Treatment of neurocysticercosis: is it beneficial?

Abstract

Evaluation of: Carpio A, Kelvin EA, Bagiella E et al.; Neurocysticercosis Group TE. The effects of albendazole treatment on neurocysticercosis: a randomized controlled trial. J. Neurol. Neurosurg. Psychiatry DOI: 10.1136/jnnp.2008.144899 (2008) (Epub ahead of print).

Neurocysticercosis is the most common parasitic disease of the CNS. Intracranial neurocysticercosis is classified into cerebral parenchymal and extraparenchymal forms (subarachnoidal and intraventricular). Current medical therapy for parenchymal and extraparenchymal neurocysticercosis invovles the use of anticysticercal drugs. Albendazole and praziquantel are two commonly used drugs. Most experts prefer to always use oral or parenteral corticosteroids along with anticysticercal drugs. The role of anticysticercal drugs in the treatment of parenchymal neurocysticercosis has always been a subject of intense controversy. Whether therapy with anticysticercal drugs results in improved seizure-related prognosis remains a major concern. A recent meta-analysis evaluating six controlled trials suggests that treatment with anticysticercal drugs results in better resolution of colloidal and vesicular cysticerci; in patients taking anticysticercal drugs, there was a lower risk of seizure reccurence in patients with colloidal cysticerci and a significant reduction in the rate of generalized seizures in patients with vesicular cysticerci. However, the findings of the study by Carpio et al. have revived the controversy regarding this treatment. These authors noted that the effect of a single dose of albendazole is, at best, only modest. Only a minority of patients with parenchymal neurocysticercosis benefitted and became cyst free and there was a lack of effectiveness toward the associated seizure disorders. No response was seen in patients with degenerative parenchymal or extraparenchymal forms of neurocysticercosis. Carpio et al. suggest that there is a need for further studies that employ different approaches, such as the use of high initial doses of albendazole, the use of two anticysticercal drugs or repeated prolonged courses of albendazole.

Keywords::

• albendazole
• antiepileptic drug
• cysticercosis
• epilepsy
• granuloma
• headache
• neurocysticercosis
• praziquantel

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

Definitive diagnosis: presence of one absolute criterion; presence of two major plus one minor and one epidemiological criterion. Probable diagnosis: presence of one major plus two minor criteria; presence of one major plus one minor and one epidemiological criteria; presence of three minor plus one epidemiological criteria.

EITB: Enzyme-linked immunoelectrotransfer blot assay.

Adapted from [4].

Definitive diagnosis: presence of one absolute criteria; presence of two major plus one minor criteria.

Probable diagnosis: presence of one major plus two minor criteria; presence of three minor criteria.

^*If diagnosis is not based upon one absolute criterion, the conditions under ‘diagnosis with caution in the presence of certain conditions’ should always be considered.

EITB: Enzyme-linked immunoelectrotransfer blot assay.

Adapted from [5].