Antiparasitic treatment improves the prognosis for NCC-induced seizures. However, patients with high lesion loads are typically denied the possible benefit of cysticidal therapy for fear of complications, and such patients are not represented in trials. We provide proof of concept for treatment with dual-antiparasitic therapy and corticosteroids in patients with diffuse or calcific NCC.

Written, informed consent was taken and all patients underwent MRI brain to rule out an intraventricular/subarachnoid NCC, hydrocephalus, diffuse cerebral edema and raised intracranial pressure. An ophthalmological examination was done to rule out intra-ocular cysts. Patients were pre-treated with intravenous dexamethasone (0.2mg/kg/body weight divided into three doses), and continued to be treated during the anti-parasitic treatment.  Oral antiparasitic drugs were initiated three days later. Albendazole 200mg was started first, and increased to the target dose of 15mg/kg/day with increments of 200mg every three days. Thereafter, praziquantel 300mg was started, and up-titrated by 300mg every three days to the target dose of 50mg/kg/day. Both were continued for twelve weeks after reaching the desired dose. Thereafter, dexamethasone was tapered and stopped over three weeks. NCCT head and MRI brain were repeated in all patients two weeks after completing treatment. Hemogram, liver and renal function tests were performed every week.

Baseline neuroimaging showed multiple viable and calcified parenchymal NCC in all patients. Post-treatment images revealed near-complete clearance of both viable and calcific parenchymal NCC in all three patients. Case 1 had approximately 10-ring lesions and 21-disc lesions remaining (>400 at baseline), case 2 had around 40 (>400 at baseline) and case 3 had 13 (40 at baseline) remaining lesions.

The safety and efficacy of treating patients with diffuse parenchymal or calcific NCC should be tested in a randomised controlled trial.