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神经囊尾蚴病:关于基础及未来药物治疗的新概念与见解。

Neurocysticercosis: A new concept and insight into basic and future pharmacotherapy.

作者信息

Al-Saeed Wisam Mahdi, Oleiwi Al-Kuraishi Azhar Hatif, Dahash Salma Luaiby, Al-Gareeb Ali Ismail, Alkuraishy Hayder Mutter

机构信息

Department of Clinical Pharmacology, Medicine and Therapeutic, Al- Mustansiriya University, Baghdad, Iraq.

出版信息

J Pak Med Assoc. 2019 Aug;69(Suppl 3)(8):S113-S118.

Abstract

Neurocysticercosis is a neurological infection caused by the larva of taenia solium. The larva infection may affect different parts of the human brain and spinal cord, leading to focal neurological deficit with/without inflammatory reactions. Neurocysticercosis is one of the major causes of epilepsy in the developing countries. It is of two types. One is extra-parenchymal neurocysticercosis in which cysticerci cysts at subarachinoid space and ventricles lead to obstructive hydrocephalus and increase in the intracranial pressure. The other type is intra-parenchymal neurocysticercosis in which the cysticerci cyst grows inside the brain parenchyma, causing the feature of space-occupying lesion. The common presentation of intra-parenchymal neurocysticercosis is secondary epilepsy which is due to focal lesion and/or local inflammatory reactions. Cysticidal therapy increases the risk of seizure due to the induction of host inflammatory reactions. Therefore, coadministration of corticosteroids reduces the risk of seizure through attenuation of inflammatory reactions and brain oedema. Praziquantel alone or in combination with albendazole is regarded as the basic cysticidal therapy against neurocysticercosis. Newer drugs and agents are recommended to overcome the partial failure of standard cysticidal therapy.

摘要

神经囊尾蚴病是由猪带绦虫幼虫引起的一种神经系统感染。幼虫感染可能会影响人脑和脊髓的不同部位,导致有或无炎症反应的局灶性神经功能缺损。神经囊尾蚴病是发展中国家癫痫的主要病因之一。它有两种类型。一种是脑实质外神经囊尾蚴病,其中蛛网膜下腔和脑室的囊尾蚴囊肿会导致梗阻性脑积水和颅内压升高。另一种类型是脑实质内神经囊尾蚴病,其中囊尾蚴囊肿在脑实质内生长,导致占位性病变的特征。脑实质内神经囊尾蚴病的常见表现是继发性癫痫,这是由于局灶性病变和/或局部炎症反应所致。杀囊治疗由于诱发宿主炎症反应而增加癫痫发作风险。因此,联合使用皮质类固醇可通过减轻炎症反应和脑水肿来降低癫痫发作风险。吡喹酮单独使用或与阿苯达唑联合使用被视为治疗神经囊尾蚴病的基本杀囊治疗方法。推荐使用更新的药物和制剂来克服标准杀囊治疗的部分失败。

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