Abstract
In the first section, the panel summarizes background information relevant to the topic. In the second section, the panel poses questions regarding the diagnosis and treatment of NCC, evaluates applicable clinical trial and observational data, and makes recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.1 The following 27 clinical questions were answered: I. How should NCC be diagnosed? II. What imaging studies should be used to classify disease? III. What additional tests should be performed before initiation of therapy? IV. How should antiparasitic and anti-inflammatory therapy be monitored? V. What is the role of antiparasitic drugs in VPN? VI. What is the role of anti-inflammatory therapy in management of VPN? VII. What is the role of antiepileptic drugs in VPN? VIII. What follow-up is recommended after initial antiparasitic therapy for patients with VPN? IX. What should be the initial approach to the patient with multiple enhancing lesions from NCC? X. What is the role of antiepileptic medications in patients with SEL from cysticercosis with seizures? XI. What is the role of antiparasitic drugs in patients with SEL? XII. What is the role of anti-inflammatory therapy in SEL? XIII. How should patients with SEL be followed? XIV. What should the initial approach be to patients with calcified lesions suggestive of CPN? XV. What is the role of antiparasitic drugs, antiepileptic drugs, and anti-inflammatory medications in the management of patients with CPN? XVI. Is there a role for surgical therapy in refractory cases? XVII. How are extra parenchymal cysts best identified? XVIII. What is the optimal approach to management of IVN in the lateral and third ventricles? XIX. What is the optimal surgical approach to management of IVN in the fourth ventricles? XX. What is the optimal approach to adherent IVN? XXI. Does medical therapy as an adjunct to procedures or as primary therapy have an impact on outcome in treating patients with IVN? XXII. What is the role of medical therapy in SAN in the basilar cisterns or Sylvian fissures? XXIII. What is the role of neurosurgery in SAN? XXIV. How is SN best treated? XXV. What is the optimal management of OC? XXVI. Should children be managed differently from adults? XXVII. Should management be different in pregnant women?
Highlights
In the first section, the panel summarizes background information relevant to the topic
These guidelines present our approaches to the diagnosis and management of patients with the different forms of NCC, including viable parenchymal NCC (VPN), single enhancing lesions (SEL), calcified parenchymal NCC (CPN), ventricular NCC (IVN), and subarachnoid NCC (SAN)
We recommend that patients with multiple enhancing lesions and seizures be initially treated with antiepileptic drugs, antiparasitic therapy, and corticosteroids as outlined in the section on viable parenchymal cysticerci
Summary
Guidelines for the clinical management of patients with neurocysticercosis (NCC) were prepared by a panel of the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). The guidelines are intended for infectious disease specialists, neurologists, neurological surgeons, internists, pediatricians, and family practitioners These guidelines present our approaches to the diagnosis and management of patients with the different forms of NCC, including viable parenchymal NCC (VPN), single enhancing lesions (SEL), calcified parenchymal NCC (CPN), ventricular NCC (IVN), and subarachnoid NCC (SAN). A criterion for grading evidence is presented in Figure 1.1 Note that diagnosis and management of patients with NCC can be challenging even with expert guidelines. Because of this complexity, clinicians with little experience with this disease should have a low threshold for consultation with an expert in the disease. We recommend both a brain magnetic resonance imaging (MRI) and a non-contrast computed tomography (CT) scan for classifying patients with newly diagnosed NCC (strong, moderate)
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