Strongyloides stercoralis is a small nematode that can parasitize the small bowel of humans. Larvae living freely in moist soil invade rapidly through contacted skin and migrate into lymphatics to reach the venous system, where they travel to the lungs, migrate up airways to the glottis, and then down the esophagus to the small intestine.

When immune function is compromised (e.g., in HIV infection or AIDS), the CNS can become involved in disseminated strongyloidiasis. CNS manifestations can be secondary to larvae infestation. More commonly, however, gut bacteria transmitted by the migrating parasite produce bacterial meningitis. Seizures can be an epiphenomenon of these complications.

Thiabendazole can be helpful if started early in the disease process, but disseminated strongyloidiasis is usually fatal.Comorbid seizure management is routine.162

Adapted from: Goldstein MA and Harden CL. Infectious states. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;83-133. 
With permission from Elsevier ( 

Reviewed By: 
Steven C. Schachter, MD
Monday, March 1, 2004