Neurocysticercosis: A Treatable Cause of Epilepsy

Epilepsy Notes

Andrew N. Wilner, MD


September 06, 2013

In This Article

New Guidelines: Treatment of Parenchymal Neurocysticercosis

The American Academy of Neurology (AAN) recently published evidence-based guidelines[1] on the treatment of parenchymal neurocysticercosis. According to the AAN guideline, neurocysticercosis is responsible for approximately 2 million cases of epilepsy worldwide and is "the most common preventable cause of epilepsy in the developing world."

A Successful Parasite

Neurocysticercosis is an infection of the brain or spinal cord caused by Taeniasolium, the pork tapeworm. It is the most common parasitic disease of the central nervous system.[2] People become infected when they eat food, such as undercooked pork, infected with larval tapeworms (cysticerci). Alternatively, people who harbor adult tapeworms in their intestines may excrete tapeworm eggs in their feces, and other people may become infected by the fecal-oral route as a result of poor hygiene. (People can also reinfect themselves by this route.) Most carriers are unaware of their infection.[3] Infection with neurocysticercosis can be reduced and even eradicated by education about cooking and improved sanitary practices.

Clinical Manifestations of Neurocysticercosis

Neurocysticercosis often results in seizures. Whether the cyst is alive or dead and the number of brain cysts may be important prognostic factors.[4] Besides the central nervous system, other parts of the body may be affected by cysticercosis. Tapeworm embryos can spread from the intestine through the hepatoportal circulation to virtually any organ.[5] Patients can present with skin nodules. Cysticercosis of the muscles can cause pseudohypertrophy, resulting in a "Herculean" appearance. The most common areas of infection are the subcutaneous tissues, skeletal muscles, lungs, brain, eyes, and liver, and less commonly the heart, thyroid, and pancreas.[5]


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