Neurocysticercosis in transition: expanding clinical spectrum, evolving diagnostics, and emerging therapies

Neurocysticercosis (NCC) infection of the central nervous system by Taenia solium larvae, remains a leading cause of acquired epilepsy in endemic regions and an increasingly recognized imported disease elsewhere. The traditional view of NCC as a solitary parenchymal cyst causing seizures has shifted to a heterogeneous syndrome shaped by parasite burden, stage, location, and host immune response. Clinical manifestations extend beyond seizures to headaches, cognitive impairment, psychiatric symptoms, visual loss, movement disorders, and stroke. Progress in neuroimaging, serology, and molecular diagnostics has improved case detection and disease phenotyping, while management increasingly relies on stage and compartment specific combinations of antiparasitic drugs, anti-inflammatory therapy, and neurosurgical or endoscopic interventions for extraparenchymal disease and hydrocephalus. Persistent gaps include limited randomized evidence, incomplete validation of diagnostic algorithms, and constrained access to advanced care in high-burden regions, underscoring the need for coordinated research and implementation strategies to reduce NCC's global neurological impact.