Drug therapy for solitary cysticercus granuloma

Otte, Willem M.; Singla, Monika; Sander, Josemir W.; Singh, Gagandeep

doi:10.1212/wnl.0b013e31827b90a8

Cited by 68 publications

(54 citation statements)

References 35 publications

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“…Although these calcifications cannot usually be differentiated from similar calcified lesions due to other etiologies, there is little question that most are derived from degenerating granulomas. The most direct evidence comes from serial observations using computerized tomography (CT) and magnetic resonance imaging (MRI) of patients with characteristic T. solium cysts that degenerate naturally or following cysticidal treatment [20, 21]. In a sizable proportion, these lesions gradually become calcified, typically evolving into characteristic dense calcifications.…”

Section: Characteristics Of Calcified Neurocysticercosismentioning

confidence: 99%

Disease Centered Around Calcified Taenia solium Granuloma

Nash

Bustos²,

Garcı́a

2017

Trends in Parasitology

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Taenia solium (the pork tapeworm) is present in most developing countries, where it is a frequent cause of seizures and other neurological disease. Parasitic larvae invade the human brain, establish, and eventually resolve, leaving a calcified scar. While these lesions are common in endemic regions and most of these are clinically silent, a proportion of individuals with calcified cysticerci develop seizures from these lesions and in from 30–65% of the time associated with perilesional edema, likely due to host inflammation. This manuscript summarizes the importance, characteristics, natural history and potential prevention and treatments of symptomatic calcified neurocysticercosis.

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Section: Characteristics Of Calcified Neurocysticercosismentioning

confidence: 99%

Disease Centered Around Calcified Taenia solium Granuloma

Nash

Bustos²,

Garcı́a

2017

Trends in Parasitology

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“…5 Antiparasitic treatment of patients with viable intraparenchymal brain cysts seems to improve the prognosis of their seizure disorders. 6–9 However, antiparasitic treatment has suboptimum efficacy, killing roughly 65% of parasites and obtaining complete cyst resolution (no viable parasites remaining) in less than 40% of patients after a course of praziquantel or albendazole. 10,11 …”

Section: Introductionmentioning

confidence: 99%

Efficacy of combined antiparasitic therapy with praziquantel and albendazole for neurocysticercosis: a double-blind, randomised controlled trial

Garcı́a

Gonzáles²,

Lescano

et al. 2014

The Lancet Infectious Diseases

168

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Summary Background Neurocysticercosis causes a substantial burden of seizure disorders worldwide. Treatment with either praziquantel or albendazole has suboptimum efficacy. We aimed to establish whether combination of these drugs would increase cysticidal efficacy and whether complete cyst resolution results in fewer seizures. We added an increased dose albendazole group to establish a potential effect of increased albendazole concentrations. Methods In this double-blind, placebo-controlled, phase 3 trial, patients with viable intraparenchymal neurocysticercosis were randomly assigned to receive 10 days of combined albendazole (15 mg/kg per day) plus praziquantel (50 mg/kg per day), standard albendazole (15 mg/kg per day), or increased dose albendazole (22·5 mg/kg per day). Randomisation was done with a computer generated schedule balanced within four strata based on number of cysts and concomitant antiepileptic drug. Patients and investigators were masked to group assignment. The primary outcome was complete cyst resolution on 6-month MRI. Enrolment was stopped after interim analysis because of parasiticidal superiority of one treatment group. Analysis excluded patients lost to follow-up before the 6-month MRI. This trial is registered with ClinicalTrials.gov, number NCT00441285. Findings Between March 3, 2010 and Nov 14, 2011, 124 patients were randomly assigned to study groups (41 to receive combined albendazole plus praziquantel [39 analysed], 43 standard albendazole [41 analysed], and 40 increased albendazole [38 analysed]). 25 (64%) of 39 patients in the combined treatment group had complete resolution of brain cysts compared with 15 (37%) of 41 patients in the standard albendazole group (rate ratio [RR] 1·75, 95% CI 1·10–2·79, p=0·014). 20 (53%) of 38 patients in the increased albendazole group had complete cyst resolution at 6-month MRI compared with 15 (37%) of 41 patients in the standard albendazole group (RR 1·44, 95% CI 0·87–2·38, p=0·151). No significant differences in adverse events were reported between treatment groups (18 in combined treatment group, 11 in standard albendazole group, and 19 in increased albendazole group). Interpretation Combination of albendazole plus praziquantel increases the parasiticidal effect in patients with multiple brain cysticercosis cysts without increased side-effects. A more efficacious parasiticidal regime without increased treatment-associated side-effects should improve the treatment and long term prognosis of patients with neurocysticercosis. Funding National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health.

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“…Calcification in NCC is a common long-term outcome with observed rates of calcification in pediatric NCC varying widely from 6.2% to as high as 60% [24]. Interestingly, cysticidal therapy was found to have no significant effect in the calcification of solitary parenchymal NCC [25, 26]. A retrospective analysis of solitary parenchymal NCC from India [24] reported that the risk of breakthrough seizures was significantly higher in calcified lesions on follow-up scan when compared to normal scans or persisting lesions.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Response to Cysticidal Therapy, and Risk Factors for Persistent Seizure in Indian Children with Neurocysticercosis

Kumar

Mandal

Sinha

et al. 2017

International Journal of Pediatrics

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Background. Neurocysticercosis (NCC) is the commonest cause of childhood acquired epilepsy in developing countries. The use of cysticidal therapy in NCC, except “single lesion NCC,” is still debated in view of its doubtful usefulness and potential adverse effects. Methods. Children presenting with first episode of seizure or acute focal neurological deficit without fever were screened for NCC and received appropriate therapy (followup done for 1 year to look for the response and side effects). Results. The prevalence of NCC was 4.5%. Most common presenting feature was generalized seizure and commonest imaging finding was single small enhancing lesion in the parietal lobe. Abnormal EEG and CSF abnormalities were found in almost half of the children. The response to therapy was very good with infrequent recurrence of seizure and adverse effects of therapy were encountered rarely. No risk factors for persistent seizure could be identified. Conclusion. Present study shows that the response to cysticidal therapy is very good in NCC as seizure recurrence was observed in only 5%, 4.2%, and 4.2% of cases at 3-month, 6-month, and 1-year followup. Adverse effects of therapy were observed in 20% of cases during therapy but they were mild and self-limiting.

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Drug therapy for solitary cysticercus granuloma

Cited by 68 publications

References 35 publications

Disease Centered Around Calcified Taenia solium Granuloma

Disease Centered Around Calcified Taenia solium Granuloma

Efficacy of combined antiparasitic therapy with praziquantel and albendazole for neurocysticercosis: a double-blind, randomised controlled trial

Prevalence, Response to Cysticidal Therapy, and Risk Factors for Persistent Seizure in Indian Children with Neurocysticercosis

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