On the Horizon of Treatments for Neurocysticercosis in Children

Control and Prevention

The neglected tropical diseases campaign has focused the attention of health organizations on the control and prevention of NCC. The U.S. Centers for Disease Control and Prevention have created a list of recommendations that is summarized below(61).

• Avoiding fecal–oral transmission of eggs from persons with taeniasis: Provision of safe water, sanitation, and hygiene. Integrated vector control/management (6,7,21).
• Education of food handlers: Instruction in good hand washing practices (6).
• Identification and treatment of tapeworm carriers: Evidence-based guidelines showed that albendazole (conventional dosage 15 mg/kg/day in 2 divided doses for at least 15 days) is safe and effective in reducing both the number of cysts and long-term seizure frequency in adults and children with NCC (28).
• Stool examinations for taeniasis:  Stool examinations results in detection and preventive treatment of population at risk or infected individuals (6).
• Pig immunization: Using antigens from the scolex, from the entire cyst, or from the oncosphere, immunizations have demonstrated different degrees of protection. TSOL18 is an oncospheral recombinant protein that can provide almost absolute protection to further infection (62–64).
• Pediatric diagnostic criteria: For the moment, there are no validated diagnostic criteria applicable to clinical use in pediatric population, therefore, frequently the adult diagnostic criteria are applied.

 Host Susceptibility

• Immune mechanisms: Understanding underlying symptomatic human cysticercosis and helminth-induced immune suppression is of clinical interest. Research indicates the Toll-like Receptor-4 (a transmembrane protein encoded by the TLR4 gene) and the intercellular adhesion molecule K469E polymorphisms may predispose to symptomatic infection (65,66).
• Genetic susceptibility: Preliminary works have been reported on positive association of increased frequency of some genes (HLA-A28, HLA-B63, HLA-B58, TLR 4 Asp299Gly, sICAM1 gene K469E, GSTM1, and GSTT1) and NCC, while other (HLADQW2 and HLA-A11) were shown to provide protection from disease (67).

New Treatments

• New drugs: Oxfendazole was proven to be safe in animals and is a promising alternative to the limited portfolio of antiparasitic drugs. Nanoparticle delivery systems offering prednisone and albendazole are still in being tested in vitro (68,69).