Question

A 10-year-old boy presents with focal seizures. MRI brain shows multiple small ring-enhancing lesions suggestive of neurocysticercosis. What is the appropriate management?

• A. Albendazole + Antiepileptics + Steroids $\pm$ Praziquantel
• B. Praziquantel alone
• C. Carbamazepine alone
• D. IV antibiotics

Hint:

Always start corticosteroids before or along with antihelminthic therapy (Albendazole $\pm$ Praziquantel) to prevent acute raised ICP and paradoxical worsening from the inflammatory response to dying larvae.

Answer 1

The Correct Option is A

Concept:
Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system, caused by the larval stage of the tapeworm Taenia solium.
The management of active parenchymal neurocysticercosis with multiple lesions requires a multimodal strategy addressing seizure control, inflammation, and antiparasitic eradication.
Explanation:
• Seizures are the most common clinical manifestation of parenchymal NCC in pediatric patients; thus, antiepileptic drug (AED) monotherapy is mandatory as the initial symptomatic step to achieve complete seizure control.

• Cysticidal therapy (albendazole at $15\text{ mg/kg/day}$ in two divided doses for 10--14 days) hastens the resolution of active parenchymal cysts and decreases long-term seizure recurrence.

• For patients with multiple non-encephalitic viable parenchymal cysticerci ($>2$ lesions), dual cysticidal therapy combining albendazole and praziquantel ($50\text{ mg/kg/day}$) has demonstrated superior cyst clearance compared to albendazole monotherapy.

• Destruction of the parasite releases antigenic material that triggers severe local host inflammatory response and perilesional brain edema; therefore, concomitant corticosteroid therapy (dexamethasone or prednisolone) is essential and must be initiated prior to or simultaneously with cysticidal agents.
Final Answer:
The appropriate comprehensive management of multiple parenchymal lesions in neurocysticercosis consists of Albendazole + Antiepileptics + Corticosteroids $\pm$ Praziquantel.