Cysticercosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Not all cases of cysticercosis are treated and the use of albendazole and praziquantel is controversial.
Neurocysticercosis
Neurocysticercosis most often presents as headaches and acute onset seizures, thus the immediate mainstay of therapy is anticonvulsant medications. Once the seizures have been brought under control, antihelminthic treatments may be undertaken. The decision to treat with antiparasitic therapy is complex and based on the stage and number of cysts present, their location, and the patient's specific clinical presentation.[1] Antiparasitic treatment should be given in combination with corticosteroids and anticonvulsants to reduce inflammation surrounding the cysts and lower the risk of seizures. Albendazole is generally preferable over praziquantel due to its lower cost and fewer drug interactions.[2]
Asymptomatic cysts, such as those discovered incidentally on neuroimaging done for another reason, may never lead to symptomatic disease and in many cases do not require therapy.
Calcified cysts have already died and involuted. Further antiparasitic therapy will be of no benefit.
Ophthalmic cysticercosis
In ophthalmic disease, surgical removal is necessary for cysts within the eye itself while antihelminth drugs with steroids alone might be sufficient to treat cysts outside globe.Treatment recommendations for subcutaneous cysticercosis includes surgery, praziquantel and albendazole.
Subcutaneous cysticercosis
In general, subcutaneous disease does not need specific therapy. Painful or bothersome cysts can be surgically excised.
Contraindicated medications
Ocular cysticercosis is considered an absolute contraindication to the use of the following medications:
References
- ↑ White, Jr., A. Clinton (2009). "New developments in the management of neurocysticercosis". The Journal of Infectious Diseases. 199 (9): 1261. doi:10.1086/597758. PMID 19358667.
- ↑ Dimitrios K. Matthaiou, Georgios Panos, Eleni S. Adamidi,Matthew E. Falagas “Albendazole versus Praziquantel in the Treatment of Neurocysticercosis: A Meta-analysis of Comparative Trials” PLoS Negl Trop Dis. 2008 March; 2(3): e194