Neurocysticercosis: Treatment

00:00 So how do we treat this infection? Well, there are different stages of the disease and we consider treatment differently during those stages. The decision to treat is based on the stage, the number of cysts, their location because lesions that are important locations particularly around the ventricles if treated could become inflamed and cause obstructive hydrocephalus and problems as well as the patient's specific clinical presentation. So it really varies by patients, but I want to guide you through 3 ways of thinking about treating neurocysticercosis. Again, we said there are asymptomatic cysts, they may never lead to symptomatic disease, they may become symptomatic many many years in the future, and so certain cases are treated but others may not. There is the symptomatic phase, that colloidal stage as this lesion is degenerating with intense inflammation and symptoms. At those times, patients present with seizures and need seizure treatment. Antiparasitic agents are used to treat that infection and help to resolve it and steroids are critical to manage the secondary immune response that occurs to this infectious process. And then there is the calcified stage, what's done is done. This organism is no longer going to cause problems at least for that lesion, it's died and involuted and further therapy is neither warranted, needed, or should not be given. So let's think about each of those stages and talk about some of the agents we would use. I'd like you to know of this approach, but you don't need to know all the details. During the vesicular stage, we treat with antihelminthic agents like albendazole and praziquantel. If we do and when we treat in that stage, it's important to prevent the immune response. When we treat the organism, it will be released, the immune system will respond to it, and there can be vigorous immunologic complications from that in the first several days and even week after treating these presymptomatic lesions. So steroids are often considered and antiepileptic drugs may be used for patients where we're particularly concerned. This is also a reason why not all patients are treated during the vesicular stage of the cyst. In the colloidal stage, what's happening is happening and we need to prevent complications, so antihelminthic agents are used, steroids are used, and antiepileptics are often required to manage these patients through that stage. In the granular stage, the scolex, the parasite is degenerating. So antihelminthic agents are not needed at that point in time and steroids are used symptomatically to manage edema and antiepileptics obviously to manage seizures that may occur. In the calcified stage, no treatment is needed, not the helminthic agents or the antiepileptics, or the steroids. What we worry about in these patients is long-term epilepsy or future epilepsy after the lesion, after the cyst has undergone these stages. And it is unclear currently who will need long-term therapy and who will not so we really try and personalize this to the patient who is in front of us.