Neurocysticercosis: the good, the bad, and the missing

Area of Science:

• Neurology
• Infectious Diseases
• Parasitology

Background:

• Neurocysticercosis (NC) is a major cause of neurological disability and death in low-income nations, with rising incidence in high-income countries due to migration.
• Despite advances, significant knowledge gaps persist regarding NC's epidemiology, pathophysiology, and management.
• The disease poses a substantial public health challenge, necessitating improved understanding and control measures.

Purpose of the Study:

• To provide a comprehensive review of neurocysticercosis, covering its epidemiology, pathophysiology, immunology, diagnosis, treatment, and eradication.
• To highlight current challenges and areas requiring further research for effective NC management and control.
• To inform stakeholders on the latest understanding and future directions in combating this neglected disease.

Main Methods:

• Literature review synthesizing current knowledge on neurocysticercosis.
• Discussion of epidemiological data, pathophysiological mechanisms, and immunological responses.
• Analysis of diagnostic methods, treatment strategies, and prevention/eradication approaches.

Main Results:

• Global prevalence of NC remains undetermined, requiring better ascertainment.
• Further research into extraparenchymal cyst pathophysiology and the role of inflammation is crucial for improved management.
• Development of valid immunological and molecular screening tools is needed to complement neuroimaging, particularly in endemic regions.
• Prognosis for parenchymal NC is generally favorable post-treatment, but evidence for antiparasitic efficacy in extraparenchymal NC is limited.
• NC is overemphasized as a cause of epilepsy, potentially leading to stigmatization; most individuals with seizures do not develop epilepsy.

Conclusions:

• Accurate global prevalence data for neurocysticercosis is lacking and urgently needed.
• Enhanced understanding of pathophysiology and inflammation is critical for optimizing treatment, particularly for extraparenchymal cysts.
• Development of accessible diagnostic tools and robust clinical trial data for antiparasitic treatments are essential.
• Integrated strategies involving all stakeholders are required for the effective prevention and eradication of neurocysticercosis and associated taeniasis/cysticercosis.