Medical management of neurocysticercosis

Neurocysticercosis is the most common parasitic disease of the central nervous system. Praziquantel and albendazole, the two antiparasitic drugs, have been reported to be effective against cysticercosis. Both the drugs effectively destroy the cerebral parenchymal cystic lesions. However, albendazole is possibly more effective in subarachnoidal, ventricular and spinal forms of cysticercosis, and frequently obviates the need for surgery. Initially, longer courses of albendazole and praziquantel had been advocated. Now even shorter treatment regimens are found equally effective. Complete course of praziquantel therapy can be administered in a single day with comparable efficacy instead of conventional treatment of 15 days. Similarly, one week therapy of albendazole is as effective as 30 days' treatment regimen. Recently, there is an intense debate whether anticysticercal treatment is useful and safe. Opponents of anticysticercal therapy argue that effectiveness of therapy is possibly a reflection of natural course of the disease. It has been observed that even if cysticercal lesions are left untreated, they either disappear spontaneously or calcify. Anticysticercal therapy is potentially risky, it may aggravate cerebral oedema, and may produce vasculitis and stroke, and several deaths have also been reported. To minimise these risks, concomitant corticosteroids should be administered especially, if there is a massive parasitic load. It is better to avoid anticysticercal treatment in patients with cysticercotic encephalitis. Doubts have been expressed that anticysticercal therapy really affects ultimate long-term clinical outcomes (e.g. control of seizure and possibility of seizure free state after discontinuation of antiepileptic drugs). So far, definite evidences in this regard, based on finding of well planned placebo-controlled studies, are lacking and an opinion that, there is an urgent need for such a study, has been expressed. Measures for effective prevention like provision for safe drinking water and safe excreta disposal should be emphasisfxed.