Unraveling the Enigma: Navigating Challenges in the Diagnosis and Treatment of Neurocysticercosis – A Thorough Exploration Review

Abstract

Background: Neurocysticercosis, caused by the larvae of the pork tapeworm Taenia solium, presents a unique challenge to public health, particularly in low- and middle-income endemic countries. This parasitic infection affects the central nervous system and is often associated with epilepsy, contributing significantly to the global burden of neurological disorders. This review delves into recent advances in both the diagnosis and treatment of neurocysticercosis, offering insights into the evolving landscape of strategies to address this complex condition. In neurocysticercosis-endemic regions, the prevalence of epilepsy linked to this parasitic infection is substantial, underscoring the need for improved understanding and management. The symptoms of neurocysticercosis result from the death of the parasite and subsequent inflammatory reactions in the central nervous system, presenting challenges in direct symptom attribution. The lack of awareness about neurocysticercosis epidemiology further exacerbates the burden on affected communities, where NCC accounts for a significant proportion of epilepsy cases. Approach: This systematic review comprehensively synthesized recent neurocysticercosis advancements in diagnosis and treatment over the past two decades. The search strategy included diverse sources such as the World Health Organization reports and utilized advanced search engines and databases like Google Scholar, PubMed, and Elsevier. The selection process considered study design, publication date, language, and relevance. A standardized data extraction process collected information on study characteristics, patient demographics, diagnostic methods, treatment interventions, outcomes, and adverse events. Results: To boost diagnostic precision, this review underscores the global employment frequency of diagnostic techniques. Neuroimaging, notably CT scans (46.6%) and MRI (32.8%), emerges as pivotal, trending toward integrating immunodiagnosis for a holistic approach. In treatment, the multifaceted nature of neurocysticercosis management is apparent. Albendazole, corticosteroids, and Praziquantel are widely used, showcasing a comprehensive approach. The Praziquantel and Albendazole combination exhibits promising efficacy of 40%, underlining the necessity for personalized treatment plans. However, anthelmintic initiation demands recent neuroimaging to exclude contraindications, highlighting the delicate balance between treatment modalities. The management scope extends beyond pharmacology, encompassing larvicidal agents, corticosteroids, antiepileptic drugs, and surgical interventions. Individualized management, prioritizing growing cysticerci and addressing intracranial hypertension, underscores the complexity. Patients with specific conditions, such as cysticercotic encephalitis or isolated granulomas and calcifications, require specialized considerations to avert exacerbating intracranial hypertension or targeting non-viable parasites. Conclusion: In conclusion, this comprehensive review scrutinizes recent advances in neurocysticercosis diagnosis and treatment. Evolving diagnostic techniques, particularly the integration of advanced imaging and immunodiagnosis that are hardly available in low- and middle-income endemic countries, promise accurate assessments. The complex neurocysticercosis nature mandates ongoing research and a personalized approach for effective management, integrating diverse therapeutic interventions to enhance outcomes, especially in regions with substantial burdens.