The Epidemiology and Health Burden of Neurocysticercosis in Nepal

Neurocysticercosis (NCC) is a public health burden in Nepal. In patients burdened by this disease epileptic seizures are common. Computerized tomography scan (CT-scan) and Magnetic resonance imaging (MRI) techniques are most commonly used investigative tools for the diagnosis of NCC. Radio imaging techniques combined with serological techniques such as Enzyme linked immunosorbent assay (ELISA) and/or Enzyme linked immunoelectrotransfer blot (EITB) are commonly used as confirmatory diagnostic tools for this disease. Poor sanitation and hygiene accompanied with free range system of keeping pigs, deliberate use of human feces as pig feeds and social economic status of the society were reviewed the main causes for the persistence of Neurocysticercosis in Nepal. It was found that NCC exists in various development stages in the human brain as vesicular, colloidal, granular nodular and calcified forms. Based on the developmental stage and location of the cyst, a patient may present a focal seizure (FS), focalised seizure secondary generalised (FSSG), generalised toniclonic seizure (GTCS) , intractable seizures, headache, vomiting, impaired vision and or cognitive dysfunctions. Radio-imaging (CT scan and MRI) techniques and immunodiagnostic kits (ELISA, EITB, Dot Blots, and Western Blots) were found to be the main tools for diagnosis of NCC/Cysticercosis in Nepal. The chemotherapeutic treatment for NCC associated epilepsy was found to be analgesics, corticosteroids, and/or a combination of both. Albendazole was found the most used and effective anthelminthic drug for the treatment of multiple lesion. NCC is an easily preventable disease of poor and the neglected people. In a resource limited setting like Nepal, effective diagnostic techniques and treatment routines in place is very difficult. It is recommended that provision of education to the public on the epidemiology of the disease, promotion of safe pork production practices, supply of tap water, improvement of personal hygiene and sanitation would play a bigger role in eradicating the disease.