Cysticercosis (cont.)

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How is cysticercosis diagnosed?

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The diagnosis of cysticercosis can sometimes be difficult, and it may require a combination of tests and imaging studies to make the diagnosis. In Texas, young adults who have immigrated from Mexico, especially from the mountainous regions, that have a new onset seizure should have cysticercosis considered as a possible cause. In general, however, the patient's clinical presentation along with abnormal radiographic imaging results (CT scan of the brain/MRI of the brain) lead to the diagnosis of neurocysticercosis. Blood testing can sometimes be used as an adjunct in making the diagnosis, though it is not always helpful or accurate. These tests are usually performed in more specialized labs. Rarely, a biopsy from affected tissue may be needed to make the diagnosis. Stool studies are sometimes also obtained because they may contain identifiable parasite eggs.

What is the treatment for cysticercosis?

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The treatment of cysticercosis depends on various factors, including the individual's symptoms, the location and number of cysticerci, and the stage of cyst development. Generally speaking, treatment is tailored to each individual patient and their particular presentation, and treatment regimens may include anthelmintic agents, corticosteroids, anticonvulsant medications, and/or surgery. Asymptomatic patients may not require any treatment at all. Controversy does exist as to which patients require treatment with the various medications.

The most commonly used anthelmintic agents include albendazole (Albenza) and less commonly praziquantel (Biltricide). These antiparasitic medications are effective in eliminating viable cysticerci though they may cause reactive localized inflammation. Consequently, the use of these medications must be evaluated on a case-by-case basis. More than one course of treatment may be necessary to completely eliminate active cysts.

Corticosteroids may also be used in conjunction with, or instead of, antiparasitic medications. Corticosteroids are used to decrease inflammation but are not active against the parasite. Again, treatment with these medications must be tailored to each individual case. Consultation with an infectious disease expert is recommended.

Anticonvulsant medications are used in patients with neurocysticercosis experiencing seizures or at high risk for recurrent seizures. Various anticonvulsant medications, such as carbamazepine (Tegretol) or phenytoin (Dilantin), may be prescribed. Consultation with an experienced neurologist may be helpful to determine patient treatment.

Surgical management may also be necessary in select cases of cysticercosis. Surgical removal of central nervous system cysts or placement of a brain shunt (to relieve pressure) is sometimes necessary in some cases of neurocysticercosis. Certain cases of cysticercosis involving the eyes or subcutaneous cysts may also require surgery.

Medically Reviewed by a Doctor on 1/16/2014

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