Neurocysticercosis
Del Brutto, O.H.
Revista de Neurologia 29(5): 456-466
1999
ISSN/ISBN: 0210-0010 PMID: 10584250 Document Number: 506838
This paper review current literature about neurocysticercosis with emphasis on recent advances on diagnosis and therapy. Cysticercosis is the most common parasitic disease of the nervous system. The disease occurs when humans become the intermediate host in the life cycle of Taenia solium by ingesting its eggs from contaminated food. Endemic in developing countries of Latin America, Asia and Africa, massive immigration of people to industrialized nations caused a recent increase in the number of patients with cysticercosis in the United States of America and in some European countries. Neurocysticercosis is a pleomorphic disease due to individual differences in the number, size, and location of the parasites within the nervous system as well as to differences in the severity of the host's immune reaction against the parasite. Epilepsy, focal neurological signs, and intracranial hypertension are the most common clinical manifestations of neurocysticercosis. Since the diagnosis is not possible on clinical grounds, it is necessary the practice of complementary exams in every suspected case. Neuroimaging studies (CT or MRI) usually permit the diagnosis as they show objective evidence of the parasites and the inflammatory changes induced in the surrounding nervous tissue. Immunological tests developed to detect anticysticercal antibodies in serum or CSF present many problems inherent to the lack of specificity or sensibility; therefore, they should not be used by themselves to confirm or exclude the disease. Two drugs, albendazole and praziquantel, have been used with success to destroy most intracranial parasites; however, surgery still play a role in the management of some forms of the disease, particularly hydrocephalus and intraventricular cysts. Development of modern diagnostic tests and introduction of potent cestocidal drugs have increased our knowledge on neurocysticercosis and have improved its prognosis. Nevertheless, some patients still have torpid clinical courses despite proper therapy.