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Managing neurocysticercosis: challenges and solutions

Authors Fogang Y, Savadogo A, Camara M, Toffa D, Basse A, Sow A, Ndiaye MM

Received 26 May 2015

Accepted for publication 7 August 2015

Published 16 October 2015 Volume 2015:8 Pages 333—344


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Thomas Campbell

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Video abstract presented by Dr Yannick Fogoum Fogang.

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Yannick Fogoum Fogang, Abdoul Aziz Savadogo, Massaman Camara, Dènahin Hinnoutondji Toffa, Anna Basse, Adjaratou Djeynabou Sow, Mouhamadou Mansour Ndiaye

Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar, Senegal

Abstract: Taenia solium neurocysticercosis (NCC) is a major cause of neurological morbidity in the world. Variability in the neuropathology and clinical presentation of NCC often make it difficult to diagnose and manage. Diagnosis of NCC can be challenging especially in endemic and resource-limited countries where laboratory and imaging techniques are often lacking. NCC management can also be challenging as current treatment options are limited and involve symptomatic agents, antiparasitic agents, or surgery. Although antiparasitic treatment probably reduces the number of active lesions and long-term seizure frequency, its efficacy is limited and strategies to improve treatment regimens are warranted. Treatment decisions should be individualized in relation to the type of NCC. Initial measures should focus on symptomatic management, with antiparasitic therapy only to be considered later on, when appropriate. Symptomatic treatment remains the cornerstone in NCC management which should not only focuses on epilepsy, but also on other manifestations that cause considerable burden (recurrent headaches, cognitive decline). Accurate patients' categorization, better antiparasitic regimens, and definition of new clinical outcomes for trials on NCC could improve management quality and prognosis of NCC. Prevention strategies targeting tapeworm carriers and infected pigs are yielding good results in local models. If local elimination of transmission is confirmed and replicated, this will open the door to cysticercosis eradication efforts worldwide.

Keywords: neurocysticercosis, Taenia solium, epilepsy, headache, albendazole, praziquantel

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