Current approaches to cysticidal drug therapy for neurocysticercosis

ABSTRACT

Introduction

Cysticidal drugs have improved the prognosis of thousands of patients with neurocysticercosis (NCC). However, conflicting studies have created controversies on the actual value of these drugs. Here, the reasons of these controversies, as well as evidence showing the beneficial role of cysticidal drugs are reviewed.

Areas covered

The present review (based on different databases searches up to March 2020), focuses on the evidence supporting the use of cysticidal drugs in patients with NCC. For parenchymal NCC, albendazole alone must be used for patients with one or two cysts, while the combination of albendazole plus praziquantel is advised for those with more than two lesions. Level I evidence on the optimal regimens of cysticidal drugs for treatment of extraparenchymal NCC is lacking, although there is growing evidence supporting the use of cysticidal drugs in these cases, providing that hydrocephalus and intracranial hypertension have previously been treated.

Expert opinion

With the exception of therapy of patients with viable parenchymal brain cysticerci, we are far from getting level I evidence on the best approach for each of the other forms of NCC, as most of our knowledge on therapy for extraparenchymal NCC is based on non-controlled studies or small series of patients.

KEYWORDS:

• Cysticercosis
• neurocysticercosis
• taenia solium
• parasitic diseases
• albendazole
• praziquantel
• cysticidal drugs

Article highlights

• Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system, and a major cause of neurological disease worldwide.

• NCC is pleomorphic. Therefore, a single therapeutic approach cannot be useful in every patient. Characterized by NCC in terms of cysts’ viability, severity of the host’s immune response to the parasites and location of lesions within the CNS, is important before planning a rationale therapeutic approach.

• The first line of management must be directed to control the clinical manifestations and the pathogenic mechanisms involved in their occurrence. Cysticidal drugs should be used only after the patient has been stabilized.

• Praziquantel and albendazole have been used for more than 40 years. However, the efficacy of these drugs has been questioned, based on anecdotal reports of drug toxicity, results of some biased studies claiming that cysts’ destruction is similar after the use of cysticidal drugs than when the disease is left untreated, and the incorrect assumption that cysticidal drugs do not modify the clinical course of NCC.

• A large body of evidence have increased our knowledge of the efficacy of cysticidal drugs for therapy of some forms of NCC. Recent guidelines of a panel of experts detailed current evidence of the approaches for the various forms of NCC.

• With the exception of therapy of patients with viable parenchymal brain cysticerci, we are far from getting level I evidence on the best approach for other forms of NCC.

Acknowledgments

Dr. Del Brutto’s research is supported by Universidad Espíritu Santo – Ecuador.

Declaration of interest

The authors have 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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.