Table 1
Hypokinetic Movement Disorders in Neurocysticercosis: A Summary of Reported Cases (n = 21).
| REFERENCE | COUNTRY | AGE/ SEX | DURATION OF ILLNESS | TYPE OF MOVEMENT DISORDER | TYPE OF NEURO CYSTI CERCOSIS/ NEU ROIMAGING | OTHER NEU ROLOGICAL FINDINGS | CSF FINDINGS | TREATMENT GIVEN ANTIPA RASITIC/STEROIDS) | TREATMENT OF MOVEMENT DISORDER | RESPONSE TO TREATMENT | FOLLOW-UP NEU ROIMAGING, IF ANY | OUTCOME | POSSIBLE REASONS OF MOVEMENT DISORDERS |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Das et al 2025 [15] | India | 23/M | 7 days | Mutism Echolalia Gegenhalten (resistance to passive movement) Cataplexy (sudden loss of muscle tone) Abnormal limb posturing | Multiple NCC in different stages | Seizure history, reduced interaction, immobility | Not mentioned | NA | Lorazepam 12 mg/day, Amantadine 400 mg/day | Marked improvement from day 1, complete recovery in 4 weeks | Not reported | Complete recovery | Diffuse cortical and basal ganglia involvement from NCC; catatonia mechanism involving cortico-subcortical motor circuits |
| Rasaholiarison et al 2024 [16] | Madagascar | 11/F | 4 years (onset at 7 years) | Dystonic tremor of the left upper limb Kinesigenic dystonia of the left lower limb | A ring lesion in right thalamus with perilesional edema | Left hemiparesis Amyotrophy (muscle wasting) Walking disorder Enuresis | Not reported | Albendazole (8 mg/kg/day × 15 days), corticosteroids (1 mg/kg/day × 5 days) | Tropatepine 20 mg/day, physiotherapy | Lesion improved radiologically; movement disorder persisted | CT showed calcification (sequela of thalamic NCC) | Partial improvement; persistent movement disorder | Right thalamic NCC affecting cerebello-thalamo-cortical pathways; inflammation and sequelae |
| Ahmad N et al 2024 [17] | India | 6/M | 7 months | Painful, sustained tightening of all four limbs (generalized dystonia) | Multiple cystic lesions with scolex (basal ganglia, cortical/subcortical areas, thalamus) | Normal | CSF anticysticercal antibody strongly positive | Albendazole | Not specifically mentioned | Significant clinical and radiological improvement after 6 weeks | Yes, showing improvement | Improved | Inflammatory reaction around cysts; basal ganglia involvement; perilesional edema |
| Puig et al 2023 [18] | Spain | 49/M | 2 days (onset of dystonic tremor); history of seizures years prior | Dystonic head tremor; left faciobrachial clonic movements (partial seizures) | Multiple NCC lesions; one in subthalamic nucleus and red nucleus | Normal | Not reported | Anthelmintic treatment considered but deferred due to risk of inflammatory response | Botulinum toxin injections; beta-blockers and primidone ineffective | Partial improvement with botulinum toxin | Not specified | Partial improvement | Lesions in subthalamic/red nucleus and cerebello-thalamo-cortical pathway involvement |
| Oliveira et al 2020 [19] | Brazil | 59/F | 4 months | Parkinsonism (bradykinesia, stiffness, gait disturbance) | Parenchymal and intraventricular NCC; hydrocephalus; MRI: cysts with scolex, calcifications, transependymal edema | Urinary incontinence, dementia, epilepsy (history of 15 years) | Normal CSF findings | Albendazole and praziquantel (14 days); corticosteroids used initially | Ventriculoperitoneal shunt (VPS); symptomatic therapy as needed | Clinical improvement after VPS | Post-op CT showed well-placed drain and calcifications | Marked improvement in parkinsonian symptoms | Hydrocephalus-induced compression of nigrostriatal pathway; mass effect and inflammation from cysticerci |
| Verma R et al 2013 [20] | India | 50/F | 3 months | Parkinsonism | MRI: Multiple cystic lesions with mural nodules in bilateral basal ganglia | Hypokinetic speech, slow ocular movements, reduced blink, positive Meyerson’s sign, generalized rigidity, severe bradykinesia, postural instability | Not reported | Albendazole 15 mg/kg/day with steroids | Not separately given | Deteriorated with worsening sensorium; died despite anti-edema measures | Not reported | Death | Inflammatory reaction due to multiple basal ganglia cysts disrupting dopaminergic pathways |
| de Lima PMG et al 2012 [21] | Brazil | 38/F | 4 months | Parkinsonism (rigidity, bradykinesia, tremor, postural instability) | MRI: Intraventricular cyst at frontal horn of right lateral ventricle extending through foramen of Monro to third ventricle; edema in midbrain periaqueductal region | Mutism, hypomimia, sialorrhea, anarthria, vertical ophthalmoparesis, severe intracranial hypertension | Positive for antibodies in CSF | Albendazole (3.2 g/day), later methylprednisolone 1 g IV x5 days | Levodopa/carbidopa (250/50 mg daily) | Progressive improvement, remained asymptomatic after 8 months | MRI showed stable cyst and edema initially; post-surgical changes not specified | Full recovery, returned to routine activities | Hydrocephalus, ependymitis, and inflammatory edema affecting dopaminergic midbrain pathways |
| Sharma et al 2011 [22] | India | 64/M | 1.5 years | Parkinsonism Progressive supranuclear palsy (PSP)-like syndrome | MRI: Multiple vesicular NCC lesions in dorsal and tegmental midbrain, also in bilateral cerebral hemispheres | Hypophonic spastic speech, MMSE 16, vertical gaze palsy (up-gaze > down), slow horizontal saccades, axial rigidity, brisk DTRs, primitive reflexes, cognitive decline | Positive ELISA for NCC, negative for HIV; other CSF details not reported | Albendazole for 2 weeks + dexamethasone | Not specifically treated; only antiparasitic and steroids given | No significant clinical improvement after 2 months | Not performed | Persistent disability | Midbrain involvement by NCC lesions affecting vertical gaze and extrapyramidal pathways, mimicking PSP |
| Prashantha et al 2008 [23] | India | 38/M | 1 year with acute onset after 2nd VP shunt | Bilateral Parkinsonism with resting and postural tremor (5–5.5 Hz), bradykinesia, rigidity, hypomimia | MRI: Enhancing granuloma with scolex in fourth ventricle, significant perilesional edema involving cerebellum | No cognitive or ocular deficits; rigidity, bradykinesia, mild dysarthria, normal reflexes | Normal CSF during 1st shunt; no repeat CSF after onset | Short course of steroids (due to perilesional edema); no antiparasitic given | Levodopa (275 mg × 4/day) + Trihexyphenidyl (up to 12 mg/day) | Slow response initially; marked clinical improvement by 3 weeks; asymptomatic off drugs by 3 months | Follow-up MRI: Lesion persisted but edema decreased; no hydrocephalus | Near-complete recovery without recurrence | VP shunt may have altered CSF dynamics triggering basal ganglia dysfunction; possible transient inflammation or degeneration of cyst; not direct NCC effect |
| Cabo López et al 2008 [24] | Spain | 29/F | Not precisely stated (chronic course with hydrocephalus) | Parkinsonism (L-dopa responsive) | Cyst in the fourth ventricle causing obstructive hydrocephalus | Multiple episodes of shunt malfunction; no focal deficits described | Not detailed | Cysticidal drugs and repeated shunt surgeries | L-dopa | Marked improvement with L-dopa and antiparasitic therapy | Not reported | Improved; symptoms resolved | Raised intracranial pressure from obstructive hydrocephalus due to IV ventricle cyst affecting midbrain basal ganglia circuits |
| Patel et al 2006 [25] | India | 60/M | Not clearly stated | Parkinsonism, dystonia, tremor, gait disturbance | Multiple cysticerci (vesicular and granular) including basal ganglia | Normal cognition (MMSE), no cerebellar signs | Positive ELISA, normal biochemistry and cytology | None specifically mentioned | Levodopa + Trihexyphenidyl | Initial improvement, lost to follow-up | Not mentioned | Initial improvement, lost to follow-up | Basal ganglia involvement (caudate, putamen, thalamus) |
| 19/F | Not clearly stated | Focal dystonia (left upper limb) | Single ring-enhancing granuloma in right thalamus (colloidal) | Normal mental and systemic exams | Normal | Albendazole + Steroids | None specific | No improvement, lost to follow-up | Not mentioned | No improvement, lost to follow-up | Thalamic lesion causing focal dystonia | ||
| Sá et al 2005 [26] | Brazil | 32/F | Rapidly progressive over 1 month | Parkinsonism Symmetrical resting tremor, rigidity, bradykinesia, postural instability | Cysticercotic ependymitis, MRI showed lesions at cerebral aqueduct and 4th ventricle | Vertical gaze paresis, hypomimia, sialorrhea, diffuse hyperreflexia | WBC 112 (60% lymphocytes), protein 91 mg/dL, glucose 45 mg/dL, NCC positive (ELISA, IIF) | Albendazole (30 mg/kg/day × 60 days), steroids not specified | Levodopa 125–250 mg tid | Marked improvement; able to walk unaided; later mild symptoms required levodopa re-initiation | Not specified | Clinically better, residual mild parkinsonism | Midbrain lesion and inflammation affecting substantia nigra |
| 30/M | 2 weeks | Parkinsonism Marked rigidity, bradykinesia, postural instability | MRI: cysticercotic ependymitis affecting quadrigeminal/ambient cisterns; hydrocephalus on CT | Headache, vomiting, reduced consciousness | WBC 81 (64% lymphocytes), protein 90 mg/dL, glucose 42 mg/dL, NCC positive (ELISA, IIF) | Albendazole (high dose), steroids not specified | Levodopa | Improved consciousness, motor function; mild bradykinesia remained at 6 months | MRI abnormalities observed | Sustained clinical improvement at 6 months | Brainstem lesions with inflammation near substantia nigra | ||
| Serrano-Dueñas & Placencia 1999 [27] | Ecuador | 75/M | 8 years | Tremor | Cortical and subcortical cystic lesions, hydrocephalus | Gait disorder, cognitive decline | Positive anticysticercal antibodies | Albendazole 15 mg/kg/day × 8 days | VP shunt replacement | Improved; tremor disappeared by 6 months | Not reported | Tremor resolved | Hydroce phalus and neurocy sticercosis-related basal ganglia involvement |
| 66/M | 10 years | Parkinsonism, Tremor | Obstructive hydrocephalus, fourth ventricle cysticercus, multiple calcifications | Diplopia, headache, rigidity, bradykinesia | Positive anticysticercal antibodies | Albendazole × 8 days, surgical cyst removal, VP shunt | Clonazepam 2 mg/day | Improved after surgery | Not specified | Good recovery maintained over 3 years | Compression from cyst, basal ganglia involvement | ||
| 40/F | 4 years | Tremor | Third ventricle cysticercus, cortical/subcortical lesions | Headache, visual decline | Positive anticysticercal antibodies | Albendazole × 8 days, Prednisone, VP shunt | None specified | Improved, tremor resolved in 7 days | Lesion resolution | Tremor resolved | Compression and cystic lesions affecting motor areas | ||
| 60/M | 6 years | Dystonia (retrocollis) | Cortical/subcortical lesions, hydrocephalus | Memory, speech, gait disturbances | 35 cells/mm3, protein 56 mg/dL, positive antibodies | Albendazole × 8 days, VP shunt | None specified | Gradual improvement, dystonia resolved | Not reported | Complete recovery at 1 year | Brainstem involvement, disinhibition of facial/trigeminal motor nuclei | ||
| Sawhney et al 1998 [28] | India | 21/M | 2 years | Unilateral dystonia (right upper and lower limbs) | Temporal/frontal lobe, hypodense cysts in globus pallidi, ring-enhancing lesion in corona radiata, bifrontal diffuse white matter oedema | Complex partial seizures | Not reported | Steroids, anticonvulsants | Anticonvulsants | Improved | Not reported | Improved | Ictal dystonia due to temporal lobe epilepsy with spread to basal ganglia |
| Verma et al 1995 [29] | USA | 31/F | 2 days (parkinsonism developed later during treatment) | Parkinsonism (hemi parkinsonism, rigidity, tremor, bradykinesia) | Enhancing cyst in periaqueductal gray and ventral midbrain; cyst in 4th ventricle; multiple calcifications | Vertical gaze palsy, diplopia, ptosis, corectopia, hemiparesis, stupor, central 7th nerve palsy | Opening pressure 280 mm H2O, 120 cells/µL (98% monocytes), protein 54 mg/dL, glucose 57.7 mg/dL | Praziquantel 50 mg/kg/day × 21 days, IV dexamethasone | Supportive care, corticosteroids; no specific antiparkinsonian drug mentioned | Marked improvement; near-complete resolution of parkinsonism | Not specified in detail post-recovery | Full recovery with residual gaze palsy and corectopia | Inflammatory response to degenerating cyst in midbrain structures (substantia nigra, periaqueductal gray) |
| De Assis et al 1955 [30] | Brazil | 26/F | 1.5 months | Parkinsonism | Racemose cyst in interpeduncular fossa compressing brainstem; multiple cysticerci in cerebral hemispheres (autopsy) | Vertical gaze palsy, bilateral facial weakness, extrapyramidal hypertonia, somnolence, papilledema, cranial nerve palsies | CSF: 26 cells/mm3 (lymphomononuclear), protein 25 mg/dL, glucose 52 mg/dL, Pandy +; serology negative | Not specified (diagnosis made postmortem) | Not given | No improvement; progressive deterioration | Not applicable (autopsy diagnosis) | Death in coma | Compression of midbrain, subthalamus, substantia nigra, and hypothalamus by racemose cysticercus; inflammatory damage |
[i] AFB = Acid-Fast Bacilli; ANA = Antinuclear Antibody; ASO = Anti-Streptolysin O; CSF = Cerebrospinal Fluid; CT = Computed Tomography; DTR = Deep Tendon Reflex; ELISA = Enzyme-Linked Immunosorbent Assay; HIV = Human Immunodeficiency Virus; IV = Intravenous; JE = Japanese Encephalitis; MMSE = Mini-Mental State Examination; MRI = Magnetic Resonance Imaging; NA = Not Available/Not Applicable; NCC = Neurocysticercosis; PSP = Progressive Supranuclear Palsy; SN = Substantia Nigra; TB = Tuberculosis; TB-PCR = Tuberculosis–Polymerase Chain Reaction; VP Shunt/VPS = Ventriculoperitoneal Shunt; WBC = White Blood Cell Count.
Table 2
Hyperkinetic Movement Disorders in Neurocysticercosis: A Summary of Reported Cases.
| REFERENCE | COUNTRY | AGE/SEX | DURA TION OF ILLNESS | TYPE OF MOVEMENT DISORDER | TYPE OF NEURO CYSTICERCOSIS/ NEUROI MAGING | OTHER NEURO LOGICAL FINDINGS | CSF FINDINGS | TREATMENT GIVEN ANTIPA RASITIC/STEROIDS) | TREATMENT OF MOVEMENT DISORDER | RESPONSE TO TREATMENT | FOLLOW-UP NEUROI MAGING, IF ANY | OUTCOME | POSSIBLE REASONS OF MOVEMENT DISORDERS |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Matos Pereira 2022 [31] | Portugal | 59/M | 1 hour (acute onset of myoclonus) | Right hand myoclonus | Multiple cystic lesions CT: 3 hypodense cystic lesions with hyperdense center MRI: bilateral cysts and right hippocampal nodular lesion with edema | None reported | Not reported | Albendazole and dexamethasone | Phenytoin | Complete resolution of myoclonus | MRI at 3 months showed resolution of lesions | No recurrence of myoclonus at 3 months | Lesions involving motor cortex or hippocampus; inflammation and edema |
| Yang et al 2020 [32] | Peru | 38/M | 2 months | Hemifacial spasm (left side) | Subarachnoid NCC; cyst in cerebellopontine angle with severe arachnoiditis | Obstructive hydrocephalus (VP shunt placed 6 months earlier) | Not reported | Albendazole + dexamethasone (no response) | Surgical decompression and cyst excision | Complete resolution of hemifacial spasm | Not reported post-op, but intraoperative imaging confirmed cyst removal | Symptom-free at 8-month follow-up | Compression and irritation of the facial nerve due to arachnoiditis from NCC cyst in cerebellopontine angle |
| Kumar S et al 2020 [33] | India | 77/M | 15 days | Hemichorea (right upper limb) | Multiple cysts in cortex, and basal ganglia with surrounding edema and calcified scars on MRI | None besides hemichorea and mild shoulder pain | Not reported | Albendazole 400 mg BID + Prednisolone 1 mg/kg/day | NA | Marked improvement within 1 week | Marked reduction in lesions at 1-month MRI | Significant clinical improvement | Inflammation around cysts disrupting GABAergic pathways in basal ganglia |
| Anjana KK et al 2020 [34] | India | 29/F | 15–20 days | Motor and vocal tics | MRI: Multiple ring-enhancing lesions with perilesional edema in bilateral frontal, gangliocapsular, and parietal regions | Psychosis (hallucinations, delusions, disorientation), headache, impaired tandem walking | Not done (family declined) | Albendazole 400 mg BID for 14 days, dexamethasone 4 mg IV TID tapered, mannitol, antiepileptic prophylaxis | Risperidone 2 mg for psychosis and tics | Marked improvement in both psychosis and tics within 1 week | Not available (patient did not return after 1-month visit) | YGTSS score reduced from 55 to 3, MMSE reached 30/30 at 14 days | Likely basal ganglia involvement or edema causing functional disruption in tic-regulating circuits |
| Campos EM et al 2018 [35] | Ecuador | 21/F | Not clearly specified (known NCC for 2 years) | Cerebellar outflow tremor, ophthalmoparesis | Racemose/extraparenchymal NCC; MRI: intraventricular cysts (right lateral and fourth ventricle), communicating hydrocephalus with transependymal CSF egress | Bilateral Babinski signs | Opening pressure 16 cm H2O; other CSF findings not detailed | Steroids and Albendazole for 3 weeks | Same as antiparasitic and anti-inflammatory therapy | Marked clinical and radiological improvement within 3 weeks | Post-treatment MRI showed resolution of hydrocephalus and cysts | Reversal of tremor and ophthalmoparesis | Hydrocephalus and cyst-related pressure or inflammatory changes affecting cerebellar and cranial nerve pathways |
| Yoganathan et al 2016 [36] | India | 11/M | 1 month | Perioral dyskinesia, dystonia | Single ring-enhancing granuloma (right posterior temporal lobe), hyperintensities in basal ganglia, thalami, SN, hippocampi | Fever, headache, seizures, altered sensorium, hemiparesis | Not provided in table, diagnosis based on serology and imaging | Albendazole 15 mg/kg/d × 28d + Prednisolone 1 mg/kg/d × 5d | Antispasticity drugs, supportive care | Marked improvement in sensorium and dystonia | Resolution of signal changes; granuloma persisted with reduced edema; no calcification | Residual hemiparesis and dystonia; good ambulation | JE involvement of basal ganglia in patient with preexisting NCC |
| 13/M | 3 months | Meige syndrome, generalized dystonia, oromandibular dystonia, blepharospasm, bradykinesia | Multiple ring-enhancing cysticercal granulomas (right cingulate and inferior frontal gyri); gyral hyperintensities and basal ganglia involvement | Extrapyramidal symptoms, rigidity, hypophonia, difficulty swallowing | Normal initially; serology positive for JE | Ribavirin + Clonazepam, tetrabenazine, trihexyphenidyl | Symptomatic drugs for dystonia and dystonic spasms | Significant reduction in oromandibular and hand dystonia | Resolution of hyperintensities, persistent ring enhancement of granulomas, calcified scolex on CT | Marked clinical improvement | Basal ganglia damage by JE in presence of NCC may contribute to movement disorders | ||
| Gokhale et al 2015 [37] | India | 8/M | 7 days | Focal myoclonus (right upper and lower limbs) | MRI: Solitary lesion in left frontal lobe with perilesional edema, consistent with NCC | Brisk DTRs, bilateral ankle clonus, no other focal deficits | Not done (other metabolic, autoimmune, Wilson’s disease ruled out) | Albendazole 15 mg/kg/day, oral prednisolone 2 mg/kg/day for 5 days | Same as antiparasitic/steroid therapy | Marked improvement within 2 days; complete resolution of myoclonus | Not reported | Full clinical recovery with discharge | Inflammatory edema in frontal cortex causing focal cortical myoclonus via sensorimotor hyperexcitability |
| Venkatarathna mma et al 2013 [38] | India | 25/M | 1 week | Cerebellar ataxia, Orofacial dyskinesia, Choreiform movements | Disseminated neurocysticercosis with multiple lesions in cerebral and cerebellar hemispheres, brainstem, spinal cord, intramuscular and subcutaneous tissue | Scanning dysarthria, horizontal gaze nystagmus, bilateral cerebellar signs | Not reported | Albendazole, corticosteroids | Discontinuation of phenytoin; switched to sodium valproate | Significant improvement; symptoms resolved within 3 days | Not specifically reported | Symptomatic improvement, regular follow-up | Phenytoin toxicity; cerebellar ataxia also possible due to neurocysticercosis |
| Karnik et al 2011 [39] | India | 11/F | 5 years | Right hemiballismus | Solitary ring-enhancing lesion in the left thalamus on MRI suggestive of NCC | Otherwise normal neurological examination | Not detailed; serological and autoimmune workup negative | Albendazole + prednisolone | Haloperidol initially (no response); main treatment was antiparasitic and steroids | Marked improvement within 2 days of starting antiparasitic/steroid therapy | Planned but patient lost to follow-up | Dramatic symptomatic improvement; long-standing hemiballismus resolved | Lesion in the thalamus, a structure involved in motor control, likely caused involuntary flinging movements |
| Dewan et al 2011 [40] | India | 10/F | 4 days | Chorea (generalized choreiform movements) | MRI: Ring-enhancing lesion (5.2 × 4.8 mm) in right paramedian midbrain with mild perilesional oedema (suggestive of active NCC) | Quadriparesis (power 3/5–4/5), sluggish reflexes, extensor plantar response, slurred speech, emotional lability | Normal blood counts, ESR, CRP, ASO titre, ANA, ceruloplasmin; no CSF analysis reported | Albendazole (started after steroids); steroids; mannitol for raised ICP | Haloperidol | Dramatic improvement in chorea within 2 weeks; returned to school at 3 months | Not performed | Good recovery without neurological deficit | Midbrain NCC lesion affecting extrapyramidal pathways |
| Razdan et al 2009 [41] | India | 20/M | 1 week | Hemifacial spasm (right) | MRI: Isointense ring lesion with eccentric scolex and perilesional edema in right posterior pons at facial/acoustic nerve exit | Headache, vertigo, imbalance, fever, recurrent vomiting (resolved); facial twitching persisted | Peripheral eosinophilia; CSF not done | Albendazole (8 days), prednisolone (14 days) | Not separately given | Complete resolution of symptoms | Follow-up MRI not done due to affordability | Full recovery | Parenchymal lesion near facial nerve nucleus in pons causing irritation or compression of the nerve |
| Bhatia R et al 2008 [42] | India | 45/M | 2 weeks | Isolated facial myokymia (right side) | MRI: Ring-enhancing lesion with scolex and edema in right pons (colloidal-vesicular stage) | Normal cranial nerves except facial myokymia; no limb weakness or cerebellar signs | CSF: Normal protein and sugar; no pleocytosis; negative for organisms and TB-PCR | Oral prednisolone tapered over 2 weeks; no antiparasitic given | Clonazepam (initial), then switched to carbamazepine due to incomplete response | Marked improvement with carbamazepine; complete resolution in 2 months | Follow-up MRI: Decrease in lesion size and edema | Complete resolution of symptoms; no recurrence | Pontine lesion near facial nerve nucleus likely caused hyperexcitability of facial motor neurons |
| Hamed and El-Metaal 2006 [43] | Egypt | 21/F | 2 years | Left hemichorea | CT: Single calcified lesion in right caudate nucleus | No other focal neurological deficits reported | CSF: Normal (non-inflammatory); serology for cysticercosis positive in serum | Prednisolone (short course); no antiparasitic needed for calcified stage | Haloperidol 1 mg/day | Marked improvement in chorea within a few days; full remission at 4 weeks | CT confirmed persistent calcification; no active lesion | Symptom-free at 8-month follow-up | Calcified NCC in basal ganglia disrupting motor circuits, leading to hemichorea |
| Verma et al 2006 [44] | India | 12/F | Acute onset | Right hemichorea | CT: Single ring-enhancing lesion with perifocal edema in left thalamic area suggestive of NCC | No specific additional findings reported | Not reported | Albendazole and steroids | Haloperidol | Marked improvement at 1 month | Repeat CT showed resolution of lesion | Complete recovery | Thalamic lesion disrupting motor circuits involved in contralateral movement regulation |
| Cosentino C, et al 2006 [45] | Peru | 22/F | 2.5 years | Left hemichorea with foot dystonia and episodic facial deviation | CT: Multiple viable cysts and calcified scars, some with scolex; lesions in cortex, subcortex, and basal ganglia (putamen) | Generalized hypotonia, hyperreflexia, episodic facial asymmetry | Normal hemogram; positive serum Western blot for Taenia solium; stool negative for parasites | Albendazole (15 mg/kg/day × 30 days), Dexamethasone (up to 16 mg/day), Phenytoin | None specifically mentioned; managed with anti-parasitic and steroids | Marked improvement starting with steroids; complete remission over time | CT after 6 months: minimal decrease in viable cysts | Full clinical remission; one partial complex seizure post-treatment | Likely due to inflammation surrounding cysts in basal ganglia; not cyst death itself |
| Bouldin and Pinter 2006 [46] | USA | 11/M | Acute onset; recurrent episodes over 2 days | Transient left hemichorea | Periarterial NCC; MRI showed T2 hyperintensity near right MCA, gadolinium enhancement; MRA showed M1 segment stenosis | None during evaluation; episodes limited to movement abnormalities | WBC: 122/mm3 (87% lymphocytes), protein 35 mg/dL, glucose 64 mg/dL, negative cytology, cultures, AFB; CSF ELISA negative | Prednisone (60 mg/day for 2 weeks, then taper), aspirin (81 mg/day); antiparasitic not given due to infarct risk | Supportive; no specific anti-chorea medication | No recurrence of chorea; clinical improvement | MRI and MRA at 6 weeks showed resolution of vessel stenosis and edema | No recurrence at 28 months | Ischemia in basal ganglia due to inflammatory vasculitis/stenosis of right MCA from periarterial NCC |
| Scott et al 2005 [47] | India | 1/M | 4 days | Involuntary movements (tremors) involving tongue, left upper and lower limbs | CT: Multiple ring-enhancing lesions in cortical, subcortical and basal ganglia regions | Fever, inability to stand/walk, left-sided focal seizures developed later | Traumatic tap: WBC 70 (90% lymphocytes), RBCs 1250, protein 41 mg/dL, glucose 67 mg/dL | Albendazole with steroid cover | Haloperidol not mentioned; improvement noted with antiparasitic and steroid therapy | Gradual improvement; no abnormal movements at discharge | Not mentioned | Seizure-free and well at 3-month follow-up | Basal ganglia involvement by NCC causing involuntary movements; likely due to lesion-related inflammation |
| Psarros et al 2003 [48] | USA | 26/F | 18 months | Akinetic mutism | Cystic lesion at left foramen of Monro; hydrocephalus on CT and MRI | Papilledema; blurred vision; lethargy | Positive for cysticercosis antibodies | Albendazole (postoperatively) | Bromocriptine 25 mg/day | Marked improvement; full recovery within 26 days | CT and MRI at 6 months: no recurrence, normalized ventricles | Complete recovery | Disruption of ascending dopaminergic pathways during surgery; intraventricular hemorrhage; transient hydrocephalus |
| Gutierrez et al., 1998 [49] | Mexico | 69/F | 7 months (headache, hearing issues, confusion); hemifacial spasm transient post-surgery | Left hemifacial spasm | Subarachnoid cyst rostral to brainstem, compression of pons, calcifications in basal cisterns and right temporal lobe, hydrocephalus | Confusion, bilateral papilledema, upward gaze paresis, impaired hearing (left), brisk reflexes, bilateral Babinski | 19 WBC/mm3 (100% lymphocytes), protein 45 mg/dL, glucose 48 mg/dL, positive ELISA for cysticercus antibodies | Prednisone 50 mg orally thrice weekly; no cysticidal drugs | Not specific; supportive management with CSF shunting and steroids | Hemifacial spasm resolved in 3 months | MRI at 58 months: reduction of cyst, no abnormal enhancement | Complete resolution of hemifacial spasm, no recurrence at 5-year follow-up | Compression of facial nerve root exit zone by cyst; altered brainstem dynamics post-CSF shunt |
| Keane JR, 1995 [50] | USA | 32/F | Several recurrences over 14 months | Severe resting and postural tremor (head, jaw, tongue, right upper extremity) | Obstructive hydrocephalus from NCC; mild dilation of third ventricle | Pretectal signs, convergence nystagmus, stupor | Not detailed | Shunt revision, low-pressure valve | Shunt revision | Marked improvement with shunt revision; tremor disappeared | Not detailed | Symptom-free after final shunt | Raised intracranial pressure due to shunt obstruction; possible basal ganglia involvement |
| Beydoun et al 1994 [51] | USA | 34/M | Several years (recurrent hydrocephalus); facial myokymia noted later | Facial myokymia (right orbicularis oris, mentalis, orbicularis oculi) | Multiple lobulated cysts in aqueduct, 4th ventricle, supracerebellar, interpeduncular, ambient, and prepontine cisterns | Tremor (bilateral upper limbs), diplopia, gait instability, bilateral papilledema, upward gaze paresis | Not reported in detail | Praziquantel, Decadron (steroids), Dilantin | Supportive with above treatment | Modest improvement in myokymia and neurological symptoms | MRI showed cystic lesions; no follow-up scan detail given | Partial clinical improvement | Compression and/or inflammation of facial nerve by subarachnoid cysts, toxic or hypoxic effects |
| Puri et al 1991 [52] | India | 11/F | 1 month | Myoclonus (generalized, tactile-sensitive) | Multiple cystic lesions with peripheral enhancement and meningeal inflammation; diffuse low-density lesions on CT | Generalized EEG discharges; no other focal neurological deficits | Normal cytology and biochemistry; ELISA positive for cysticercosis | Praziquantel (50 mg/kg/day × 15 days, 2 courses), Sodium valproate | Sodium valproate | Complete resolution of symptoms after second praziquantel course | Normal CT scan post-treatment | Complete recovery | Cortical irritation by active parenchymal cysts; inflammation-induced hyperexcitability |
| Bhigjee et al 1987 [53] | South Africa | 15/F | 2 months | Hemichorea (left-sided) | CT scan: Multiple cysts with calcification and contrast enhancement, especially in basal ganglia (right caudate, internal capsule, lenticular nucleus) | Left-sided facial distortions, non-stereotyped jerks, flinging of left arm and leg; no other systemic abnormalities | Positive cysticercus haemagglutination and fluorescent antibody test (titres 1:16 and 1:1 respectively); no eosinophils | Haloperidol; no antiparasitic used | Haloperidol | Some improvement noted | Not available (patient lost to follow-up) | Partial improvement, long-term outcome unknown | Cystic lesions in basal ganglia causing contralateral hemichorea |
[i] ANA = Antinuclear Antibody; ASO = Anti-Streptolysin O; BID = Bis in Die (Twice Daily); CSF = Cerebrospinal Fluid; CT = Computed Tomography; DTR = Deep Tendon Reflex; EEG = Electroencephalography; ELISA = Enzyme-Linked Immunosorbent Assay; ESR = Erythrocyte Sedimentation Rate; IIF = Indirect Immunofluorescence; IV = Intravenous; JE = Japanese Encephalitis; MMSE = Mini-Mental State Examination; MRI = Magnetic Resonance Imaging; MRA = Magnetic Resonance Angiography; NA = Not Available/Not Applicable; NCC = Neurocysticercosis; SN = Substantia Nigra; VP Shunt/VPS = Ventriculoperitoneal Shunt; WBC = White Blood Cell Count; YGTSS = Yale Global Tic Severity Scale.
Figure 1
The PRISMA flow diagram illustrates the study selection process for the systematic review.
Table 3
Spectrum of hypokinetic and hyperkinetic movement disorders in neurocysticercosis.
| CHARACTERISTICS | HYPOKINETIC MOVEMENT DISORDERS (N = 21) | HYPERKINETIC MOVEMENT DISORDERS (N = 24) |
|---|---|---|
| Age (in years) | Mean: 39.3 Median: 38 Mode: 38, 60 Range: 6–69 Interquartile range: 35 | Mean: 25.8 Median: 21 Mode: 11 Range: 1–77 Interquartile range: 22 |
| Sex | Male (M): 11 (52.38%) Female (F): 10 (47.62%) | Male (M): 13 (54.17%) Female (F): 11 (45.83%) |
| Geographical areas of published records | India: 7 (43.75%) Brazil: 4 (25.0%) Spain: 2 (12.5%) Madagascar: 1 (6.25%) Ecuador: 1 (6.25%) USA: 1 (6.25%) Total = 16 | India: 11 (52.38%) USA: 4 (19.05%) Peru: 2 (9.52%) Portugal: 1 (4.76%) Ecuador: 1 (4.76%) Egypt: 1 (4.76%) Mexico: 1 (4.76%) Total = 21 |
| Type of movement disorder | Parkinsonism (all types combined): 11 (52.38%) PSP-like syndrome: 1 (4.76%) Dystonia (all types): 5 (23.81%) Abnormal limb posturing): 3 (14.29%) Other (Mutism, Echolalia, Gegenhalten, Cataplexy: 1 (4.76%) | Chorea/Hemichorea/Hemiballismus: 7 (29.17%) Myoclonus: 4 (16.67%) Tremor (Cerebellar/Resting/Postural): 3 (12.50%) Facial Dyskinesias/Hemifacial Spasm/Myokymia: 6 (25.00%) Dyskinesia (Oromandibular/Focal/Generalized): 4 (16.67%) Other Hyperkinetic/Mixed/Complex Syndromes: 2 (8.33%) |
| Other neurological findings | Cognitive & Behavioral Abnormalities: 6 (28.57%) Cranial Nerve Involvement & Ocular Abnormalities: 6 (28.57%) Motor Weakness & Pyramidal Signs: 6 (28.57%) Gait Disturbance & Postural Instability: 6 (28.57%) Seizures & Epilepsy: 3 (14.29%) Signs of Raised ICP: 4 (19.05%) | Signs of Raised ICP: 5 (20.83%) Pyramidal/Motor Weakness/Reflex Changes: 6 (25.00%) Cerebellar/Brainstem Signs: 4 (16.67%) Seizures/Epilepsy/Psychosis/Encephalopathy: 4 (16.67%) Normal/No Significant Additional Neurological Findings: 6 (25.00%) |
| Type of Neurocysticercosis/ neuroimaging | Parenchymal NCC: 8 (38.10%) Intraventricular NCC: 6 (28.57%) Thalamic/Midbrain/Brainstem NCC: 6 (28.57%) Subarachnoid/Racemose NCC: 2 (9.52%) | Parenchymal NCC (multiple lesions or calcifications): 9 (37.50%) Solitary Ring-Enhancing Granuloma: 2 (8.33%) Extraparenchymal (Intraventricular or Racemose) NCC: 7 (29.17%) Mixed Parenchymal + Extraparenchymal NCC: 3 (12.50%) Subarachnoid/Cistern NCC (e.g., CPA, basal cisterns): 2 (8.33%) Periarterial/Vascular NCC: 1 (4.17%) Disseminated/Multisystem NCC: 1 (4.17%) |
| Duration of illness | <1 month: 5 (26.32%) 1–6 months: 4 (21.05%) >6 months – 1 year: 2 (10.53%) >1 year – 5 years: 4 (21.05%) >5 years: 4 (21.05%) Not clearly stated: 3 (13.64%) | <1 month: 5 (20.83%) 1–6 months: 6 (25.00%) >6 months – 1 year: 2 (8.33%) >1 year – 5 years: 5 (20.83%) >5 years: 3 (12.50%) Not clearly stated: 3 (12.50%) |
| CSF Abnormalities | Positive Serology for NCC: 9 (42.86%) Inflammatory CSF (pleocytosis, high protein): 5 (23.81%) Normal CSF: 3 (14.29%) Not Reported: 6 (28.57%) Serology Negative: 1 (4.76%) | CSF Positive for Cysticercosis: 6 (25.00%) Normal or Non-Inflammatory CSF: 4 (16.67%) Inflammatory CSF: 3 (12.50%) CSF Not Done/Not Reported: 11 (45.83%) |
| Treatment Given Antiparasitic/Steroids) | Albendazole Given: 14 (66.67%) Praziquantel Given: 2 (9.52%) Steroids Administered: 13 (61.90%) No Antiparasitic/Deferred: 3 (14.29%) Surgical Intervention: 4 (19.05%) Not Specified/NA: 3 (14.29%) | Albendazole + Steroids: 13 (54.17%) Albendazole Alone or Given (Steroid status unclear): 2 (8.33%) Steroids Alone (No antiparasitic): 3 (12.50%) Praziquantel-Based Therapy: 2 (8.33%) No Antiparasitic/Symptomatic Only: 2 (8.33%) Other Symptomatic/Adjuvant Therapy: 2 (8.33%) |
| Treatment of Movement Disorder | Levodopa-Based Therapy: 6 (28.57%) Anticholinergic Agents: 3 (14.29%) Benzodiazepines/Sedatives: 2 (9.52%) Dopaminergic/Other Parkinsonian Support (e.g., Amantadine): 1 (4.76%) VP Shunt/Surgical Management: 2 (9.52%) Botulinum Toxin/Dystonia-Specific Therapy: 1 (4.76%) Physiotherapy/Supportive Only: 2 (9.52%) Anticonvulsants: 1 (4.76%) None Given/Not Mentioned: 7 (33.33%) | Antipsychotic Agents (Haloperidol, Risperidone): 7 (29.17%) Antiepileptics: 5 (20.83%) Surgical Intervention/CSF Shunting: 3 (12.50%) Other Movement Disorder Medications: 3 (12.50%) Supportive/Not Specifically Mentioned: 6 (25.00%) |
| Response to Treatment | Marked or Complete Clinical Improvement: 10 (47.62%) Partial or Gradual Improvement: 5 (23.81%) No Improvement/Clinical Deterioration: 3 (14.29%) Radiological Improvement Only: 1 (4.76%) NA: 2 (9.52%) | Complete Resolution/Full Recovery: 9 (37.50%) Marked Improvement: 11 (45.83%) Gradual or Delayed Improvement: 2 (8.33%) Partial/Some Improvement: 1 (4.17%) Outcome Not Clearly Specified: 1 (4.17%) |
| Follow-up Neuroimaging, if any | Lesion Resolution/Improvement: 3 (14.29%) Calcification/Residual Sequelae: 2 (9.52%) MRI/CT Changes Without Clear Outcome: 3 (14.29%) NA: 13 (61.9%) | Lesion/Cyst Resolution: 7 (29.17%) Partial Resolution/Persistent Findings: 4 (16.67%) Calcification/Sequelae Without Active Disease: 2 (8.33%) Not Performed/Not Available/Lost to Follow-Up: 8 (33.33%) Intraoperative or Non-standard Imaging Only: 1 (4.17%) Normal Imaging Post-Treatment: 2 (8.33%) |
| Outcome | Complete/Full Recovery: 6 (28.57%) Improved/Marked Clinical Improvement: 6 (28.57%) Partial Improvement/Persistent Symptoms: 3 (14.29%) Persistent Disability: 1 (4.76%) Death: 2 (9.52%) NA: 2 (9.52%) | Complete Recovery/Full Remission: 9 (37.50%) Marked/Dramatic Improvement: 6 (25.00%) No Recurrence/Seizure-Free/Stable at Follow-Up: 4 (16.67%) Partial Improvement/Residual Symptoms: 3 (12.50%) Objective Functional Scores Reported: 2 (8.33%) |
| Possible reasons of movement disorders | Basal Ganglia Involvement: 11 (52.38%) Midbrain/Brainstem Involvement: 10 (47.62%) Thalamic/Cerebello-Thalamo-Cortical Pathway Involvement: 5 (23.81%) Cortico-Subcortical Motor Circuit Disruption: 2 (9.52%) Hydrocephalus/Raised ICP Effects: 6 (28.57%) Inflammatory/Immune-Mediated Pathogenesis: 8 (38.10%) Epileptogenic Spread (Ictal Dystonia): 1 (4.76%) | Basal Ganglia Involvement: 10 (41.67%) Thalamic/Subthalamic Involvement: 3 (12.50%) Facial Nerve Involvement (Nucleus or Exit Zone): 5 (20.83%) Cortical Hyperexcitability/Motor Cortex Involvement: 3 (12.50%) Brainstem/Midbrain Extrapyramidal Pathway Disruption: 2 (8.33%) Hydrocephalus/CSF Dynamic Alteration/Raised ICP: 4 (16.67%) Drug-Induced/Toxic Etiology: 1 (4.17%) |
[i] AFB = Acid-Fast Bacilli; Alb = Albendazole; CPA = Cerebellopontine Angle; CSF = Cerebrospinal Fluid; CT = Computed Tomography; ICP = Intracranial Pressure; MRI = Magnetic Resonance Imaging; NA = Not Available; NCC = Neurocysticercosis; PSP = Progressive Supranuclear Palsy; VP = Ventriculoperitoneal.
Video
Hemichorea in a patient with neurocysticercosis. The video demonstrates continuous, irregular, non-rhythmic involuntary movements predominantly affecting the right upper limb. These hyperkinetic movements are consistent with hemichorea. Neuroimaging revealed a cystic lesion with an eccentric scolex and surrounding edema. Written informed consent was obtained from the patient for video recording and publication.
Figure 2
MRI of the brain reveals a cystic lesion with an eccentric scolex and surrounding edema located near left thalamic region. Clinically, the patient presented with right-sided hemichorea (Video).