Single-Day Praziquantel Therapy for Neurocysticercosis

Abstract

Study about the relation between aspirin use and the risk of colorectal cancer (Sept. 7 issue), 1 a key question was whether the investigation inadvertently identified women who were resistant to colorectal cancer. A number of potentially confounding factors, including family history of colorectal cancer, smoking history, alcohol consumption, diet, and level of physical activity, were considered in the data analysis. Unaddressed was the effect of hormone-replacement therapy on the risk of colorectal cancer in the study population. Data from the Nurses' Health Study on hormone-replacement therapy and its relation to colorectal cancer have suggested a protective effect of this therapy against colon cancer. 2 Evidence linking hormone-replacement therapy and a reduced risk of colon cancer is also available from other studies. 3,4 Could the authors comment on whether women in their study who used aspirin two or more times a week were also more likely to be receiving hormone-replacement therapy?It was reported previously that the relation between the risk of colorectal cancer and the use of nonsteroidal antiinflammatory drugs (NSAIDs) -almost entirely aspirin -depended more on current use of NSAIDs than on previous use discontinued for at least a year. 5 It would be interesting to know more about this aspect of the data from the Nurses' Health Study. 1. Giovannucci E, Egan KM, Hunter DJ, et al. Aspirin and the risk of colorectal cancer in women. N Engl J Med 1995;333:609-14. 2. Chute CG, Willett WC, Colditz GA, Stampfer MJ, Rosner B, Speizer FE. A prospective study of reproductive history and exogenous estrogens on the risk of colorectal cancer in women. Epidemiology 1991;2:201-7. 3. Newcomb PA, Storer BE. Postmenopausal hormone use and risk of largebowel cancer. J Natl Cancer Inst 1995;87:1067-71. 4. Calle EE, Miracle-McMahill HL, Thun MJ, Heath CW Jr. Estrogen replacement therapy and risk of fatal colon cancer in a prospective cohort of postmenopausal women.Letters to the Editor are considered for publication (subject to editing and abridgment) provided they do not contain material that has been submitted or published elsewhere. Please note the following:• Your letter must be typewritten and triple-spaced. • Its text, not including references, must not exceed 400 words (please include a word count). • It must have no more than five references and one figure or table.• It should not be signed by more than three authors. • Letters referring to a recent Journal article must be received within four weeks of its publication. • Please include your full address, telephone number, and fax number (if you have one). Our fax numbers: 617-739-9864 and 617-734-4457Our Internet address: letters@edit.nejm.orgWe cannot acknowledge receipt of your letter, but we will notify you when we have made a decision about publication. We are unable to provide prepublication proofs. Please enclose a stamped, self-addressed envelope if you want unpublished material returned to you.Financial associations or other possible conflicts of interest mu...

Review of neurocysticercosis

“…On this basis, it has been suggested that if parenchymal brain cysticerci are exposed to high concentrations of praziquantel maintained for up to 6 hours (three doses of 25-30 mg/kg at 2-hour intervals on a single day), this might be sufficient to destroy the parasites. 10 Preliminary results are encouraging. The decrease in the number of cysts visualized on neuroimaging studies after a 1-day therapy is similar to that observed in patients receiving longer courses of the drug at conventional doses.…”

“…The decrease in the number of cysts visualized on neuroimaging studies after a 1-day therapy is similar to that observed in patients receiving longer courses of the drug at conventional doses. 10,17,39,46 Albendazole is another strong cysticidal drug, initially tested at doses of 15 mg/kg/day for a 1-month period. 28 It was later found, however, that at similar doses the length of therapy could be shortened to 1 week without lessening the drug efficacy.…”

Neurocysticercosis in sub-Saharan Africa: a review of prevalence, clinical characteristics, diagnosis, and management

“…This treatment regimen has been demonstrated to be successful in singlecysticercus disease, but unfortunately efficacy could not be demonstrated in patients with multiple cysticerci which represent the major phenotype in sub-Saharan Africa. 87,88 Follow-up of patients and monitoring of treatment success represents another challenge. The CT scanner may not be functional anymore or the financial constraints may be too high.…”

Current Consensus Guidelines for Treatment of Neurocysticercosis

“…Initial studies with praziquantel noted that doses as low as 5 to 10 mg/kg/day had some effect against cysts, and doses as high as 50 to 75 mg/kg/day were well tolerated. A dosage of 50 mg/kg/day for 2 weeks was adopted by most subsequent studies (11, 13, 16, 29, 32, 59, 63, 67, 68, 71, 94-96, 98, 103, 111), although a single-day regimen of praziquantel has recently been described (24,25,35,69,80,81), with similar rates of cyst disappearance in some groups of patients. No dose ranging studies were performed with albendazole in cysticercosis.…”