Carpio A, Escobar A, Hauser W A
Faculty of Medicine and Research Institute, University of Cuenca, Ecuador.
Epilepsia. 1998 Oct;39(10):1025-40. doi: 10.1111/j.1528-1157.1998.tb01287.x.
Neurocysticercosis (NC) remains a major public health problem in developing and some developed countries. Currently, the best procedures for diagnosing NC are neuroimaging studies. Immunoserologic assays, such as enzyme-linked immunoelectrotransfer blot assay (EITB) or enzyme-linked immunosorbent assay (ELISA), detect antibodies against Taenia solium, or cysticercus. Consequently, they are useful in identifying a population at risk of contact with the parasite but do not necessarily indicate a systemic active infection. Most seropositive individuals are asymptomatic. No data from prospective studies concern the proportion of these individuals that will develop seizures or other neurologic symptoms. There is a discrepancy between the results of serologic assays and neuroimaging studies: >50% of those individuals with NC diagnosed by computed tomography (CT) scan test EITB negative. Pathophysiologic classification of NC into active, transitional, and inactive forms permits a good correlation between clinical manifestations and neuroimaging procedures and facilitates medical and surgical management and research. The most frequent clinical manifestations of NC are seizures. We assume that NC is the main cause of symptomatic epilepsy in developing countries; however, no case-control or cohort studies demonstrate this association. Most patients with NC with seizures have a good prognosis; nevertheless, further studies analyzing factors related to recurrence of seizures and possibilities of discontinuation of antiepileptic medications (AEDs) are needed. Regarding treatment of NC with antihelminthic drugs, no controlled clinical trials exist that establish specific indications, definitive doses, and duration of treatment. The most effective approach to taeniasis/cysticercosis infection is prevention. This should be a primary public health focus for developing countries. We critically review the available information regarding the epidemiology and diagnosis of human cysticercosis, the physiopathology and imaging correlation of the parasite in the central nervous system (CNS) of the host, the relation between seizures or epilepsy and NC, and the issues surrounding the treatment and prognosis of NC, including the use of antihelminthic therapy.
神经囊尾蚴病（NC）在发展中国家和一些发达国家仍然是一个主要的公共卫生问题。目前，诊断NC的最佳方法是神经影像学检查。免疫血清学检测，如酶联免疫电转移印迹法（EITB）或酶联免疫吸附测定（ELISA），可检测抗猪带绦虫或囊尾蚴的抗体。因此，它们有助于识别有接触该寄生虫风险的人群，但不一定表明存在全身性活动性感染。大多数血清学阳性个体无症状。前瞻性研究没有数据涉及这些个体中将会出现癫痫发作或其他神经系统症状的比例。血清学检测结果与神经影像学检查结果之间存在差异：通过计算机断层扫描（CT）诊断为NC的个体中，超过50%的人EITB检测为阴性。将NC病理生理分类为活动型、过渡型和非活动型，有助于临床表现与神经影像学检查结果之间的良好关联，并便于医疗、外科治疗及研究。NC最常见的临床表现是癫痫发作。我们认为NC是发展中国家症状性癫痫的主要病因；然而，尚无病例对照研究或队列研究证实这种关联。大多数有癫痫发作的NC患者预后良好；尽管如此，仍需要进一步研究分析与癫痫发作复发相关的因素以及停用抗癫痫药物（AEDs）的可能性。关于使用抗蠕虫药物治疗NC，尚无对照临床试验确定具体适应证、确切剂量和治疗疗程。预防是治疗猪带绦虫病/囊尾蚴病感染最有效的方法。这应该是发展中国家公共卫生的首要重点。我们对有关人类囊尾蚴病的流行病学和诊断、寄生虫在宿主中枢神经系统（CNS）中的生理病理学及影像学关联、癫痫发作或癫痫与NC之间的关系以及围绕NC治疗和预后的问题（包括抗蠕虫治疗的使用）的现有信息进行了批判性综述。
