Corticosteroids Versus Albendazole for Treatment of Single Small Enhancing Computed Tomographic Lesions in Children With Neurocysticercosis

Abstract

Single small enhancing computed tomographic (CT) lesions representing cysticercus granuloma are a common cause of focal seizures in children. Controversy exists regarding the efficacy of various modalities of treatment. We conducted a randomized prospective trial to evaluate the efficacy of corticosteroids, albendazole, and corticosteroids with albendazole in children with focal seizures and single small enhancing CT lesions. The study population consisted of 133 children with focal seizures of recent onset (< 3 months) and single small enhancing CT lesions who presented to the Neurocysticercosis Clinic of Pediatric Neurology Services at the Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, an urban teaching and tertiary care hospital in Chandigarh, North India. All children were randomly assigned to receive corticosteroids (group S), albendazole (group A), or both corticosteroids and albendazole (group SA) for 28 days. CT was done at 3 and 6 months after enrollment in the study. Of the 133 patients enrolled, 23 were lost to follow-up. Of the remaining 110 patients, 38 patients were in group S, 37 in group A, and 35 in group SA. All children were followed up for at least 18 months. Disappearance of the lesion on CT scan was noted in 52.6% of patients in group S, 59.5% in group A, and 62.9% in Group SA (P > .1) at the 3-month follow-up. After the 6-month follow-up, disappearance of the lesion was noted in 76.3% in group S, 75.7% in group A, and 74.2% in group SA (P > .1). Twenty-three patients had seizure recurrence while on antiepilepsy drugs: 36.8% of patients in group S, 13.5% in group A, and 11.4% in group SA (P < .05). Seizure recurrence after antiepilepsy drug withdrawal was seen in seven children (three in group S and two each in groups A and SA). In conclusion, there was no significant difference in resolution of CT lesions in the three therapy groups at 3 and 6 months of follow-up. Children in the corticosteroid group had significantly more seizure recurrences while on antiepilepsy drugs.

Drug therapy for solitary cysticercus granuloma

“…Four of the RCTs reported granuloma resolution rates at multiple time points of follow-up and hence had a repeatedmeasures design. 31,34,39,40 A significantly higher rate of granuloma resolution was observed with anthelminthic treatment in the pooled analysis of data from 3 and 6 months (OR: 2.09; 95% CI: 1.41-3.09; p 5 0.0003; I 2 5 31%). When trials with repeated-measures design were excluded from analysis, the ORs for granuloma resolution remained increased in favor of anthelminthic treatment both at 3 months (OR: 2.25; 95% CI: 1.43-3.52; p 5 0.0004; I 2 5 12% (data removed from 6 months) and 6 months (OR: 2.10; 95% CI: 1.28-3.47; p 5 0.004; I 2 5 41%).…”

“…The proportion of subjects with seizure recurrence on antiepileptic drugs (AEDs) after therapeutic intervention with anthelminthic drugs was reported for 3-month follow-up in 2 RCTs, 32,36 6-month follow-up in 5 RCTs, 33,35,36,39,40 and 12-month follow-up in 1 RCT. 34 This information could not be extracted from one of the reports but was obtained after contacting the authors.…”

“…31,32,34,[36][37][38][39][40] Five RCTs reported resolution at 6 months follow-up time using CT 31,33,35,39,40 or MRI acquisition. 34 All CT studies but one 35 used contrast-enhanced acquisition.…”

“…[27][28][29][30] Eventually, 10 RCTs, involving 765 subjects with SCG, were included in the meta-analysis of anthelminthic treatment. [31][32][33][34][35][36][37][38][39][40] In one of these, some subjects had 2 rather than a single enhancing lesion. 36 We chose to include this trial because the proportion of subjects with 2 lesions was small (18%).…”

Evidence-based guideline: Treatment of parenchymal neurocysticercosis [RETIRED]

“…Three Class I 325 (1 Class I for imaging only 5 and Class IV for clinical measures, including seizure frequency) and 6 Class II studies [6][7][8][9][10][11] (1 Class II for imaging studies only 6 ) addressed cysticidal therapy (administered with or without steroids) in the initial treatment of neurocysticercosis. One 11 of the Class II studies compared albendazole alone with albendazole with praziquantel without a control group and therefore was not informative regarding whether antihelminthic therapy is useful.…”