Advances and controversies in the diagnosis and management of neurocysticercosis: a clinical perspective

Neurocysticercosis remains the leading parasitic infection of the human central nervous system and a primary cause of epilepsy in low- and middle-income regions. Although advances in magnetic resonance imaging, serologic assays, and antiparasitic regimens have improved disease recognition and lesion targeting, major clinical questions remain unresolved regarding optimal diagnosis and management. This Perspective critically reviews current diagnostic and therapeutic approaches in neurocysticercosis, emphasizing the role of high-resolution imaging and evolving immunologic tools. The literature search methodology included searches of PubMed and Google Scholar databases, focusing on publications related to neurocysticercosis diagnosis, clinical manifestations, treatment, and public health interventions. It discusses treatment selection based on cyst location, stage, and host immune profile, and explores the evidence supporting albendazole and praziquantel in parenchymal, ventricular, subarachnoid, and disseminated forms. Pediatric, pregnant, and immunocompromised patients are examined as distinct clinical populations. The management of neurocysticercosis demands individualized, lesion-specific strategies rather than uniform protocols. While advances in imaging and immunotherapy hold promise, implementation barriers persist in endemic areas. Future priorities include robust randomized trials for extraparenchymal disease, validation of immunologic biomarkers, and integrated public health measures to reduce the disease burden globally.