Medical Treatment

Controversy exists regarding treatment of NCC. Most experts agree that the inflammatory response associated with the death of the cyst is usually responsible for the development of symptomatic NCC and that inactive infection does not require treatment. Some cases of NCC have lesions that are in different stages of infection. The most active stage of infection should determine if treatment is necessary. If a cyst is calcified or ring-enhancing on neuroimaging, treatment with anthelmintics is probably not necessary. The anthelmintics of choice for NCC are praziquantel and albendazole [19] (Table 36.9). Both medications are cysticidal. Some clinical trials favor the use of albendazole over praziquantel, especially if sub-arachnoid cysts are present [22]. Steroids can be given concomitantly with an anthelmintic to reduce edema that occurs with medical treatment, but may lower the plasma level of praziquantel or increase the plasma level of albendazole [23]. Treatment has been associated with long-term improvement of seizures and decrease in number and size of intraparenchymal lesions [24]. If treatment is not indicated, seizures should be treated with anticonvulsants. Close contacts of people with NCC should receive serologic testing for NCC. Treatment of intestinal T. solium infection is a single dose of niclosamide: 1 g for children weighing 25-75 lb, 1.5 g for children over 75 lb and 2 g for adults.

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