What emergency care is indicated in the treatment of cysticercosis (tapeworm infestation)?

Updated: Apr 15, 2021
  • Author: Lisandro Irizarry, MD, MBA, MPH, FACEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

In neurocysticercosis, neurologic manifestations indicate the need for antihelminthic agents and antiepileptics. The recommended antihelminthic agent is albendazole. In a meta-analysis of comparative trials, albendazole provides better seizure control and resolution of cysts or granuloma as compared with praziquantel. [14, 15] In trials of nonviable lesions, seizure recurrence is substantially lower with albendazole. [16]

Antihelminthic treatment may provoke an inflammatory response in the central nervous system. Steroids affect this inflammatory response and may influence outcomes such as headache, but further research is needed to test this. [16]

Effectiveness of therapy can be monitored via radiographic imaging. The size of the active lesions should decrease within 3-6 months.

Neurosurgical interventions should be considered for patients with mass effect, cerebral spinal fluid obstruction, and fourth ventricular cysts. [17] Endoscopic approaches provide better outcomes than the traditional open approaches for intraventricular neurocysticercosis with hydrocephalus. [17] Among patients who had undergone surgical resection of a single intraventricular lesion, those who received postoperative antihelminthic therapy, most commonly albendazole, had significantly lower risk of developing delayed hydrocephalus. [18]


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