Initial Management at Presentation
- Control of seizures: Emergent status epilepticus should be treated. Children can usually be managed with single anti-epileptic drugs (53).
- Control of brain edema: Corticosteroids suppress the inflammatory response elicited by destruction of live cysticerci at a dose of 0.15 mg/kg per day of dexamethasone for at least 5 days in 2 to 3 divided doses (54).
- Anthelmintic drugs: Antihemintic medication is generally indicated for symptomatic patients with multiple, live parenchymal noncalcified cysts. Anthelmintic drugs will not benefit patients with calcified, dead worm cysts.
- Anthelmintic drugs may also be effective on ventricular or cisternal cysts: Their efficacy in these situations is debatable. Otherwise, it is unlikely that live cysts will be spontaneously destroyed (30,32,39)
- Albendazole is the drug of choice: It has been used in a dose of 15 mg/kg/day in two or three divided doses for 28 days.
- Praziquantel is the oldest cysticidal drug. It is used in a dose of 50 mg/kg/day for 15 days. A single-day praziquantel therapy (25 mg/kg/dose every 2 h × 3 doses) has been reported to be as effective as 7-day treatment with albendazole.
- Ocular cysticercosis: Treatment with anthelmintic drugs is contraindicated when there is ocular cysticerosis because the inflammatory response may worsen the outcome. Surgical removal is usually necessary in individuals with intraocular cysts (55).
- Resolution of the lesion on CAT scans: The cysts resolve in about 68% of the patients 4 weeks to 3 months after treatment. Cured patients may remain seropositive even 1 year after the end of the treatment (5,19,28,32).
- Imaging at 3 months: MRI or CAT scanning is performed after 3 months to follow resolution of lesions.
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