Neurocysticercosis: treatment with albendazole and dextrochloropheniramine

Abstract

We evaluated the use of albendazole in combination with dextrochloropheniramine for the treatment of neurocysticercosis. Forty patients were treated from September 1984 to December 1987; each was diagnosed on the basis of clinical, epidemiological, cerebrospinal fluid and tomographic data. Patients were divided into 3 groups according to the albendazole treatment schedule. Group I received 10-15 mg/kg albendazole daily; group II received 15-25 mg/kg/d; group III received 15-30 mg/kg/d. Each patient also received simultaneously 18 mg/d of dextrochloropheniramine. Clinical improvement was observed in 4 patients in group I (50.0%), 10 patients in group II (83.3%) and 18 patients in group III (94.7%). Three patients in group II, and one in group III, died. Group III patients showed a significant improvement in quality of life compared to the other 2 groups. Side effects were insignificant in all groups. The combination of albendazole and dextrochloropheniramine seems to be a promising treatment for neurocysticercosis, especially at the doses used for group III, i.e. 15 mg/kg/d of albendazole for 21 d followed by 20-30 mg/kg/d for 30 d after a one-week interval, in combination with 18 mg/d of dextrochloropheniramine.

Treatment of cerebral cysticercosis with albendazole in elevated dosages

“…Elevated dosage of albendazole does not seem to be associated to the increase of side effects when compared with the usual doses 5,8,9 .…”

“…Comparative studies between the treatment of subarachnoidal and intraventricular forms of the parasite with a 15 and a 30 mg dose of albendazole, had shown an involution of the cysticercus much more significant in the groups treated with higher doses of the cysticid 5,8,9 . In our patient we used 30 mg/Kg dose, for 30 days.…”

“…For the intracranial hypertension, manitol would be indicated as well. Some authors recommended antihistaminics instead of dexametasone, and this is also useful in diabetes and blood hypertension 5,9 .…”

Management of Neurocysticercosis

“…If no signs of intracranial hypertension exist, common analgesics should be used to obtain appropriate pain control. The use of anti-infl ammatory drugs agents has been mostly restricted to corticosteroids, although early reports on the use of dextrochloropheniramine or, more recently, of methotrexate also exist (Agapejev et al 1989 ;Keiser and Nash 2003 ). Acute anti-infl ammatory therapy in neurocysticercosis is primarily directed to reduce edema and local infl ammation, thus ameliorating intracranial hypertension and decreasing the propensity to further seizures.…”

Steroids in neuroinfection

“…Neurocysticercosis is accompanied by prolonged, sometimes recurrent, periods of inflammatory status leading to long-term treatments, and consequently accumulation of steroids side-effects. Hence, the need of a sparing steroid drug to be used for longer periods, such as dexchlorpheniramine 21 . Similarly, in neuroschistosomiasis the use of steroids overcomes the use of specific antiparasitic drugs.…”