Albendazole versus praziquantel in the treatment of cerebral cysticercosis: clinical evaluation

Abstract

One hundred consecutive patients presenting with symptoms and signs of neurocysticercosis, confirmed by neuroimaging techniques, were randomly assigned to treatment with either praziquantel 50 mg/kg/d for 15 d or albendazole 15 mg/kg/d for 30 d. All patients were treated in addition with steroids for 45 d. Follow-up was for 90 d for response to treatment and at least 1 year for recurrence. Although similar numbers of patients showed no improvement in neuroimaging criteria at 3 months, the response to albendazole was more pronounced with larger numbers showing marked improvement or disappearance of lesions. Resolution of the presenting neurological signs and symptoms was also more frequent in the albendazole group. Electroencephalographic changes also became normal. The use of steroid cover eliminated the headache frequently present during the first few days of treatment and permitted severe cases to be treated. Both albendazole and praziquantel appeared to be effective at the doses used, with albendazole showing a slightly better overall response.

Current Consensus Guidelines for Treatment of Neurocysticercosis

“…Instead, the dose previously used in hydatid disease (15 mg/kg/day) was used for cysticercosis. The initial length of therapy was 1 month, later reduced to 15 days and 1 week (2,3,14,21,29,55,63,89,90,94,95,98,111). There is limited experience with higher doses of both drugs (1,11,58).…”

Review of neurocysticercosis

“…35,68 Albendazole destroys 75 to 90% of parenchymal brain cysts and has been shown to be superior to praziquantel in several comparative trials. 11,62,64,73 Another advantage of albendazole over praziquantel is that the former also destroys subarachnoid and ventricular cysts because of its better penetration in CSF, as well as the fact that it can be administered jointly with corticosteroid agents for antiinflammatory therapy. 12,23,48 The introduction of praziquantel and albendazole has radically changed the prognosis in most patients with NCC.…”

Management of Neurocysticercosis

“…This created confusion among some physicians involved in the care of neurocysticercosis patients, who questioned the benefi ts of praziquantel and even considered that this drug may actually be deleterious in this setting (Kramer 1995 ). Meanwhile, albendazole, another cysticidal drug, was fi rst tested in Mexico and then in other disease-endemic countries, and proved effective for destroying parenchymal brain cysticerci, with the advantages of being cheaper and somewhat more effective than praziquantel (Alarcón et al 1989 ;Cruz et al 1991 ;Escobedo et al 1987 ;García et al 1997 ;Sotelo et al 1988Sotelo et al , 1990Takayanagui and Jardim 1992 ). Some early studies also found a clinical effect on seizure control, with 50-80 % of treated patients being free of seizures compared to 25 % of untreated patients (Del Brutto et al 1992a , b ;Vazquez and Sotelo 1992 ).…”