Ns of cerebral oedema steroids are used with and without antihelminthic medication. Steroids are also used prophylactically together with antihelminthic medication in active disease without cerebral oedema, as oedema may develop over the course of treatment. In multicystic disease with obvious oedema (5encephalitis) antihelminthic medication must not be used and the WP1066 web treatment of choice are steroids alone or in combination with antiepileptic medication. The latter is used in all stages whenever epileptic seizures are present. In subarachnoid disease antihelminthic medication together with steroids may have to be given in higher doses and over longer time than in patients with intraparenchymal disease. The same is true for get SP600125 ventricular disease, although the first line treatment is surgery with removal of the ventricular cysts.45 AED5antiepileptic medication.Difficulties of treating NCC in sub-Saharan AfricaTreatment in the presence of neuroimaging In sub-Saharan Africa, the treatment algorithm of Fig. 3 should be adhered to, if possible. In urban centres, CT scanners may be available and in these areas NCC-suspected cases should undergo cCT. However, in the majority of cases, especially in rural areas, CT scanners are not available or the financial means to get a CT scan are not at hand. In both scenarios, with and without CT scan, the attending doctor faces various `black boxes’. If a cCT scan shows active NCC then treatment according to guidelines (antihelminthic medication, i.e. praziquantel that is mainly available in sub-Saharan Africa, and steroids; Fig. 3) should be started (in encephalitis antihelminthic medication must not be administered and patients should be given steroids only). Also, in resource-poor settings, patients may not be particularly compliant with treatment due to various reasons, or they may take one tablet and not the other, which may seriously jeopardize their health. There is no easy way out. Obviously, the patient has to be informed about the condition and the potential side effects of the medication. The best solution may be to keep the patient in hospital for the time of treatment, but due to financial expenses the patient may not agree. To minimise costs an elegant solution may be a high-dose short-term treatment with100 mg/kg praziquantel in three divided doses every 2 h followed by corticosteroids. This treatment regimen has been demonstrated to be successful in singlecysticercus disease, but unfortunately efficacy could not be demonstrated in patients with multiple cysticerci which represent the major phenotype in sub-Saharan Africa.87,88 Follow-up of patients and monitoring of treatment success represents another challenge. The CT scanner may not be functional anymore or the financial constraints may be too high. An alternative could be the performance of T. solium cysticercosis antigenELISA which has been shown to indicate active disease82 and the course of antigen levels has been suggested as a successful tool to monitor treatment response.89 In the eastern and southern African region, the T. solium cysticercosis antigen-ELISA has been used for detecting the infection in both pigs and humans. These tests have been conducted in Zambia at the Cysticercosis Working Group of Eastern and Southern Africa Regional Reference Centre for Immunodiagnosis of T. solium Infections at the University of Zambia. Member countries of the Cysticercosis Working Group of Eastern and Southern Africa usually send samples for.Ns of cerebral oedema steroids are used with and without antihelminthic medication. Steroids are also used prophylactically together with antihelminthic medication in active disease without cerebral oedema, as oedema may develop over the course of treatment. In multicystic disease with obvious oedema (5encephalitis) antihelminthic medication must not be used and the treatment of choice are steroids alone or in combination with antiepileptic medication. The latter is used in all stages whenever epileptic seizures are present. In subarachnoid disease antihelminthic medication together with steroids may have to be given in higher doses and over longer time than in patients with intraparenchymal disease. The same is true for ventricular disease, although the first line treatment is surgery with removal of the ventricular cysts.45 AED5antiepileptic medication.Difficulties of treating NCC in sub-Saharan AfricaTreatment in the presence of neuroimaging In sub-Saharan Africa, the treatment algorithm of Fig. 3 should be adhered to, if possible. In urban centres, CT scanners may be available and in these areas NCC-suspected cases should undergo cCT. However, in the majority of cases, especially in rural areas, CT scanners are not available or the financial means to get a CT scan are not at hand. In both scenarios, with and without CT scan, the attending doctor faces various `black boxes’. If a cCT scan shows active NCC then treatment according to guidelines (antihelminthic medication, i.e. praziquantel that is mainly available in sub-Saharan Africa, and steroids; Fig. 3) should be started (in encephalitis antihelminthic medication must not be administered and patients should be given steroids only). Also, in resource-poor settings, patients may not be particularly compliant with treatment due to various reasons, or they may take one tablet and not the other, which may seriously jeopardize their health. There is no easy way out. Obviously, the patient has to be informed about the condition and the potential side effects of the medication. The best solution may be to keep the patient in hospital for the time of treatment, but due to financial expenses the patient may not agree. To minimise costs an elegant solution may be a high-dose short-term treatment with100 mg/kg praziquantel in three divided doses every 2 h followed by corticosteroids. This treatment regimen has been demonstrated to be successful in singlecysticercus disease, but unfortunately efficacy could not be demonstrated in patients with multiple cysticerci which represent the major phenotype in sub-Saharan Africa.87,88 Follow-up of patients and monitoring of treatment success represents another challenge. The CT scanner may not be functional anymore or the financial constraints may be too high. An alternative could be the performance of T. solium cysticercosis antigenELISA which has been shown to indicate active disease82 and the course of antigen levels has been suggested as a successful tool to monitor treatment response.89 In the eastern and southern African region, the T. solium cysticercosis antigen-ELISA has been used for detecting the infection in both pigs and humans. These tests have been conducted in Zambia at the Cysticercosis Working Group of Eastern and Southern Africa Regional Reference Centre for Immunodiagnosis of T. solium Infections at the University of Zambia. Member countries of the Cysticercosis Working Group of Eastern and Southern Africa usually send samples for.
