Abstract
BackgroundSolitary cysticercus granuloma (SCG) is the commonest form of neurocysticercosis in the Indian subcontinent and in travelers. Several different treatment options exist for SCG. We conducted a Bayesian network meta-analysis of randomized clinical trials (RCTs) to identify the best treatment option to prevent seizure recurrence and promote lesion resolution for patients with SCG.Methods and Principal FindingsPubMed, EMBASE and the Cochrane Library databases (up to June 1, 2015) were searched for RCTs that compared any anthelmintics or corticosteroids, alone or in combination, with placebo or head to head and reported on seizure recurrence and lesion resolution in patients with SCG. A total of 14 RCTs (1277 patients) were included in the quantitative analysis focusing on four different treatment options. A Bayesian network model computing odds ratios (OR) with 95% credible intervals (CrI) and probability of being best (Pbest) was used to compare all interventions simultaneously. Albendazole and corticosteroids combination therapy was the only regimen that significantly decreased the risk of seizure recurrence compared with conservative treatment (OR 0.32, 95% CrI 0.10–0.93, Pbest 73.3%). Albendazole and corticosteroids alone or in combination were all efficacious in hastening granuloma resolution, but the combined therapy remained the best option based on probability analysis (OR 3.05, 95% CrI 1.24–7.95, Pbest 53.9%). The superiority of the combination therapy changed little in RCTs with different follow-up durations and in sensitivity analyses. The limitations of this study include high risk of bias and short follow-up duration in most studies.ConclusionsDual therapy of albendazole and corticosteroids was the most efficacious regimen that could prevent seizure recurrence and promote lesion resolution in a follow-up period of around one year. It should be recommended for the management of SCG until more high-quality evidence is available.
Highlights
Neurocysticercosis (NCC), a parasitic disease of the nervous system caused by Taenia solium, is a leading cause of acquired epilepsy worldwide [1, 2]
Albendazole and corticosteroids alone or in combination were all efficacious in hastening granuloma resolution, but the combined therapy remained the best option based on probability analysis
Dual therapy of albendazole and corticosteroids was the most efficacious regimen that could prevent seizure recurrence and promote lesion resolution in a follow-up period of around one year. It should be recommended for the management of Solitary cysticercus granuloma (SCG) until more highquality evidence is available
Summary
Neurocysticercosis (NCC), a parasitic disease of the nervous system caused by Taenia solium (pork tapeworm), is a leading cause of acquired epilepsy worldwide [1, 2]. Solitary cysticercus granuloma (SCG), presenting as a single small enhancing lesion, is found in ~20% of NCC cases in endemic areas, and is the commonest type of NCC in the Indian subcontinent as well as in travelers of industrialized countries returning from endemic zones [3, 4]. While there is sufficient information in support of the use of the combination of anthelmintics and corticosteroids in patients with viable cystic parenchymal NCC [6,7,8,9,10], the treatment of SCG has not been optimally defined [11]. Solitary cysticercus granuloma (SCG) is the commonest form of neurocysticercosis in the Indian subcontinent and in travelers. We conducted a Bayesian network meta-analysis of randomized clinical trials (RCTs) to identify the best treatment option to prevent seizure recurrence and promote lesion resolution for patients with SCG
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