Inflammation in neurocysticercosis: clinical relevance and impact on treatment decisions

ABSTRACT

Introduction

Neurocysticercosis is caused by the localization of Taenia solium larvae in the central nervous system. The disease remains endemic in most countries of Latin America, Asia and Africa. While major improvements have been made in its diagnosis and treatment, uncertainties persist regarding the clinical implications and treatment of the inflammatory reaction associated with the disease.

Areas covered

In this review, based on PubMed searches, the authors describe the characteristics of the immune-inflammatory response in patients with neurocysticercosis, its clinical implications and the treatment currently administered. The dual role of inflammation (participating in both, the death of the parasite, and the precipitation of serious complications) is discussed. New therapeutic strategies of potential interest are presented.

Expert opinion

Inflammatory reaction is the main pathogenic mechanism associated to neurocysticercosis. Its management is mainly based on corticosteroids administration. This strategy had improved prognostic of patients as it allows for the control of most of the inflammatory complications. On the other side, it might be involved in the persistence of parasites in some patients, despite cysticidal treatment, due to its immunosuppressive properties. New strategies are needed to improve therapeutical management, particularly in the severest presentations.

KEYWORDS:

• Anti-inflammatory drugs
• corticosteroids
• inflammation
• neurocysticercosis
• neuroinflammation
• parasite
• taenia solium

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• Neuroinflammation is the main pathogenic mechanism in patients with parenchymal and extraparenchymal neurocysticercosis.

• Neuroinflammation is involved in the main symptoms of NC, namely seizures, epilepsy, intracranial hypertension, and symptoms related to vasculitis and arachnoiditis.

• Corticosteroids are able to control the inflammatory reaction in most patients, significantly improving their prognosis.

• Corticosteroids could be involved in the non-response to cysticidal treatment mainly observed in patients with extraparenchymal disease, due to their immunosuppressive effects.

• The development of new strategies to control the inflammatory response is necessary.

Additional information

Funding

This work was partially supported by the Consejo Nacional de Ciencia y Tecnología (CONACYT, grant numbers S0008-2015-1, 261153 and FOSISS-272519)..