Medical treatment for neurocysticercosis characterized by giant subarachnoid cysts

Background Infection with the larval form of the pork tapeworm, Taenia soli um, can lead to the development of cysts in the brain. Surgical removal of cysts has been the accepted treatment for neurocysticercosis characterized by giant cysts when there is associated intracranial hypertension. Methods We describe 33 patients whom we treated medically for malignant for ms of neurocysticercosis. All patients had evidence of intracranial hyperte nsion and subarachnoid cysts at least 50 mm in diameter. All patients recei ved 15 mg of albendazole per kilogram of body weight per day for four weeks . Ten patients were also treated with 100 mg of praziquantel per kilogram p er day for four weeks. Seventeen patients received a second course of alben dazole, three received a third course, and one received a fourth course. Du ring the first cycle of treatment, all patients also received dexamethasone . Five patients had previously undergone neurosurgery for giant cysts. Results After a median of 59 months of follow-up (range, 7 to 102), the con dition of all 33 patients had improved, and the cysts had disappeared or be come calcified. Of the 22 patients with a history of seizures, only 11 cont inued to receive antiseizure medications. The median quality-of-life score on the Karnofsky scale improved from 40 to 100. Fifteen patients received a ventriculoperitoneal shunt because of hydrocephalus. Four patients had per sistent sequelae ( bilateral partial optic atrophy, stroke, or diplopia) of the cysts. Conclusions Intensive medical treatment can be effective in patients with n eurocysticercosis characterized by giant cysts. Neurosurgery may be require d only when there is an imminent risk of death. (N Engl J Med 2001; 345: 87 9-85.) Copyright (C) 2001 Massachusetts Medical Society.