NEUROCYSTICERCOSIS

NCC is the commonest parasitic infection of the brain and a major cause of epilepsy. The clinical presentation is variable and is determined by the number and location of cyst(s) and the host response. Seizures, particularly partial seizures are seen in over 80% cases and features of raised intracranial pressure in about a third of cases.

Diagnosis is mainly by CT or MRI scan. Most (≈ 85%) children have single parenchymal lesions; some have multiple lesions. Morphology of lesions depends on the stage of the cyst. Single small (<20mm) enhancing CT lesions (SSECTL) with perilesional oedema are common. Visualization of the scolex confirms the diagnosis. Multiple cysts in various stages give the characteristic 'starry sky appearance' on CT. Seizures are often well controlled with a single anticonvulsant. Corticosteroids are indicated in cases with cerebral oedema. The efficacy of cysticidal therapy in single lesions continues to be debated. Controlled studies have shown that cysticidal therapy helps in increased and faster resolution of lesions but there is no conclusive evidence that it improves long term seizure control. Albendazole 15mg / kg/ day for 28 days has been the standard treatment. Shorter course of 1 week was found to be as effective as a four weeks course. The prognosis of cases with single lesions is good; over 60% lesions disappear in 3–6 months and anticonvulsants can be stopped thereafter; children with persistent or calcified lesions and those with multiple lesions require longer duration of antiepileptic therapy. Extraparenchymal NCC often has a poor prognosis.

NCC must be considered in the differential diagnosis of seizures and other neurological conditions, especially in endemic areas. Proper sanitation and hygiene are essential for prevention of NCC.