Unraveling the Enigma: Navigating Challenges in the Diagnosis and Treatment of Neurocysticercosis – A Thorough Exploration Review

Main Article Content

Beda John Mwang'onde


Background: Neurocysticercosis, caused by the larvae of the pork tapeworm Taenia solium, presents a unique challenge to public health, particularly in low- and middle-income endemic countries. This parasitic infection affects the central nervous system and is often associated with epilepsy, contributing significantly to the global burden of neurological disorders. This review delves into recent advances in both the diagnosis and treatment of neurocysticercosis, offering insights into the evolving landscape of strategies to address this complex condition. In neurocysticercosis-endemic regions, the prevalence of epilepsy linked to this parasitic infection is substantial, underscoring the need for improved understanding and management. The symptoms of neurocysticercosis result from the death of the parasite and subsequent inflammatory reactions in the central nervous system, presenting challenges in direct symptom attribution. The lack of awareness about neurocysticercosis epidemiology further exacerbates the burden on affected communities, where NCC accounts for a significant proportion of epilepsy cases.

Approach: This systematic review comprehensively synthesized recent neurocysticercosis advancements in diagnosis and treatment over the past two decades. The search strategy included diverse sources such as the World Health Organization reports and utilized advanced search engines and databases like Google Scholar, PubMed, and Elsevier. The selection process considered study design, publication date, language, and relevance. A standardized data extraction process collected information on study characteristics, patient demographics, diagnostic methods, treatment interventions, outcomes, and adverse events.

Results: To boost diagnostic precision, this review underscores the global employment frequency of diagnostic techniques. Neuroimaging, notably CT scans (46.6%) and MRI (32.8%), emerges as pivotal, trending toward integrating immunodiagnosis for a holistic approach. In treatment, the multifaceted nature of neurocysticercosis management is apparent. Albendazole, corticosteroids, and Praziquantel are widely used, showcasing a comprehensive approach. The Praziquantel and Albendazole combination exhibits promising efficacy of 40%, underlining the necessity for personalized treatment plans. However, anthelmintic initiation demands recent neuroimaging to exclude contraindications, highlighting the delicate balance between treatment modalities. The management scope extends beyond pharmacology, encompassing larvicidal agents, corticosteroids, antiepileptic drugs, and surgical interventions. Individualized management, prioritizing growing cysticerci and addressing intracranial hypertension, underscores the complexity. Patients with specific conditions, such as cysticercotic encephalitis or isolated granulomas and calcifications, require specialized considerations to avert exacerbating intracranial hypertension or targeting non-viable parasites.

Conclusion: In conclusion, this comprehensive review scrutinizes recent advances in neurocysticercosis diagnosis and treatment. Evolving diagnostic techniques, particularly the integration of advanced imaging and immunodiagnosis that are hardly available in low- and middle-income endemic countries, promise accurate assessments. The complex neurocysticercosis nature mandates ongoing research and a personalized approach for effective management, integrating diverse therapeutic interventions to enhance outcomes, especially in regions with substantial burdens.

Article Details

How to Cite
MWANG'ONDE, Beda John. Unraveling the Enigma: Navigating Challenges in the Diagnosis and Treatment of Neurocysticercosis – A Thorough Exploration Review. Medical Research Archives, [S.l.], v. 12, n. 1, jan. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4902>. Date accessed: 03 mar. 2024. doi: https://doi.org/10.18103/mra.v12i1.4902.
Review Articles


1. Moyano LM, Saito M, Montano SM, et al. Neurocysticercosis as a Cause of Epilepsy and Seizures in Two Community-Based Studies in a Cysticercosis-Endemic Region in Peru. PLoS Negl Trop Dis. 2014;8(2).


3. Sharma R, Bargotra R, Tandon VR, Gupta SK, Verma S SJB. Neurocysticercosis: Current Vitae. JK SCIENCE. 2005;7(1).

4. Molinari JL and Tato P. Molecular Determinants of Host-Parasite Interactions: Focus on Parasite. CAB International 2002. Taenia solium cysticercosis From Basic to Clinical Science. In: Prabhakar). GS and S, ed. CAB International 2002. ; 2002:25-33.

5. Flisser A, Correa D ECAW. Taenia solium cysticercosis: New and Revisited Immunological Aspects. Taenia solium cysticercosis From Basic to Clinical Science. In: G Singh and S Prabhakar, ed. CAB International 2002. ; 2002:15-24.

6. Ndimubanzi PC, Carabin H, Budke CM, et al. A systematic review of the frequency of neurocyticercosis with a focus on people with epilepsy. PLoS Negl Trop Dis. 2010;4(11). doi:10.1371/journal.pntd.0000870

7. Owolabi LF, Adamu B, Jibo AM, Owolabi SD, Imam AI, Alhaji ID. Neurocysticercosis in people with epilepsy in Sub-Saharan Africa: A systematic review and meta-analysis of the prevalence and strength of association. Seizure. 2020;76:1-11. doi:10.1016/j.seizure.2020.01.005

8. Herrick JA, Bustos JA, Clapham P, Garcia HH, Loeb JA. Unique characteristics of epilepsy development in neurocysticercosis. American Journal of Tropical Medicine and Hygiene. 2020;103(2):639-645.

9. Bern C, Garcia HH, Evans C, et al. Magnitude of the disease burden from neurocysticercosis in a developing country. Clinical Infectious Diseases. 1999;29(5):1203-1209. doi:10.1086/313470

10. Carpio A. Letter to the Editor. American Journal of Tropical Medicine and Hygiene. 2020;103(3):1235-1236. doi:10.4269/ajtmh.20-0569

11. Winkler AS. Neurocysticercosis in sub-Saharan Africa: A review of prevalence, clinical characteristics, diagnosis, and management. Pathog Glob Health. 2012;106(5):261-274. doi:10.1179/2047773212Y.0000000047

12. WHO. Epilepsy: A Public Health Imperative. World Health Organization; 2019.

13. Mwang’onde, BJ., Mwita, JC., Gamba, N. The status and health burden of neurocysticercosis in Mbulu district, northern Tanzania. BMC Res Notes. 2018;11(890):1-5. doi:https://doi.org/10.1186/s13104-018-3999-9

14. Trevisan C, Devleesschauwer B, Schmidt V, Winkler AS, Harrison W, Johansen MV. The societal cost of Taenia solium cysticercosis in Tanzania. Acta Trop. 2017;165:141-154. doi:10.1016/j.actatropica.2015.12.021

15. Stelzle D, Makasi C, Schmidt V, et al. Efficacy and safety of antiparasitic therapy for neurocysticercosis in rural Tanzania: a prospective cohort study. Infection. 2023;51(4):1127-1139. doi:10.1007/s15010-023-02021-y

16. Guzman C, Garcia HH. Current Diagnostic Criteria for Neurocysticercosis. Res Rep Trop Med. 2021;Volume 12:197-203. doi:10.2147/rrtm.s285393

17. Carabin H, Ndimubanzi PC, Budke CM, et al. Clinical manifestations associated with neurocysticercosis: A systematic review. PLoS Negl Trop Dis. 2011;5(5). doi:10.1371/journal.pntd.0001152

18. Tarun Dua and S. Aneja. Neurocysticercosis: Management Issues. Published online March 2006.

19. Coyle CM, Tanowitz HB. Diagnosis and Treatment of Neurocysticercosis. Interdiscip Perspect Infect Dis. 2009;2009:1-9. doi:10.1155/2009/180742

20. Takayanagui OM. Therapy for neurocysticercosis. Expert Rev Neurother. 2004;4(1):129-139. doi:10.1586/14737175.4.1.129

21. Sankhyan N, Kadwa RA, Kamate M, Kannan L, Kumar A. Management of Neurocysticercosis in Children: Association of Child Neurology Consensus Guidelines GOURI RAO PASSI, 6 INDAR KUMAR SHARAWAT, 7 PRATIBHA SINGHI, 8 FOR ASSOCIATION OF CHILD NEUROLOGY DELPHI GROUP FOR NEUROCYSTICEROSIS IN CHILDHOOD*. Vol 871.; 2021.

22. Garcia HH, Nash TE, Del Brutto OH. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol. 2014;13(12):1202-1215. doi:10.1016/S1474-4422(14)70094-8

23. Yi Y, Zhi-Bao G. Neurocysticercosis with convulsion, confusion, and hypomnesia Case Report Journal of Clinical Images and Medical Case Reports. Open Access. 2022;3. doi:10.52768/2766-7820/1628

24. O’neal SE, Noh J, Handali S. Laboratory Diagnosis of Neurocysticercosis (Taenia Solium). Vol 56.; 2018.

25. Nash TE, Ware JAM, Coyle CM, Mahanty S. Etanercept to control inflammation in the treatment of complicated neurocysticercosis. American Journal of Tropical Medicine and Hygiene. 2019;100(3):609-616.

26. Singh G, Chiodini P, Sander JW. Mortality associated with cysticercosis in a historical cohort from Britain. Arq Neuropsiquiatr. 2022;80(3):248-254. doi:10.1590/0004-282X-ANP-2021-0001

27. Vinod Puri and Rakesh Kumar Gupta. Magnetic Resonance Imaging Evaluation of Focal Computed Tomography Abnormality in Epilepsy. Epilepsia. 1991;32(4):460-466.

28. Mlowe F, Karimuribo E, Mkupasi E, et al. Challenges in the Diagnosis of Taenia solium Cysticercosis and Taeniosis in Medical and Veterinary Settings in Selected Regions of Tanzania: A Cross-Sectional Study. Vet Med Int. 2022;2022. doi:10.1155/2022/7472051

29. Nkwengulila Gamba. A Review of Human Cysticercosis and Diagnostic Challenges in Endemic Resource Poor Countries. Adv Infect Dis. 2014;4:207-213.

30. Stelzle D, Makasi C, Schmidt V, et al. Epidemiological, clinical and radiological characteristics of people with neurocysticercosis in Tanzania–a cross-sectional study. PLoS Negl Trop Dis. 2022;16(11). doi:10.1371/journal.pntd.0010911

31. García HH, Evans CAW, Nash TE, et al. Current Consensus Guidelines for Treatment of Neurocysticercosis Current Consensus Guidelines for Treatment of Neurocysticercosis. Clin Microbiol Rev. 2002;15(4):747-754.
doi:DOI: 10.1128/CMR.15.4.747–756.2002

32. Abba K, Ramaratnam S, Ranganathan LN. Anthelmintics for people with neurocysticercosis. In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd; 2010. doi:10.1002/14651858.cd000215.pub4

33. Carpio A, Chang M, Zhang H, et al. Exploring the complex associations over time among albendazole treatment, cyst evolution, and seizure outcomes in neurocysticercosis. Epilepsia. 2019;60(9):1820-1828.