Management of Neurocysticercosis in Children

Initial Management at Presentation

  • Control of seizures: Emergent status epilepticus should be treated. Children can usually be managed with single anti-epileptic drugs (53).
  • Control of brain edema: Corticosteroids suppress the inflammatory response elicited by destruction of live cysticerci at a dose of 0.15 mg/kg per day of dexamethasone for at least 5 days in 2 to 3 divided doses (54).

Adjunctive Therapies

  • Anthelmintic drugs: Antihemintic medication is generally indicated for symptomatic patients with multiple, live parenchymal noncalcified cysts. Anthelmintic drugs will not benefit patients with calcified, dead worm cysts.
  • Anthelmintic drugs may also be effective on ventricular or cisternal cysts: Their efficacy in these situations is debatable. Otherwise, it is unlikely that live cysts will be spontaneously destroyed (30,32,39)
  • Albendazole is the drug of choice: It has been used in a dose of 15 mg/kg/day in two or three divided doses for 28 days.
  • Praziquantel is the oldest cysticidal drug. It is used in a dose of 50 mg/kg/day for 15 days. A single-day praziquantel therapy (25 mg/kg/dose every 2 h × 3 doses) has been reported to be as effective as 7-day treatment with albendazole.
  • Ocular cysticercosis: Treatment with anthelmintic drugs is contraindicated when there is ocular cysticerosis because the inflammatory response may worsen the outcome. Surgical removal is usually necessary in individuals with intraocular cysts (55).

Follow-up

  • Resolution of the lesion on CAT scans: The  cysts resolve in about 68% of the patients 4 weeks to 3 months after treatment. Cured patients may remain seropositive even 1 year after the end of the treatment (5,19,28,32).
  • Imaging at 3 months: MRI or CAT scanning is performed after 3 months to follow resolution of lesions.