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Treatment of neurocysticercosis

Current status and future research needs

From the Laboratory of Parasitic Diseases (T.E.N.), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD; Dayanand Medical College and Hospital (G.S.), Ludhiana, Punjab, India; Infectious Disease Section (A.C.W.), Department of Medicine, Baylor College of Medicine, Houston, TX; Department of Neurological Sciences (V.R.), Christian Medical College and Hospital, Vellore, India; Department of Neurology and Center for Molecular Medicine and Genetics (J.A.L.), Wayne State University School of Medicine, Detroit, MI; Medical Research Unit for Neurologic Diseases (J.V.P.), Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexican Institute of Social Security, Mexico City; Department of Neurology (O.M.T.), School of Medicine of Ribeirao Preto, Universidade de Sao Paulo, Ribeirão Preto, Brazil; School of Veterinary Medicine (A.E.G.), Universidad Nacional Mayor de San Marcos, Lima, Perú; Department of International Health (A.E.G., R.H.G., H.H.G.), Johns Hopkins University Bloomberg School of Hygiene and Public Health, Baltimore, MD; Diagnostic Radiology Department (J.A.B.), Warren G. Magnuson Clinical Center, NIH, Bethesda, MD; Department of Neurology (C.D.G., A.D.-E.), Reed Neurological Research Center, UCLA, Los Angeles, CA; Department of Neurological Sciences (O.H.D.B.), Hospital-Clínica Kennedy, Guayaquil, Ecuador; VA Epilepsy Center of Excellence (A.D.-E.), Los Angeles, CA; University of Cambridge Clinical School (C.A.W.E.), Cambridge, and Department of Infectious Diseases and Microbiology, Imperial College London, London, UK; Department of Microbiology (R.H.G., E.J.P., H.H.G.), Universidad Peruana Cayetano Heredia, Lima, Perú; Cysticercosis Unit (S.M.M., H.H.G.), Instituto Especializado en Ciencias Neurológicas, Lima, Peru; Universidad Nacional Autonoma de Honduras (M.T.M.), Tegucigalpa, Honduras; and Department of Microbiology and Immunology (J.T.), University of Texas Health Science Center, San Antonio.

Address correspondence and reprint requests to Dr Nash, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD; e-mail: tnash{at}niaid.nih.gov

Here we put forward a roadmap that summarizes important questions that need to be answered to determine more effective and safer treatments. A key concept in management of neurocysticercosis is the understanding that infection and disease due to neurocysticercosis are variable and thus different clinical approaches and treatments are required. Despite recent advances, treatments remain either suboptimal or based on poorly controlled or anecdotal experience. A better understanding of basic pathophysiologic mechanisms including parasite survival and evolution, nature of the inflammatory response, and the genesis of seizures, epilepsy, and mechanisms of anthelmintic action should lead to improved therapies.

Supported by the Office of Rare Diseases (NIH), National Institute of Allergy and Infectious Diseases/Laboratory of Parasitic Diseases (NIH), Universidad Peruana Cayetano Heredia (Lima, Peru), and Instituto de Ciencias Neurologicas (Lima, Peru).

Disclosure: The authors report no conflicts of interest.

Received January 6, 2006. Accepted in final form June 7, 2006.

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