Cysticidal Therapy for Diffuse Parenchymal and Calcific Neurocysticercosis

Value of whole-body MRI for the assessment of response to albendazole in disseminated neurocysticercosis: a prospective follow-up study

BACKGROUND

Disseminated neurocysticercosis is defined as simultaneous involvement of the brain (≥3 cysts) and at least one additional body site/organ. We aimed to identify disseminated cystic lesions in other body parts and investigate the effect of albendazole.

METHODS

We enrolled patients with multiple (≥3) neurocysticercosis brain lesions. Whole-body MRI (short tau inversion recovery coronal sequences) was performed to assess the number of lesions in the brain and other body parts at baseline and 3 months after albendazole therapy.

RESULTS

We screened 35 patients with multiple brain neurocysticercosis. In 13 patients, whole-body MRI demonstrated disseminated neurocysticercosis lesions. Ten patients were treated with albendazole. We excluded three patients. Brain MRI showed a mean lesion count of 163.6±193.8. Whole-body MRI (excluding the brain) showed a mean lesion count of 629.9±486.1. After albendazole therapy, the lesion load of the brain reduced significantly (163.6±193.8 to 99±178.3; p=0.008). Similarly, whole-body MRI showed a significant reduction in extracerebral neurocysticercosis lesion load (629.9±486.1 to 183.4±301.9; p=0.005). Three patients had complete resolution, five patients showed ≥50% reduction and two patients had <50% reduction in extracerebral lesion load.

CONCLUSION

Whole-body MRI should routinely be performed in multiple neurocysticercosis lesions of the brain. Albendazole treatment leads to a remarkable reduction in neurocysticercosis lesions throughout the body.

Disseminated Cysticercosis-Should we treat?

Disseminated cysticercosis is defined by the presence of multiple vesicular cystic lesions in the brain with cysts demonstrable in at least two other body parts. The exact course of disseminated cysticercosis is not known and the individual cysts either become inflamed or calcify. A patient's quality of life is often poor and disseminated cysticercosis treatment is far from satisfactory. Anecdotal reports have suggested dual antiparasitic therapy to be beneficial for treating diffuse parenchymal neurocysticerci and might be worth trying in patients with massively infiltrating disseminated cysticercosis with concomitant corticosteroids.