Neurocysticercosis due to parenchymal cysts carries a good prognosis regardless of therapy. Extraparenchymal neurocysticercosis (including ventricular, spinal, and subarachnoid types) carries a poorer prognosis. Most extraparenchymal cases present with hydrocephalus. Medical treatment alone in doses and schedules developed for parenchymal disease is frequently unsuccessful. For ventricular disease, most cases can be managed with shunting procedures either alone or together with the administration of antiparasitic agents (e.g., praziquantel or albendazole), without extirpation of the cysts. Subarachnoid disease was formerly associated with a case fatality rate of about 50%. However, with the combination of shunting procedures for hydrocephalus, antiparasitic agents, and, in some cases, surgical extirpation of the cysts, the prognosis is much improved. Spinal cysticercosis can be either leptomeningeal (which responds like subarachnoid disease) or intramedullary. For all forms of neurocysticercosis, the role of antiparasitic agents needs to be better defined.
In an attempt to find a dose of recombinant leukocyte A interferon (rIFN-alpha A) that is both efficacious against rhinovirus challenge and is tolerable, double-blind, placebo-controlled studies were performed; 56 normal volunteers received either placebo or one of two relatively small doses of rIFN-alpha A (i.e., 2.4 X 10(6) units [2.4M] or 0.7 X 10(6) units [0.7M] per day) for four days. The frequency of illness was significantly lower in the group given doses of 2.4M than in a group of volunteers given placebo (29% vs. 73%; P less than .032); however, the frequencies of illness in the group given doses of 0.7M and in a placebo group were similar (67% vs. 63%). The rates of infection in these pairs of groups were not significantly different from each other. No significant local or systemic reactions were noted during the four days of rIFN-alpha A administration. In a 26-day tolerance study, 15% of volunteers given 2.4M doses of rIFN-alpha A developed bloody mucus and nasal mucosal erosions, while no such local reactions were noted in volunteers given 0.7M doses or in those given placebo. Thus, increasing doses of rIFN-alpha A were associated with both increasing efficacy against rhinovirus-induced illness and increasing frequency of local adverse reactions.
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