**5. Treatment**

There are four stages of neurocysticercosis completion (**Figure 4**). Based on which stage of neurocysticercosis is identified as are necessary for treatment, not every patient with neurocysticercosis is expected to respond favourably to a certain course of therapy. A well-informed treatment plan depends on accurately describing the illness in terms of the health of the cysts, the strength of the host's immune response to the worm, and the place and number of lesions [30]. Typically, treatment involves taking both symptomatic and cestocidal/cysticidal drugs. Additionally, surgery is used to treat certain individuals [31].

The prognosis for the majority of patients with neurocysticercosis has been considerably influenced by the widespread use of two potent cestocidal/cysticidal drugs (praziquantel and albendazole) [32]. Initial dosages of praziquantel were given for 15 days at a rate of 50 mg/kg/day (given every 8 hours) [33]. Then it was suggested that eliminating the parasites could only require three different doses of 25 to 30 mg/kg

*Taeniasis and Cycticercosis/Neurocysticercosis – Global Epidemiology, Pathogenesis, Diagnosis...*

#### **Figure 4.**

*Representing Stages of Neurocysticercosis [29].*

given at intervals of 2 hours, exposing cysticerci to high drug concentrations sustained for up to 6 hours. It seems that patients with a single parenchymal brain cyst respond better to praziquantel's one-day therapy, but those with numerous cysts should utilise the 15-day trial, despite the early data with this unique regimen being encouraging.

Albendazole, the other cestocidal/cysticidal drug, was originally administered at dosages of 15 mg/kg/day for a month [34]. According to additional studies, if a patient just has a single brain cyst, the period of treatment might be shortened to just 1 week or perhaps just 3 days. In trials comparing the effectiveness of the two drugs, albendazole has outperformed by praziquantel. Another advantage of albendazole is that it removes ventricular and subarachnoid cysts. In some of these circumstances, especially in people with significant subarachnoid cysts, higher doses of albendazole (up to 30 mg/kg/day) or longer or even repeated courses may be necessary.

The use of cestocial/cysticidal medications has come under investigation due to the mild nature of some cases of neurocysticercosis, which has caused patient uncertainty

#### *Neurocysticercosis: A Review on Global Neurological Disease DOI: http://dx.doi.org/10.5772/intechopen.110627*

and poor treatment choices. Cestocidal/Cysticidal medications are allegedly only effective at removing cysts; they have no impact on the clinical course of the disease. Recent studies, however, have shown that the majority of patients who use cestocidal/cysticidal drugs also see improvements in their clinical conditions. In a placebo-controlled study, albendazole was effective in treating viable parenchymal brain cysticerci [35–37].

Other well-conducted trials demonstrated that, in contrast to non-treatment, therapy improves the prognosis of individuals with colloidal parenchymal brain cysts. A recent meta-analysis of randomised controlled trials investigated the effects of cestocidal/cysticidal drugs on neuroimaging and clinical outcomes in patients with neurocysticercosis. According to that meta-analysis of published data, cestocidal/cysticidal drug therapy results in a lower risk of seizure recurrence in patients with colloidal cysticerci, a decrease in the frequency of generalised seizures in patients with vesicular cysticerci, and better resolution of both colloidal and vesicular cysticerci. Remember that not all neurocysticercosis patients should be treated with cestocidal/ cysticidal drugs. These drugs may exacerbate the symptoms of intracranial hypertension found in cysticercotic encephalitis patients [36].

To avoid further therapy-related increases in intracranial pressure, cestocidal/ cystocidal medicines should only be administered to patients with parenchymal brain cysts and hydrocephalus. Concurrent steroid administration is necessary to reduce the risk of a cerebral infarct. Individuals with ventricular cysts should refrain from taking cestocidal/cysticidal drugs. Last but not least, cestocidal/cysticidal drugs should not be administered to individuals who merely have calcifications because these lesions simply reveal parasites that are already dead. Patients with epilepsy brought on by neurocysticercosis often get seizure control after using just one first-line antiepileptic drug. According to some research, in order to effectively manage their seizures, patients with live intracranial cysts should first receive cestocidal/cysticidal medication before receiving antiepileptic medication [38].

It is unknown how long patients with neurocysticercosis should take antiepileptic medication. Prospective research found that up to 50% of patients with parenchymal brain cysticercosis who were successfully handled with cestocidal/cysticidal drugs later lost consciousness after quitting their antiepileptic drugs [39].
