Neurocysticercosis: The Scope of Homoeopathy

Dr Joanna Irwin

Abstract:
Neurocysticercosis is the most prevalent helminth infection of the nervous system in humans and is brought on by encysted larvae of Taenia solium. It is a significant contributor to epilepsy in tropical regions and the most frequent cause of focal-onset seizures in young children. Depending on the location, quantity, and viability of the cysts as well as the host response, children with neurocysticercosis may exhibit pleomorphic manifestations. If there is no other indication of an underlying neurological disorder in children with recent-onset seizures, headaches, or focal motor deficits in endemic areas, neurocysticercosis should be clinically suspected. The primary method for diagnosing neurocysticercosis is clinically, neuroimaging, immunological tests however visualising a scolex is diagnostic. Use of the cysticidal drugs like albendazole, which has proved to be 82 % effective in resolving lesions and 95% effective in putting an end to seizures, is one method of management but also comes with many side effects.

 Key words: Neurocysticercosis, Taenia solium, Cysticerci,  Homoeopathy

 Introduction: The most common helminthic infection of the nervous system is neurocysticercosis. It first originated in Greece and is endemic to Africa, Latin America, Eastern Europe, and Asia. Travel and emigration are to blame for a recent rise in the incidence in developed nations. According to a recent research, Kerala had the lowest prevalence of  neurocysticercosis in India and Lucknow, Uttar Pradesh, had the highest at 18.6%. It is acquired when people consume the eggs of the pork tapeworm Taenia solium and go on to become intermediate hosts in the life cycle of the worm. Through sloppy food handling practices or direct contact with human faeces, the disease is spread from tapeworm carriers to healthy people. In developing nations, neurocysticercosis is the most prevalent acquired cause of epilepsy.

Life Cycle: The two hosts on which T. solium completes its life cycle are pigs (definite host ) and humans (intermediate hosts). Taeniasis is an intestinal infection that affects humans after eating undercooked, infected pork that contains cysts from tapeworm larvae (cysticerci). In the human faeces, the cysts release larvae that develop into adult tapeworms and shed thousands of highly contagious eggs. The ingested eggs cross the intestinal wall, enter the bloodstream, and reach various tissues (especially the striated muscles) where they mature into cysticerci when pigs graze on fecal-contaminated soil. Thus, the tapeworm’s life cycle is finished. Human cysticercosis develops when people unintentionally consume food or water that has been contaminated with eggs, that has been handled by an infected person, or that they have unintentionally consumed themselves. Some of the larvae in the human intestine that hatch from the eggs move through the intestinal mucosa to form cysts in a number of tissues, including the eyes, skeletal muscles, central nervous system, and subcutaneous tissue.

Pathogenesis: The majority of cysticerci lodge at the gray-white matter junction in the brain parenchyma. By using a variety of defence mechanisms, including the continuous release of glycoconjugates from the parasite’s tegument, immuno-modulation via the serineprotease inhibitor taeniastatin, complement pathway inactivation by parasite paramyosin binding to C1q, production of alternatively activated macrophages, and activation of alternative arginase-1 pathway, these cysticerci may live asymptomatically for extended periods of time. The Th1- pathway dominates the immune response in symptomatic NCC patients, resulting in the formation of granulomas. It has been proposed that toll-like receptor-4 polymorphisms increase the risk of developing symptoms of infection. The cyst then goes through the following 4 stages (Escobar staging)

1. Vesicular stage (metacestode): The parasite resides in a clear fluid-filled cyst with thin semitransparent wall and an invaginated eccentric scolex seen as a 4-5 mm nodule. These viable cysts are generally asymptomatic and elicit inflammatory response if they start degenerating.
2. Colloidal stage: Hyaline degeneration of the larva results in opaque gelatinous cyst fluid.
3. Granular nodular stage: The cyst contracts and the wall is replaced by focal lymphoid nodules and necrosis.
4. Nodular calcified stage: The degenerating granular tissue is replaced by calcification and perilesional astrocytic gliotic changes. However, these calcified cysticerci are not totally inert and may intermittently release parasite antigens resulting in inflammatory edema and symptoms

Clinical manifestations: Neurocysticercosis clinical pleomorphism is primarily associated with individual variations in the number and distribution of lesions within the CNS as well as the intensity of disease activity. The most frequent clinical symptom of neurocysticercosis is seizures, which may be the only or primary symptom in nearly 70% of patients. Patients with parenchymal neurocysticercosis experience seizures more frequently than those with subarachnoid or ventricular disease. It is debatable whether patients with calcified neurocysticercosis experience symptoms. Although calcifications have traditionally been thought of as inert lesions, recent data indicate that calcified cysticerci are neither clinically inactive nor pathologically inert lesions, as they are capable of inducing recurrent seizures when parasitic antigens trapped in the calcium matrix are made available to the host immune system as a result of a process known as calcification remodelling.

Up to 20% of patients with neurocysticercosis have been reported to have focal neurological symptoms that change depending on the size, number, and location of the parasites. Pyramidal tract signs predominate, but some patients may also exhibit sensory deficits, language issues, uncontrollable movements, parkinsonian rigidity, and signs of brainstem dysfunction. These symptoms typically have a subacute or chronic course that resembles a brain tumour, and they are most frequently present in people who have large subarachnoid cysts compressing the brain. Patients with cysticercotic encephalitis, a severe form of neurocysticercosis caused by a widespread cysticerci infection of the brain parenchyma that triggers a severe immune response in the host, also experience intracranial hypertension. This condition, which is more common in children and young women, is characterized by papilledema, headaches, vomiting, seizures, and decreased visual acuity. Other neurocysticercosis patients could exhibit psychiatric symptoms ranging from severe dementia to subpar performance on neuropsychological tests. Cysts in the spinal cord parenchyma commonly present with motor and sensory deficits that vary depending on the level of the lesion, while spinal arachnoiditis is characterized by root pain and weakness of subacute onset.

Diagnosis : As per a proposed diagnostic criteria for Neurocysticercosis, its components are an absolute criteria, major and minor criteria and an epidemiological criteria.

• Absolute criteriaincluded histology (histologic demonstration of the parasite from biopsy of a subcutaneous nodule or brain lesion), direct visualization of an ocular parasite by funduscopic examination, or cystic lesions showing the scolex on CT or MRI.
• Major criteriaincluded lesions suggestive of neurocysticercosis on neuroimaging studies, positive immunologic tests for the detection of anticysticercal antibodies, or plain X-ray films showing multiple “cigar-shaped” calcifications in thigh and calf muscles.
• Minor criteriawere the presence of subcutaneous nodules on clinical examination, punctuate calcifications on plain X-ray films, suggestive clinical manifestations, or the disappearance of intracranial lesions after a trial with anticysticercal drugs.
• Epidemiologic criteria included living in a cysticercosis-endemic area, frequent travel to cysticercosis-endemic areas, or a household contact with  solium taeniasis.

These criteria configured three degrees of diagnostic certainty: definitive, probable and possible:

– A definitive diagnosis requires the presence of one absolute criterion, two major criteria or one major criterion plus two minor and one epidemiological.

– A probable diagnosis required one major plus two minor criteria, or one major plus one minor plus one epidemiologic, or three minor plus one epidemiologic criteria.

– A possible diagnosis could be established with one major criterion, two minor criteria or one minor plus one epidemiologic criteria.

Along with the diagnostic criteria, Neuroimaging through CT scan provides data regarding number, size, localization, perilesional inflammation, and stage of lesions, as well as information on collateral alterations such as hydrocephalus or other signs. Immunodiagnosis through antibody detection using the enzyme-linked immunoelectrotransfer blot assay (EITB, Western blot) using lentil lectin purified parasite glycoprotein antigen (LLGP) is also a tool of choice for serological diagnosis of cysticercosis.

Role  of  Homoeopathy in Neurocysticercosis
In a study done to assess the effectiveness of alternative medicine in the treatment of intracranial cysticercosis, a total of 36 patients were recruited aging from 6-70 years. The subjects were treated with Ruta graveolens tincture 2 drops twice daily along with Calcarea phos 3x 5 grain twice daily. 25 patients showed  improvement out of  which 69.4% were completely cured and 8.3% showed marked improvement in a span of 3-65 months. The active principle of Ruta is Rutin which has shown to have antibacterial activity against many bacteria. The addition of phosphate helps to cleave a compound present in the cell membrane which helps in the influx of the administered calcium ions. This activates the calcium dependent enzymes. Thus all these mechanisms ultimately lead to the regression of the neurocysticercosis lesion.

Another case report of a 38years old housewife, a known case of calcified granuloma of brain, presented with insidious onset of gradually progressive pain in right parietal region along with nausea, sleeplessness and loss of appetite since 6 months reported in the outpatient of National Institute of Homoeopathy (NIH), Kolkata. Investigation revealed a small nodular calcified granuloma in right high parietal region. Patient took allopathic treatment before coming to NIH, and got partial relief. Based on the totality of symptoms, homoeopathic medicine Staphysagria was prescribed and was effective to relieve the symptoms as well as resulted in resolution of the granuloma.

Other remedies available in the homoeopathic literature are Anthracinum, Belladona, Chamomilla, Cicuta, Cina, Hyoscyamus,Ignatia,Indigo,Nux vomica, Santoninum, Stannum met,and Terebinthinae oleum. However no studies have been done regarding the same.

Conclusion:
As the incidence of Neurocysticercosis has been increasing in the present days, measures need to be taken regarding its prevention. Homoeopathy has proven to be effective in the treatment of Neurocysticercosis but further research needs to be done to show conclusive results.

References:

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Dr Joanna Irwin
MD (Hom) Scholar
Under the guidance of Dr V Guruprasad (HOD)
Department of Paediatrics
Government Homoeopathic Medical College and Hospital, Bangalore