Twenty-five years of evolution of standard diagnostic criteria for neurocysticercosis. How have they impacted diagnosis and patient outcomes?

Introduction: Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system and a global public health problem. However, its diagnosis is complicated since histological demonstration of the parasite is often not feasible, clinical manifestations are nonspecific, most neuroimaging findings are not pathognomonic, and immunological tests have problems related to poor reliability. Unified chart of criteria is needed to standardize the diagnosis of NCC in different settings. Areas covered: Starting in 1996, three charts of diagnostic criteria have been developed on the basis of objective evaluation of clinical, radiologic, immunologic, and epidemiologic data. The first chart covered the diagnosis of both human cysticercosis and NCC. The second chart focused on the diagnosis of NCC, and was structured into four degrees of criteria: absolute, major, minor and epidemiologic. The last revision took into account that neuroimaging studies are essential for the diagnosis of NCC, while clinical and exposure data only provide circumstantial evidence favoring this diagnosis. Expert opinion: These charts have been accepted by the medical community as demonstrated by their widespread use. A correct diagnosis often allows a prompt therapeutic approach, thus reducing late complications of NCC and the avoidance of invasive interventions.