Treatment of Cysticercosis of the Central Nervous System in Spinal Neurocysticercosis

Spinal neurocysticercosis (SN) is a specific presentation of CNS cysticercosis in which cysticerci involve the spinal cord or nerve roots. It carries a risk of serious neurological deficits — including paraparesis and loss of sphincter control — and requires a structured treatment approach distinct from cerebral disease.

This protocol is indicated for patients with spinal neurocysticercosis, particularly those presenting with evidence of spinal cord dysfunction. The parasitic and inflammatory components of the disease each factor into the treatment decision.

Treatment approach

Management may involve a medical strategy combining anti-inflammatory therapy with antiparasitic agents, or a surgical approach in select cases. Which path is appropriate — and the full clinical algorithm — is covered in the complete protocol.

Treatment response is assessed by regression of cystic lesions and improvement of spinal cord enhancement on serial MRI of the spine.

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References

DOI: 10.1093/cid/cix1084

We recommend corticosteroid treatment for patients with SN with evidence of spinal cord dysfunction (eg, paraparesis or incontinence) or as adjunctive therapy along with antiparasitic therapy (strong, moderate).
We suggest that both medical (antiparasitic drugs plus anti-inflammatory drugs) and surgical approaches be considered for SN (weak, low).
Surgical treatment with excision of the cysticerci after laminectomy has been the norm in cases of spinal cord or radicular compression.
The clinical picture along with the MRI of the spine should be followed and examined for regression of the cystic lesions and improvement of enhancement.

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