Singhi Pratibha, Singhi Sunit
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Child Neurol. 2004 Jul;19(7):482-92. doi: 10.1177/08830738040190070201.
Neurocysticercosis is a major cause of neurologic disease worldwide. The clinical presentations are pleomorphic depending on the stage and location of cysts in the nervous system. Most children (> 80%) present with seizures, particularly partial seizures; headache and vomiting are seen in about a third of cases. Diagnosis is made by either computed tomography (CT) or magnetic resonance imaging. Single enhancing lesions are the most common finding. Visualization of a scolex confirms the diagnosis. Some cases have multiple cysts; the "starry-sky" appearance in cases with innumerable cysts is characteristic. Most children require anticonvulsants. Corticosteroids are indicated in those with cerebral edema. The efficacy of cysticidal therapy continues to be debated. Controlled studies suggest that cysticidal therapy helps in increased and faster resolution of CT lesions, but there is no conclusive evidence that it improves long-term seizure control. The prognosis in cases with single lesions is good; seizure control is achieved with a single anticonvulsant, and the recurrence rate is low. Children with multiple lesions have recurrent seizures. Extraparenchymal neurocysticercosis is rare in children and carries a poor prognosis. Neurocysticercosis must be considered in the differential diagnosis of seizures and a wide variety of neurologic disorders, particularly in endemic areas.
神经囊尾蚴病是全球神经系统疾病的主要病因。其临床表现因囊肿在神经系统中的阶段和位置而异，具有多形性。大多数儿童（>80%）表现为癫痫发作，尤其是部分性发作；约三分之一的病例可见头痛和呕吐。诊断通过计算机断层扫描（CT）或磁共振成像进行。单个强化病灶是最常见的发现。看到头节可确诊。有些病例有多个囊肿；无数囊肿病例中的“星空”外观具有特征性。大多数儿童需要抗惊厥药物。有脑水肿的患者需要使用皮质类固醇。杀囊治疗的疗效仍存在争议。对照研究表明，杀囊治疗有助于CT病灶更快、更多地消退，但没有确凿证据表明它能改善长期癫痫控制。单个病灶病例的预后良好；使用单一抗惊厥药物即可控制癫痫发作，复发率低。有多个病灶的儿童会反复发作癫痫。儿童脑实质外神经囊尾蚴病罕见，预后不良。在癫痫和各种神经系统疾病的鉴别诊断中，尤其是在流行地区，必须考虑神经囊尾蚴病。
