Cysticercosis may not always need treatment. About 80% of the patients with cysticercosis do not present any symptoms and these patients may not require any treatment. Each case should be assessed thoroughly for deciding the treatment modalities. Patients with Subcutaneous or intramuscular cysticercosis that cause symptoms due to inflammation can be managed by administering anti-inflammatory agents or by excision of cysticerci. For a solitary symptomatic lesion, excision is preferred. In case of single extracranial lesion, excision may be considered only after neurocysticercosis is ruled out with brain imaging. Ocular cysticercosis which involves extraocular muscle may present recurrent eye pain and diplopia. Albendazole and corticosteroids are useful in the treatment of this condition. However, surgical removal is the choice of treatment for intraocular cysticerci, instead of antiparasitic drug therapy.
Neurocysticercosis is managed as per the presenting symptoms. Patient presenting with seizures are treated with antiepileptic drug therapy. Patients with vasculitis or cerebral edema should be treated with anti-inflammatory drugs like methotrexate and corticosteroids. Those diagnosed with having hydrocephalus require a shunt surgery that reduces the intracranial pressure by channeling out cerebrospinal fluid from the brain. Although antiparasitic treatment is vital for treatment of cysticercosis, it should never be given emergently. This is because the antiparasitic drugs can further deteriorate cerebral edema and these drugs must be avoided in patients with high intracranial pressure caused by untreated hydrocephalus or diffuse cerebral edema.
Antiparasitic drugs given along with corticosteroids have better outcomes for patients with parenchymal cystic neurocysticercosis. The treatment for parenchymal neurocysticercosis is based on its form. For diffuse cerebral edema or untreated hydrocephalus, treatment involves management of increased intracranial pressure alone. For viable parenchymal cysticercosis, administration of antiparasitic drugs, only of there is no increased intracranial pressure. For a single enhancing lesion or 1-2 viable parenchymal cysts, monotherapy with albendazole at 15 mg/kg/day in 2 daily doses (up to 1200 mg/day) for 10-14 days is preferable. For more than two viable parenchymal cysts, combination of praziquantel (15 mg/kg/day in 3 daily doses) and albendazole (15 mg/kg/day in 2 daily doses up to 1200 mg/day) for 10-14 days is required. Antiparasitic drugs should always be given along with corticosteroids. All cases of seizures should be treated with antiepileptic drugs. Calcified parenchymal neurocysticercosis should not be managed with antiparasitic treatment and excision is the treatment of choice in this case.
Most individuals with parenchymal cysticercosis either do not present any symptoms or develop a seizure disorder. Patients with intracerebral calcifications, often have recurrent seizures. These seizures can be easily controlled by anticonvulsant drugs. Ventricular neurocysticercosis is usually treated by shunting. Neurosurgery can have complications like focal neurologic damage. Often shunt revisions are required, unless corticosteroids or antiparasitic drugs are used for the treatment. However, some patients may still require subsequent revision despite the treatment. Subarachnoid disease was associated with a 90% 10-year fatality rate before the use of corticosteroids and antiparasitic drugs, even with shunting. With adaptation of current management guidelines, fatalities have become rare. Evidence suggests that, once a person has been infected with cysticercosis, they are immune to reinfection.
The transmission of cysticercosis can be controlled by:
Combination of mass treatment of pigs, mass treatment for tapeworm carriage, and vaccination of pigs have shown to be beneficial in interrupting the transmission of T. solium infection in endemic regions. Also, mass chemotherapy has shown to be effective in interrupting the transmission, but the infection usually recurs in a few years. Mass anthelminthic therapy have shown only limited success; but importantly, this method can cause adverse neurologic events in patients with undiagnosed neurocysticercosis.