Factors Associated With Cysticidal Treatment Response in Extraparenchymal Neurocysticercosis

Abstract

Extraparenchymal neurocysticercosis is the most severe form of cysticercosis, and response to treatment is suboptimal. We sought to determine how demographic and clinical characteristics and albendazole sulfoxide concentrations were related to cysticidal treatment response. We conducted a longitudinal study of 31 participants with extraparenchymal vesicular parasites who received the same treatment, albendazole 30 mg/kg/day for 10 days with dexamethasone 0.4 mg/kg/day for 13 days, followed by a prednisone taper. Response to treatment was determined by parasite volumes before and 6 months after treatment. Eight participants (25.8%) had a complete treatment response, 16 (51.6%) had a treatment response > 50% but < 100%, and 7 (22.6%) had a treatment response < 50%. Complete treatment response was significantly associated with higher concentrations of albendazole sulfoxide (P = .032), younger age (P = .032), fewer cysts (P = .049) and lower pretreatment parasite volume (P = .037). Higher number of previous cysticidal treatment courses was associated with a noncomplete treatment response (P = .023). Although the large proportion of participants with less than a complete response emphasizes the need to develop more efficacious pharmacologic regimens, the association of albendazole sulfoxide concentrations with treatment response highlights the importance of optimizing existing therapeutic regimens. In addition, the association of treatment response with parasite volume emphasizes the importance of early diagnosis.

Natural History of Treated Subarachnoid Neurocysticercosis

“…Some investigators use a short 8-10-day course of high-dose albendazole and dexamethasone or 15 days of praziquantel 28 with cyst regression as a measure of effectiveness. 10,28,[30][31][32][33] However, this regimen is frequently unsuccessful, requiring one or more retreatments. 33,34 Furthermore, the duration of follow-up is often short and longer term outcomes, including morbidity, mortality, side effects of treatment, and recurrence rates of this treatment approach, are unclear.…”

“…10,28,[30][31][32][33] However, this regimen is frequently unsuccessful, requiring one or more retreatments. 33,34 Furthermore, the duration of follow-up is often short and longer term outcomes, including morbidity, mortality, side effects of treatment, and recurrence rates of this treatment approach, are unclear. Proaño et al 35 treated patients with one to three giant subarachnoid cysts causing mass effects (mostly Sylvian fissure located cysts) with high-dose corticosteroids and one or more 4-week-long courses of albendazole or praziquantel.…”

Extraparenchymal neurocysticercosis: a challenge in treatment and in clinical management

“…Symptoms are more severe; particularly more of 70% of the patients developed intracranial hypertension due to the perturbation of the circulation of the cerebrospinal fluid (CSF) caused by the presence of the parasite (Marcin- Sierra et al, 2017). This situation can compromise the life of the patient and generally require the colocation of a ventriculoperitoneal shunt (Osorio et al, 2019).…”

Optimal Treatment for Subarachnoid Neurocysticercosis: Closer, but Not There yet

“…Other series have also noted few fatalities with optimal management. 10,11 Why has there been such a stark difference in case fatality rates between studies? The main difference in the management of patients between the older series and more recent reports is the recent aggressive use of antiparasitic and anti-inflammatory drugs and aggressive management of increased intracranial pressure.…”

“…Other investigators have used high-dose albendazole in short cycles, repeated as needed, with results similar to those noted by Nash. 6,10 Clearly, host inflammation plays a key role in the pathogenesis of neurocysticercosis. Nash and others 9 also used an aggressive approach to anti-inflammatory therapy.…”