NeuroSolve

The challenge

After ingesting the eggs of pork tapeworms (Taenia solium), larvae develop and can become lodged in various tissues, including the brain. Cysts form around larvae, and if they are in the brain, they may cause seizures, a condition known as neurocysticercosis (NCC). 

NCC is a common cause of epilepsy – in areas where T. solium is endemic, it can account for 30% of all cases of epilepsy. The exact number of people affected is unclear, but it could be as high as 8 million, and NCC is becoming more common.  

Although the WHO has developed treatment guidelines, these are not well implemented in sub-Saharan Africa. One major challenge is the need for brain imaging (CT or MRI) to identify brain cysts, as this technology is not widely available in many settings. Antibody-based tests for NCC are being developed and could help to identify potential cases so that NCC-specific treatments can be given. 

NCC can be treated with anthelmintic drugs such as albendazole or praziquantel. However, small-scale studies suggest that a combination of the two may be more effective. 

The project

The NeuroSolve project is carrying out multiple activities to evaluate potential improvements in prevention, diagnosis and treatment of NCC. It aims to provide a model for implementation research, to strengthen evidence-based policy and practice by building skills in the generation and use of research evidence to support the successful implementation of medical interventions. 

A key activity is a large-scale trial in Tanzania and Zambia to assess the effectiveness of the new combination drug treatment of albendazole and praziquantel at improving quality of life. The trial will compare the combination treatment with the current recommended practice, with patients in both trial arms also receiving supplementary steroids to manage the inflammation triggered by treatment of cysts.  

The project will also model the potential impact of antibody-based tests for NCC, based on the characteristics of existing tests or those with improved performance. Based on these findings, a new diagnostic and treatment pathway will be designed and evaluated in a pilot implementation study.  

The project will also explore the feasibility of developing a multisectoral One Health NCC prevention programme, including key barriers and enablers. In addition, it will explore the possibility of creating a One Health implementation strategy for Tanzania and Zambia. 

Impact

The NeuroSolve project aims to generate key evidence on a potential new treatment for neurocysticercosis (NCC), assess the role of antibody tests in NCC care, and identify factors crucial for the successful implementation of these tools. This information will: 

• Provide evidence on the effectiveness of an albendazole and praziquantel combination treatment, informing national and global policy.
• Suggest how antibody testing could best be integrated into NCC care and what the optimal properties of an antibody test would be.
• Identify factors associated with successful implementation, to guide the introduction of new treatments and patient pathways.
• Suggest how a One Health framework could reduce the prevalence of human cysticercosis. 

An improved treatment could reduce the burden of disease due to NCC. At the same time, greater use of antibody testing could mean more patients receive treatment that addresses the root causes of their epilepsy. The project will also demonstrate to policymakers how implementation research can generate evidence to inform policy and the introduction of new medical interventions.