Helminthic infections - Neurocysticercosis (NCC)

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NCC  is  a  neurologic  infection  caused  by  the  larval  stage  of  the  tapeworm  Taenia  solium.  In  the  developing world NCC is the most common cause of new onset acquired epilepsy among the adult population. Humans are the definitive hosts for this parasite, and swine are the intermediate hosts. The mature tapeworm develops in humans after they ingest live cysticercus in undercooked pork.  NCC develops when humans accidentally ingest eggs from fecal contaminated food.  

Clinical presentation 

  • Headache
  • Seizures
  • Focal neurological deficit
  • Features of increased intracranial pressure

Imaging Investigations 

  • Contrast head CT scan - can demonstrate ring enhancing lesions, calcified lesions
  • Contrast brain MRI can demonstrate viable cystic lesions with scolices

Laboratory Investigations 

  • FBP, serum electrolytes
  • Enzyme-linked immunotransfer blot (EITB)
  • Liver function tests

Non-pharmacological Treatment 

  • If unconscious, airway and breathing management
  • Insert NGT for feeding
  • Insert urethral catheter

Pharmacological Treatment 

Table 8.3: Pharmacological Management of NCC 

Condition 

Treatment 

Duration 

Antihelminthic  treatment for single viable lesion 

A: albendazole (PO) 15mg/kg/day divided into two daily doses (maximum of 1200mg/day) 

 2-4 weeks

Anthelminthic treatment for multiple viable 
lesions 

A: albendazole (PO) 15mg/kg/day divided in two daily doses (maximum of 1200mg/day) 

AND 

A: praziquantel (PO) (50mg/kg/day) 

2-4 weeks

 

 

2 weeks

Seizures control 

C: phenytoin (IV) 15mg/kg loading dose infused at 50mg/min followed by 100mg (IV/PO) 8hourly 

OR 

A: carbamazepine (PO) 200mg 12hourly (can be adjusted  based on individual response) 

OR 

C: sodium valproate (PO) 250mg 12hourly (escalate dose as required based on response) 

Until seizure free for at least 6  months 

Control of increased ICP 

D: dexamethasone (PO) 0.15mg/kg 6 hourly for 3-5days then taper down 

OR 

B: dexamethasone (IV) 0.15mg/kg 6 hourly for 3-5days 
then taper down 

2weeks 

Note: Fundoscopic examination is mandatory for all patients before initiation of anthelminthic therapy. 

Surgical management 

  • Refer all patients diagnosed with CNS cysticercosis associated with clinical or radiological features of increased intracranial pressure from hydrocephalus for neurosurgical evaluation directed at management of the associated hydrocephalus
  • In patients with untreated hydrocephalus or diffuse cerebral edema, management of elevated intracranial pressure should proceed anthelminthic treatment.