Neurocysticercosis: the good, the bad, and the missing

Introduction: Neurocysticercosis (NC) is a neglected disease that contributes substantially to neurological morbidity/mortality in lower-income countries and increasingly among high-income countries due to migration. Many advances have been made in understanding NC, but unanswered questions remain Areas covered: This review discusses the epidemiology, pathophysiology, immunology, diagnosis, treatment, and eradication of NC. Expert commentary: The global NC prevalence remains unknown and needs proper ascertainment. Further understanding of the pathophysiology of extraparenchymally located cysts is needed to improve management. The role of inflammation, which is required for parasite death and reabsorption, but may lead to severe complications, must be better understood. Valid screening tools including immunological and molecular tests need to be developed to reduce the reliance on neuroimaging which is not usually accessible in endemic areas. Prognosis for people with parenchymal NC is generally good after treatment, but there are no sufficiently powered randomized trials evaluating antiparasitic treatment for extraparenchymal NC. Most people with seizures do not develop epilepsy. Overemphasizing NC as the main cause of epilepsy could increase stigmatization with potential medico/social implications. Several tools for prevention and control of taeniasis/cysticercosis are available, but strategies to eradicate NC must be created with the involvement of all stakeholders.