercosis: emerging concepts and treatment

Nash

O’Connell

2020

Current Opinion in Infectious Diseases

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Purpose of review: Subarachnoid neurocysticercosis (SUBNCC) is due to a morphologically unique proliferative form of Taenia solium involving the subarachnoid spaces. Prolonged therapy based upon the pathophysiology of SUBNCC and long-term follow-up have shed light on the course of disease and led to highly improved outcomes.Recent findings: SUBNCC has a prolonged incubation period of between 10-25 years characterized by cyst proliferation and growth and invasion of contiguous spaces leading to mass effect(Stage 1). With induction of the host immune responses cysts degenerate leading to a predominately inflammatory arachnoiditis(Stage 2) causing hydrocephalus, infarcts and other inflammatory based neurological manifestations. Inactive disease(Stage 3) may occur naturally but mostly is a result of successful treatment, which generally requires prolonged intensive anthelminthic and anti-inflammatory treatments. CSF cestode antigen or cestode DNA falling to non-detectable levels predicts effective treatment. Prolonged treatment with extended follow-up has resulted in moderate disability and no mortality. Repeated short intensive 8-14-day courses of treatment are also used, but long-term outcomes and safety using this strategy are not reported.Summary: SUBNCC gives rise to a chronic arachnoiditis. Its unique ability to proliferate and induce inflammatory responses requires long-term anthelmintic and anti-inflammatory medications.

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Section: Prolonged Treatments Lead To Excellent Clinical Outcomesmentioning

confidence: 99%

Subarachnoid neurocysticercosis: emerging concepts and treatment

Nash

O’Connell

2020

Current Opinion in Infectious Diseases

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“…Patients respond poorly to regimens used for parenchymal NCC. Proposed alternative regimens include prolonged courses of albendazole, cycles of standard dose or higher dose albendazole (30 mg/kg/day), and combination of albendazole and praziquantel with no data comparing regimens [12 ▪▪ ,49,50]. The association of higher dose albendazole with increased rate of calcification in parenchymal disease suggests that it is not the preferred option [6].…”

Section: Treatment Approachmentioning

confidence: 99%

Neurocysticercosis: an update on diagnosis, treatment, and prevention

Pineda-Reyes

White

2022

Current Opinion in Infectious Diseases

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Neurocysticercosis (NCC) is an important cause of neurological disease worldwide, including imported cases in nonendemic countries.Purpose of reviewThe purpose of this review is to update information on diagnosis, management, and prevention of neurocysticercosisRecent findingsWHO and Infectious Diseases Society of America/American Society of Tropical Medicine and Hygiene guidelines emphasize the importance of corticosteroids and antiparasitic drugs for viable parenchymal disease and single enhancing lesions. Subarachnoid NCC is associated with a high fatality rate unless optimally treated. Advances in subarachnoid NCC include use of prolonged antiparasitic and anti-inflammatory courses and the increasing use of antigen-detection and quantitative PCR assays in diagnosis and follow-up. Emerging data support the safety and efficacy of minimally invasive surgery in ventricular cases. Calcified neurocysticercosis continues to be associated with a high burden of disease. Field studies are demonstrating the feasibility of eradication using a combination of mass chemotherapy for human tapeworms and vaccination/treatment of porcine cysticercosis.SummaryNCC remains an important and challenging cause of neurological disease with significant morbidity despite advances in treatment and prevention.

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