Management of Neurocysticercosis in Children: Association of Child Neurology Consensus Guidelines

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Lab tests:

1. Routine screening of family members of children with NCC is not recommended. If at all screening is performed, fecal testing of the family for ova/cyst can be done.
2. The use of serological tests for diagnosis and clinical decision making in children with NCC is not recommended.

Radiological tests:

1. The MRI need not be done following CT in the following situations -
1.  The CT conclusively demonstrates the presence of a scolex within the cyst
2.  In the absence of demonstration of scolex –
• If a solitary cystic/ring-enhancing lesion has all other typical sizes, shape, and location characteristics of NCC
• Multiple lesions in different stages are present, including some cystic or ring enhancing or calcified
2. MRI should be considered after CT in the following situations –
• Atypical imaging features (conglomerate lesions, subarachnoid or intraventricular lesions) along with the absence of scolex
• CT features create suspicion of intraventricular, subarachnoid, or intraspinal NCC
• Atypical clinical features including features of meningitis, encephalopathy, vision loss, fleeting headaches, stroke like features and behavioral changes.
3. MR sequences like MR spectroscopy and Magnetisation transfer imaging if MRI failed to differentiate from tuberculoma.
4. In the absence of conclusive evidence
• the features favoring NCC
• Solitary well defined, thin-walled cystic or ring-enhancing lesion usually <2 cm in size with mild perilesional edema in a typical location of grey-white matter junction or basal ganglia
• multicentricity of lesions with lesions showing different estages
• repeat contrast-enhanced MRI may be performed at an interval of 6-8 weeks to look for interval change
5. After treatment MRI done at 6mo unless worsening/new symptom/sign

Treatment:

Intraparenchymal cyst:

1 viable cyst: Albendazole 10-14days

≥ 2 viable cyst: Albendazole + Praziquantel,

10-14 days

[Albendazole: 15mkd BD Max: 1200mg/d,

Praziquantel: 50mkd Max: 3600mg/d ]

Atypical cyst:

Cysticercal encephalitis: i.v pulse steroids

Methylprednisolone: 10-30mkd Max:1000mg/d 3-5days

Dexamethasone: 3-6mkd max:16mg/d 3-5days.

persistent viable cysts:

Antiseizure medication for single cyst is 6 months if lesion resolves in follow up and 24 months if there is multiple lesions or persisting lesions.