Review of Neurocysticercosis
from Neurosurgical Focus
Julio Sotelo, M.D., and Oscar H. Del Brutto, M.D.
Abstract and Introduction
AbstractIn the neurosurgical services in many developing countries, treatment of neurocysticercosis (NCC) accounts for greater than 10% of brain surgical procedures and approximately 15% of neurological consultations. In these areas brain cysticercosis is the leading cause of hydrocephalus in adults and the first cause of late-onset epilepsy. During the last two decades, successful medical treatment has been established. Additionally, neuroimaging and immunological studies have clearly defined the topography, pathophysiological mechanisms, and biological status of these lesions. Thus, selection of cases for medical or surgical treatment has improved; in a significant number of cases, both interventions are required. New therapies with either albendazole or praziquantel have respectively reduced to 8 days and to 1 day the course of anticysticidal therapy, which now is fast, effective, inexpensive, atoxic, and convenient, particularly in endemic areas where most patients belong to the lower socioeconomic groups. Additionally, the rational use of steroid agents facilitates the treatment of inflammation, a conspicuous accompaniment in cases of NCC. A major effort, however, is still required to eradicate this disease.
IntroductionNeurocysticercosis is caused by the larvae of the tapeworm Taenia solium in the nervous system, a disease suffered by millions of people living in the developing countries of Central and South America, sub-Saharan Africa, and east and south Asia.[7,9,26,47] In these areas, the disease accounts for up to 12% of all admissions to neurological hospitals and is the leading cause of acquired epilepsy in adults.[34,42] More than 50,000 new NCC-related deaths occur annually, and of the many more patients who suffer related neurological sequelae, most are affected at productive ages.[24,53] This makes NCC a large public health problem in developing countries. Moreover, massive emigration of people from endemic to nonendemic areas has increased its prevalence in North America and some European countries, where this condition had been considered rare.[57,76]