People Presenting With Neurocysticercosis in North America

Neurocysticercosis (NCC) is the most common helminthic CNS infection and the main cause of
adult-onset seizures in low-to-middle income countries. Studies have documented significant
endemicity in Latin America, Eastern Europe, sub-Saharan Africa, India and other parts of the
world. The prevalence of NCC in North America is rising as a result of increased migration of
people with the disease and, occasionally, immigration of individuals with asymptomatic
tapeworms. Despite the gains in knowledge and understanding of the epidemiology,
pathophysiology, diagnosis, and treatment, clinical care continues to be hampered by
unanswered fundamental questions related to optimal diagnosis, staging, treatment, and
follow-up of patients with NCC.

This multi-center, natural history study seeks to characterize: the frequency of the various
forms of NCC in North American populations; the spectrum of treatment and management
strategies across the North American Cysticercosis Consortium; and the response to therapy by
evaluating a number of endpoints related to disease evolution and treatment, such as burden
of disease, cognitive changes, radiographic changes, and treatment complications. This study
will inform future research studies needed to eventually establish standardized management
protocols for each form of this complex infection.

Subjects will have visits at screening, baseline, 1, 2 (optional), 3, 6, 12, and 24 months.
Evaluations will include assessment of clinical status, antigen assays, radiographic imaging,
functional assessments, immunologic evaluations, cognitive assessments, and quality of life
measures. Additional clinically indicated visits may be scheduled as needed. This study does
not provide any interventional therapies but will collect data on the course of treatment.
Diagnostic examinations, consultations and medical treatment will be determined by the study
clinician. Any samples removed for medical indications related to NCC may be evaluated for
research purposes.

- INCLUSION CRITERIA:

1. Adults greater than or equal to18 years of age.

2. Subject, or Subject s Legally Authorized Representative (LAR)/ Durable Power of
Attorney (DPA), is able to provide informed consent and agree to allow samples to
be stored for future research.

3. Previously or currently diagnosed with definitive or probable NCC by a
practitioner at NACC in accordance with the Del Brutto criteria modified for use
in a North American populations.

For the purpose of this study, definitive and probable diagnostic certainty based on
presence of criteria below.

Definitive diagnosis

1. Presence of 1 absolute criterion

2. Presence of 2 major + 1 minor + 1 epidemiological criterion

Probable diagnosis Presence of 1 major + 2 minor criterion

1. Presence of 1 major + 1 minor + 1 epidemiological criterion

2. Presence of characteristic calcification(s)

Del Brutto Diagnostic criteria

1. Absolute criteria

1. Biopsy of a brain or spinal cord lesion

2. Cystic lesion with scolex on CT or MRI

3. Fundoscopic examination (subretinal parasites)

2. Major criteria

1. Highly suggestive lesions on neuroimaging

2. Positive serum enzyme-linked immunotransfer blot (EITB) assay

3. Resolution of intracranial cysts after therapy

4. Spontaneous resolution of small single enhancing lesions

3. Minor criteria

1. Compatible lesions on neuroimaging

2. Clinical manifestations suggestive for NCC (eg, headaches, seizures, neurological
symptoms)

3. Positive CSF ELISA for specific Ag/Ab

4. Cysts outside CNS

4. Epidemiological criteria

1. Evidence of household contact with T. solium

2. Individuals coming from/living in endemic areas

3. History of frequent travel to endemic areas

5. Single or multiple characteristic calcifications in subjects who meet epidemiologic
criteria (4) without another identifiable etiology will be considered NCC in the case
of calcified granulomas

EXCLUSION CRITERIA:

1. Subjects that in the opinion of the investigator have contraindications for
participation in the study will be excluded, such as patients with current substance abuse
or patients currently undergoing cancer chemotherapy.

Justification for Exclusion or Inclusion of Special Populations

Children

Children are eligible to participate in this clinical trial but will not be enrolled at the
NIH because the NIH investigators do not see nor specialize in pediatric populations. In
addition, NCC in the U.S. generally afflicts travelers and immigrants and is therefore
exceedingly rare in pediatric populations in the U.S.

Adults Unable To Provide Consent-

Patients will be offered standard of care treatment delivered irrespective of cognitive
status, including lumbar punctures that are used clinical management decisions as
determined by the site PI. Exclusion of patients unable to provide consent because of
cognitive impairment would limit the study population significantly, and potentially
compromise the generalizability of results from this observational study. In cases where
cognitive function precludes informed consent we will seek consent from the designated
legal guardian.