Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

Cysticercosis 457

specific therapy

Indications

■Treat patients with viable cysts (those without ring enhancement)

and signs of mass effect. Treatment of patients with cysts in stages

of degeneration, with or without focal symptoms or seizures, is con-

troversial.

Treatment Options

■Albendazole for 8–20 days. Repeat if needed.

■Praziquantel for 15 days. Repeat if needed.

Side Effects & Complications

■Death of cysts can cause inflammation, headache, seizures. Control

this with dexamethasone, and taper, or administer steroids prophy-

lactically (especially with large number of cysts). Steroids enhance

absorption of albendazole, reduce absorption of praziquantel.

Albendazole can cause mild GI distress, in longer courses can cause

neutropenia, alopecia, liver function abnormalities. Prazquantel

can cause mild GI distress, malaise, dizziness, urticaria, all usually

mild.

■Contraindications to treatment: absolute: dead, calcified cysts

■Contraindications to treatment: relative: asymptomatic patients

with viable or degenerating cysts (this is a controversial area)

follow-up

During Treatment

■Observe for headache, seizures, altered consciousness, due to sud-

den death of parasites.

Routine

■Serial MRI or CT scans. If viable cysts remain, re-treat. If seizure-

free in 2 years and EEG normal, can stop anticonvulsants. Educate

patient about epidemiology to prevent reinfection.

complications and prognosis

■Prognosis generally good in absence of hydrocephalus, though

seizures may be permanent. Shunts frequently clog up due to

cyst debris, and outlook poor. Periodic steroids may prevent shunt

obstruction.