Spotlight on Neurocysticercosis

In this article, Dr. Larry Davis of the University of New Mexico School of Medicine, discusses neurocysticercosis, which continues to be the most common CNS parasite and is becoming increasingly identified in the United States. Most patients in the United States present with seizures (focal or generalized) or headaches and have come from Mexico or Latin America.

A new set of diagnostic criteria have been published. There are now 3 serological methods of diagnosing neurocysticercosis. A serum or CSF antibody assay, especially an enzyme-linked immunotransfer blot assay, is quite sensitive and specific, and is widely available. A new PCR-based assay to detect T. solium nucleic acid is more specific and is becoming more available. The third assay detects cysticercus antigen; this assay is the most valuable in diagnosing extraparenchymal neurocysticercosis in the ventricle or meninges and can be utilized to follow patient response to treatment.

It appears that the cysticercus cyst releases specific proteins that induce an anti-inflammatory host response to prevent the host from destroying viable cerebral cysts. Although some controversy continues regarding the necessity of treating single neurocysticercosis cysts in developing countries, studies find that albendazole treatment significantly hastens the disappearance of cysts and reduces the incidence of seizures with generalization.

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