Neurocysticercosis: A Treatable Cause of Epilepsy
Neurocysticercosis: A Treatable Cause of Epilepsy
People with epilepsy caused by neurocysticercosis are typically treated with antiepileptic drugs to achieve seizure control. However, the treatment of the neurocysticercosis infection itself is not that straightforward. Brain cysts that are calcified represent dead parasites and do not need cysticidal drugs. On the other hand, pharmacologic treatment of living cysts can result in severe reactions, cyst enlargement, edema, and generalized anaphylaxis. In severe cases, increased seizures and death can result directly from treatment in patients who were otherwise functioning reasonably well.
After analysis of 123 pertinent articles, the AAN guideline committee recommended antihelminthic treatment with albendazole to reduce the number of brain cysts and help control seizures (Level B) (Table). Dexamethasone or prednisolone should be added to prevent brain edema. There was insufficient evidence to recommend steroid treatment alone (Level U).
Table. American Academy of Neurology Recommendation Levels
In exceptional cases, 1 convincing Class I study may suffice for an "A" recommendation if (1) all criteria are met; and (2) the magnitude of effect is large (relative rate improved outcome > 5 and lower limit of confidence interval > 2).
Neurocysticercosis, a common cause of epilepsy in the developing world, is potentially preventable with improved public health measures. US clinicians are likely to see an increasing number of cases as a result of immigration and foreign travel. Patients with neurocysticercosis may need to be treated for seizures and considered for antihelminthic therapy with albendazole and steroids. Adverse treatment reactions are possible.
Treatment of Neurocysticercosis
People with epilepsy caused by neurocysticercosis are typically treated with antiepileptic drugs to achieve seizure control. However, the treatment of the neurocysticercosis infection itself is not that straightforward. Brain cysts that are calcified represent dead parasites and do not need cysticidal drugs. On the other hand, pharmacologic treatment of living cysts can result in severe reactions, cyst enlargement, edema, and generalized anaphylaxis. In severe cases, increased seizures and death can result directly from treatment in patients who were otherwise functioning reasonably well.
AAN Recommendations
After analysis of 123 pertinent articles, the AAN guideline committee recommended antihelminthic treatment with albendazole to reduce the number of brain cysts and help control seizures (Level B) (Table). Dexamethasone or prednisolone should be added to prevent brain edema. There was insufficient evidence to recommend steroid treatment alone (Level U).
Table. American Academy of Neurology Recommendation Levels
| Level | Evidence |
| A | Established as effective, ineffective, or harmful (or established as useful/predictive or not useful/predictive) for the given condition in the specified population. (Level A rating requires at least 2 consistent Class I studies.) |
| B | Probably effective, ineffective, or harmful (or probably useful/predictive or not useful/predictive) for the given condition in the specified population. (Level B rating requires at least 1 Class I study or 2 consistent Class II studies.) |
| C | Possibly effective, ineffective, or harmful (or possibly useful/predictive or not useful/predictive) for the given condition in the specified population. (Level C rating requires at least 1 Class II study or 2 consistent Class III studies.) |
| U | Data inadequate or conflicting; given current knowledge, treatment (test, predictor) is unproven. |
In exceptional cases, 1 convincing Class I study may suffice for an "A" recommendation if (1) all criteria are met; and (2) the magnitude of effect is large (relative rate improved outcome > 5 and lower limit of confidence interval > 2).
Conclusions
Neurocysticercosis, a common cause of epilepsy in the developing world, is potentially preventable with improved public health measures. US clinicians are likely to see an increasing number of cases as a result of immigration and foreign travel. Patients with neurocysticercosis may need to be treated for seizures and considered for antihelminthic therapy with albendazole and steroids. Adverse treatment reactions are possible.
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