Brain worm treatment and neurocysticercosis- What should you know?

You should consult a neurologist

Neurocysticercosis (NCC) is a brain worm infection caused by Taenia solium.  This infection is caused when one swallows tapeworm eggs, which spread to muscle and brain, and form muscle worm cysts and brain worm cysts (NCC)

Patients get worm infection when they worm eggs. These worm eggs spread through food, water, or surfaces contaminated with faeces/stools.  Eating pork may not necessarily cause worm infection

Signs and symptoms will depend on the location and number of cysts

• Cysts in the muscles:
  • May not cause symptoms. Sometimes these swellings can become painful
• Cysts in the eyes:
  • Can cause blurred vision or double vision
• Neurocysticercosis (cysts in the brain, spinal cord):
  • These can cause headache, dizziness, fainting, vomiting, seizures, loss of consciousness

Diagnosis is based on contrast MRI of the brain. Sometimes special MRI like 3D Ciss and MRI spectroscopy may be needed. Blood test may need to be done, but these are not very accurate

NCC is one of the top 4 cases of epilepsy in India. The other three common causes of epilepsy include brain infections, head injury, and birth-related brain injuries. The estimated frequency of worm in brain in North India is 100-350 cases per 100,000 population

We suggest the following tests to be done before initiating treatment for NCC

Complete hemogram with ESR, liver function tests, kidney function test

Blood sugar, ionised calcium, Vitamin D, Vitamin B12, Magnesium if the person has seizures

Ophthalmological examination to see for choroidal tubercles and ocular NCC

Chest Xray and Ultrasound of the abdomen

EEG test of brain

Treatment of Neurocysticercosis or NCC has three parts:
Treatment of brain swelling: Steroid treatment to decrease peri-lesional edema or swelling around the worm. These are usually given for 2-4 weeks

Medication for seizure control- These are usually given for 1-2 years and which may need to be prolonged if seizures recur. Your treating neurologist may prefer  phenytoin, carbamazepine, oxcarbamazepine, levetiracetam or brivacetam depending on age and type of seizure

Medication for worms’ treatment in brain– is given for 2 to 4 weeks depending on the number of lesions. The choice of medication is  albendazole. The duration of  albendazole depends on number of brain worms. These medications are started 3-5 days after starting of steroid treatment to avoid any serious allergic reaction. In some cases, there is risk of worsening of neurologic symptoms due to inflammation especially if there are many lesions or there are signs of raised intracranial pressure. Worm therapy should not be given to persons with untreated hydrocephalus, cysticercal encephalitis, or calcified lesions only.

Medication for vomiting and headache as advised by the doctor

Follow-up imaging should be performed every six months following completion of initial treatment till resolution of the worm. Patients with persistent worms may need repeat treatment for worms in brain. Repeat MRI does not cause radiation risk and is safe, though children might need sedation for MRI (which has low risk associated)

Some children may have seizure recurrence even on medications. The duration of seizure medications is minimum 24 months for children with more than two lesions

Risk factor for recurrent seizures is:

Residual cystic lesion on CT/MRI brain

Calcification on CT/MRI brain

Recurrent breakthrough seizures

More than 2 seizures during the illness

Perilesional edema (swelling) around calcified lesions

Seizure medications tapering and stoppage can be considered if there are:

• Few seizures prior to worm treatment
• Normal CT and MRI of brain
• No seizures for the last 24 months 

For those with single worm lesion in brain, seizure medication can be tapered if MRI brain is normal after 6-12 months

However, if medication is reduced or stopped, and seizure recurs, anti-seizure medications need to be started

In such a scenario, anti-seizure medications are given for minimum 2 years or more. Person with calcified lesions is at risk of recurrent seizures and epilepsy

What is Treatment of worm infection in pregnancy?

Anti-seizure medication needs to be given in pregnancy. Worm treatment may need to be deferred till after pregnancy. Corticosteroids can be used in pregnancy

The seizure recurrence rate is nearly 50% for a person with calcified granuloma with seizures. The interval between two seizures can be as wide may range from 17-56 months. The duration of recurrent seizures can be very wide too ranging from 26 to 58 months. Persons with recurrent seizures are at risk of hippocampus injury, which can further prolong the duration of epilepsy. The seizure recurrence rate is very high (upto 50%) in those children who have calcified granuloma

We suggest deworming treatment of all members of the family. Stool test may be done for all family members

No. Person with brain worm infection or neurocysticercosis cannot spread the disease to other family members. However, persons with stomach worm infection can spread worm eggs to other people if they do not practice good hand washing practises which may cause worm infection if they swallow the eggs

• Wash your hands with soap and warm water after toilet, after changing diapers, and before preparing food/eating
• Teach children handwashing technique
• DO not eat raw vegetables and fruits, and wash them before eating
• During travel:
• Drink only mineral water or boiled (1 minute) water
• Aquaguard quality- absolute 1 micron or less filter
• Wash all vegetables 2 to 3 times scrub them nicely, especially the ones which are eaten raw.
• Always peel carrots, cucumbers, radishes etc.
• Insist that kids wash their hands before eating, after playing, after coming back from outside etc.
• Avoid having food off the streets.
• Always have boiled drinking water
• Hygiene measures: avoid many visitors, handle after washing hands with soap, use sterilium
• Minimize outdoor visits, parties, market visits, large crowd, travel, public travel to reduce risk of infection
• Live vaccination (Measles, MMR, varicella, BCG, Oral polio vaccine) to be avoided for 6 months.
•  

brain worm is rarely life-threatening. Certain types of brain worm infection like hydrocephalous, NCC encephalitis, worms infection, and multiple worm infection of brain can become life threatening

Seizures if prolonged can become life threatening. So kindly go through the seizure first aid measures which all family members should know

• Precautions for child on corticosteroids (oral prednisolone/ Inj ACTH): Low salt, low oil, low ghee, low butter
• Opthal evaluation for cataract and glaucoma after every month
• Foods advisable: green vegetables, salads, dal, paneer, egg without yellow part… This is for children above 6 months
• Eat Less roti and rice and more of vegetables
• Report to nearest physician of child has fever, cough cold or loose stools. Probiotics are to be avoided in the treatment of loose stools. Do not stop prednisolone/ACTH without consulting the doctor
• Side effects which are common but not worrying- darkening of skin colour, weight gain, fullness of cheeks, excessive eating, demanding feeds too frequently and during night also. Weight gain reverses in 6-12 months
• Side effects which are common, which need to be brought to the notice of doctor- vomiting, regurgitation of feed, irritability, reduced sleep, excessive crying, increased BP, increased sugar, positive urine sugar