Neurocysticercosis (NCC) is the most common helminthic disease of the nervous system in humans and a major cause of acquired
epilepsy worldwide. The presentation of the disease is dependent on both the immunological response of the host against the parasite as well as the location of the encysted organisms within the central nervous system (CNS). The principles of management utilized for intraparenchymal disease cannot be applied to extraparenchymal NCC. An advance in management of intraparenchymal NCC, the most common form encountered by physicians, is the use of both
albendazole and
praziquantel as a treatment strategy. Patients with subarachnoid NCC (SANCC) require months of treatment with both an
antiparasitic agent and
steroids to avoid complications such as
hydrocephalus and vascular events during treatment. The determinants of successful treatment in SANCC have not been established, but response to
therapy can be determined by evaluating several endpoints related to disease evolution including radiographic changes, serum
antigen, and CSF
antigen. Intraventricular NCC is primarily a surgical disease and data supports minimally invasive endoscopic removal of
cysts in many of these patients. NCC is increasingly recognized in non-endemic countries due to increased immigration making it important for physicians to become familiar with the management of this disease.