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have shown that corticosteroids alone are as effective as specific therapy plus corticosteroids for controlling seizures, and some reports have shown exacerbation of disease after antihelminthic therapy Considering active lesions, disease with a high likelihood of progression, such as intraventricular cysts, may benefit from therapy At the other end of the spectrum, inactive calcified lesions probably do not benefit from therapy Overall, it remains difficult to determine when treatment is indicated When treatment is deemed appropriate, standard therapy consists of albendazole (10 15 mg/kg/d for 8 days) or praziquantel (50 mg/kg/d for 15 30 days) Albendazole is probably the preferred therapy, as corticosteroids appear to lower circulating praziquantel levels, but increase albendazole levels Increasing the dosage of albendazole to 30 mg/kg/d may improve outcomes Corticosteroids are usually administered concurrently but dosing is not standardized Patients should be observed for evidence of localized inflammatory responses Anticonvulsant therapy is provided if needed, and shunting is performed if required for elevated intracranial pressure Surgical removal of cysts may be helpful for some difficult cases of neurocysticercosis and for symptomatic non-neurologic disease



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Del Brutto OH et al Meta-analysis: Cysticidal drugs for neurocysticercosis: albendazole and praziquantel Ann Intern Med 2006 Jul 4;145(1):43 51 [PMID: 16818928] Garcia HH et al; Cysticercosis Working Group in Peru Neurocysticercosis: updated concepts about an old disease Lancet Neurol 2005 Oct;4(10):653 61 [PMID: 16168934] Garcia HH et al New concepts in the diagnosis and management of neurocysticercosis (Taenia solium) Am J Trop Med Hyg 2005 Jan;72(1):3 9 [PMID: 15728858] Gongora-Rivera F et al Albendazole trial at 15 or 30 mg/kg/day for subarachnoid and intraventricular cysticercosis Neurology 2006 Feb 14;66(3):436 8 [PMID: 16382035] Hawk MW et al Neurocysticercosis: a review Surg Neurol 2005 Feb;63(2):123 32 [PMID: 15680651] Nash TE et al Treatment of neurocysticercosis: current status and future research needs Neurology 2006 Oct 10;67(7):1120 7 [PMID: 17030744] Yancey LS et al Cysticercosis: recent advances in diagnosis and management of neurocysticercosis Curr Infect Dis Rep 2005 Jan;7(1):39 47 [PMID: 15610670]

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Cysticercosis is due to tissue infection with cysts of T solium that develop after humans ingest food contaminated with eggs from human feces, thus acting as an intermediate host for the parasite Prevalence is high where the parasite is endemic, in particular Mexico, Central and South America, the Philippines, and Southeast Asia An estimated 20 million persons are infected with cysticerci yearly, leading to about 400,000 persons with neurologic symptoms and 50,000 deaths Antibody prevalence rates up to 10% are recognized in some endemic areas, and the infection is one of the most important causes of seizures in the developing world and in immigrants to the United States from endemic countries

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Neurocysticercosis can cause intracerebral, subarachnoid, and spinal cord lesions and intraventricular cysts Single or multiple lesions may be present Lesions may persist for years before symptoms develop, generally due to local inflammation or ventricular obstruction Presenting symptoms include seizures, focal neurologic deficits, altered cognition, and psychiatric disease Symptoms develop more quickly with intraventricular cysts, with findings of hydrocephalus and meningeal irritation, including severe headache, vomiting, papilledema, and visual loss A particularly aggressive form of the disease, racemose cysticercosis, involves proliferation of cysts at the base of the brain, leading to alterations of consciousness and death Spinal cord lesions can present with progressive focal findings Cysticercosis of other organ systems is usually clinically benign Involvement of muscles can uncommonly cause discomfort and is identified by radiographs of muscle showing multiple calcified lesions Subcutaneous involvement presents with multiple painless palpable skin lesions Involvement of the eyes can present with ptosis due to extraocular muscle involvement or intraocular abnormalities

CSF examination may show lymphocytic or eosinophilic pleocytosis, decreased glucose, and elevated protein Serologic tests can indicate prior exposure to T solium, but both sensitivity and specificity are limited

The diagnosis of neurocysticercosis can be difficult With neuroimaging by CT or MRI, multiple parenchymal cysts are most typically seen Parenchymal calcification is also common Ventricular cysts may be difficult to visualize, with MRI offering better sensitivity than CT

History of exposure to dogs or wild canines in an endemic area Large cystic lesions, most commonly of the liver or lung Positive serologic tests

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The medical management of neurocysticercosis is controversial, as the benefits of cyst clearance must be weighed against potential harm of an inflammatory response to dying worms Antihelminthic therapy hastens radiologic improvement in parenchymal cysticercosis However, some randomized trials

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