Treatment outcome in patients with spinal neurocysticercosis: a systematic review of published cases and case series

Spinal neurocysticercosis is a rare central nervous system infection caused by the larval form of the <i>Taenia solium</i>. Due to its rarity, most knowledge is derived from isolated case reports. This review aims to evaluate existing case reports and observational studies to provide a comprehensive overview of the disease’s clinical presentation and treatment outcomes. Following PRISMA guidelines, a comprehensive search was performed across various databases. The review included case reports, case series, and observational studies, and it is registered with PROSPERO (CRD42024496957). This review analyzed 206 spinal neurocysticercosis cases (from 171 published reports). Symptoms persisted for one week to six months in 49% of cases, and common presentations included paraparesis/quadriparesis (61.7%) and neck/limb/back pain (40.8%). CSF abnormalities were observed in 23.8%. Thoracic involvement was most frequent (39.3%), followed by cervical (27.2%). Neurocysticercosis lesions in other regions, primarily the brain, were found in 18.9%. Differential diagnoses included spinal cord tumors (13.1%). Treatment often involved surgery alone (32%) or with cysticidal drugs (45.6%), with a 91.3% improvement rate, indicating favorable outcomes. Spinal neurocysticercosis primarily affects the thoracic and cervical regions. Most patients respond well to medical therapy; surgery is mainly for progressive neurological deficits. Neurocysticercosis is an infection caused by the larvae of a tapeworm called <i>Taenia solium</i> entering the body. This tapeworm is common in areas with poor sanitation and hygiene, where people often have contact with contaminated food or water. Once ingested, the larvae travel through the bloodstream to various parts of the body, including the muscles, skin, eyes, spinal cord and the brain. In the brain or spinal cord, the larvae can cause severe symptoms. To diagnose neurocysticercosis, doctors often use imaging tests that show the cysts that form in the nervous system. In our study, we looked at a group of patients who had spinal neurocysticercosis to understand their symptoms, how they were diagnosed and how effective different treatments are. Most patients had weakness in the legs or lower body and ongoing back pain. Many patients were first treated with surgery to remove the cysts from the spinal cord. We found that medications to kill the tapeworm larvae, known as antiparasitic or anti-worm medicines, were often just as effective. This means that surgery could be avoided in many cases if medications are used instead.