Current approaches to cysticidal drug therapy for neurocysticercosis

Introduction: Cysticidal drugs have improved the prognosis of thousands of patients with neurocysticercosis (NCC). However, conflicting studies have created controversies on the actual value of these drugs. Here, the reasons of these controversies, as well as evidence showing the beneficial role of cysticidal drugs are reviewed. Areas covered: The present review (based on different databases searches up to March 2020), focuses on the evidence supporting the use of cysticidal drugs in patients with NCC. For parenchymal NCC, albendazole alone must be used for patients with one or two cysts, while the combination of albendazole plus praziquantel is advised for those with more than two lesions. Level I evidence on the optimal regimens of cysticidal drugs for treatment of extraparenchymal NCC is lacking, although there is growing evidence supporting the use of cysticidal drugs in these cases, providing that hydrocephalus and intracranial hypertension have previously been treated. Expert opinion: With the exception of therapy of patients with viable parenchymal brain cysticerci, we are far from getting level I evidence on the best approach for each of the other forms of NCC, as most of our knowledge on therapy for extraparenchymal NCC is based on non-controlled studies or small series of patients.