Optimization of the single-day praziquantel therapy for neurocysticercosis

Abstract

In 1996, we described a schedule of single-day therapy with praziquantel for management of neurocysticercosis. This treatment resulted in 90% less total dose and costs and 93% less duration of treatment in comparison with the 2-week regimen, achieving similar clinical efficacy. 1 It also showed similar results compared with albendazole. 2 Recent reports in healthy volunteers have suggested that plasma levels of praziquantel increase with the administration of cimetidine 3 and also with a high-carbohydrate diet, 4 apparently due to inhibition of cytochrome p450. To investigate the potential clinical advantage of this effect, we compared the praziquantel single-day regimen administered either alone or in combination with cimetidine, and administered simultaneously with a high-carbohydrate diet.Methods. We studied 18 patients diagnosed with cysticercosis in brain parenchyma or subarachnoid space at the convexity. Age range was 17 to 64 years (mean 29.2); the study included 10 men and eight women. No patients with parenchymal cysts surrounded by edema and intense enhancing in contrasted studies were selected. No pregnant women were included. A diagnosis of cysticercosis was confirmed by ELISA in CSF and imaging studies (CT or MRI or both). All had seizures as the principal symptom. The mean time between the beginning of symptoms and treatment was 8 weeks. Informed consent was obtained from each patient. Subjects were randomly separated into three groups of six pa-tients each. Group 1 received three oral doses of 25 mg/kg of praziquantel at 2-hour intervals (at 7, 9, and 11 AM) after an overnight fast. Group 2 received the same three oral doses plus 400 mg of cimetidine administered 1 hour before each praziquantel dose. Group 3 received a high-carbohydrate diet (650 calories) 30 minutes before the first dose of praziquantel. All patients received dexamethasone (8 mg intramuscular) 6 hours after the last dose of praziquantel followed by the same dosage for the next 2 days. All patients remained in the hospital during treatment. Clinical evaluations were made 1, 2, 4, 8, 12, and 24 weeks after treatment, all by the same neurologist (M.L.). Follow-up CT scanning was performed 4, 12, and 24 weeks after treatment, and MRI was performed 24 weeks after treatment. Efficacy of treatment was evaluated by the individual disappearance of cysts and by the percentage of disappearance of lesions in every patient. Imaging studies were independently reviewed by a neurologist (T.C.) and a neuroradiologist blinded to treatment group source; interobserver results were identical. Blood samples were taken immediately before the last dose of praziquantel and were assayed by highperformance liquid chromatography. 5 The Mann-Whitney test was used to assess differences in the median percentage of cysts and to assess plasma levels. The SPSS-9 analytical program was used.

Therapy for neurocysticercosis

“…Recently, a single-day scheme was proposed (25 mg/kg at 2 h intervals) leading to a 90% reduction of the direct costs in relation to the traditional scheme and preliminary results were encouraging [8,15,[26][27][28]. The decrease in the number of cysts visualized in neuroimaging studies was similar to that observed in patients receiving longer courses of PZQ at conventional doses [8,15,27,29,30]. However, the parasiticidal results obtained by Pretell and colleagues were unsatisfactory in patients with multiple lesions, in whom all cysts persisted unchanged [31].…”

“…Dexamethasone decreases plasma concentration of PZQ but increases ASOX [26,37]. Food, a high carbohydrate diet, grapefruit juice and cimetidine increase plasma PZQ concentration [26,30,[56][57][58]. Foods rich in fat and cimetidine may also favor ALB absorption.…”

Neurocysticercosis Presenting as Bipolar Disorder and Chronic Papilledema: A Rare Case Report and Review

“…Currently, albendazole is the drug of choice for antiparasitic therapy (15 mg/kg/day for 7 days with oral steroids) although a single day praziquantel regimen seems equally effective (25 mg/kg, three doses at two hour intervals followed by steroids 6 hours later) [14]. Multiple lesions or subarachnoid cysticercosis require a longer course.…”

Disseminated Cysticercosis

“…The reason why the biopsies were performed is that the diagnosis remained questionable and the disseminated cysticercosis had not been reported in Korea before. Pharmacological management with the cysticidal drugs praziquantel and albendazole is indicated as they help by reducing the parasite burden 8) . These drugs facilitate the death of the cysts.…”