Treatment of Epilepsy Secondary to Neurocysticercosis

Abstract

Lack of curative treatment in most of neurological disorder has been a permanent frustration for almost all of us. Fortunately, good news about novel therapeutic approaches and its excellent responses are gradually arriving and today we can celebrate some therapeutic advances such as: cytokines-based therapies for immune-mediated inflammatory myopathies; myoclonal antibodies for the treatment of certain types of immune-mediated inflammatory neuropathies, myopathies, and T-cell mediated disorders; enzyme replacement therapy for Pompe’s disease. Non-ergoline dopamine agonist and deep-brain stimulation of subthalamic nucleus and the globus pallidus internus in Parkinson disease, and immunomodulatory agents for multiple sclerosis among others and some exciting therapeutic approaches will come very soon for example: antisense oligonucleotides in Duchenne muscular dystrophy. Stem-cell therapy and gene therapy for inherited neuromuscular disorders, up-regulation of fetal isoforms in hereditary disorders such as: myophophorylase deficiency, and novel forms of neuromodulation. Unfortunately, for treatment of epilepsy secondary to neurocysticercosis (NC) no therapeutic advances has been reported and apart from carbamazepine (CBZ) and valproic acid (VA) no other antiepileptic drug (AED) has proven better efficacy. Although, levetiracitam seems to be as well as CBZ and VA it is not available in rural clinics and in most of the public hospitals from developing countries where NC is endemic. Therefore, several millions of epileptic patients cannot reach levetiracitam worldwide. Pharmacoresistance in developed countries, lack of AED or poor access to the AED in developing countries continue playing an important role in the high prevalence of difficult– to-control adult epilepsy and are even more 45% of the epileptic population continue experience regular seizures then the only choice that we have is to improve treatment approaches to NC hoping that it may contribute to a better control of epilepsy. Neurocysticercosis is the leading cause of epilepsy in developing countries and it is becoming one of the most common causes of epilepsy in developed countries due to globalization. It is a preventable and potentially eradicable neurological disorder. [Roman 2000]. At the present moment, treatment of NC in patients presenting epilepsy still has some controversial aspects (Goldberg, 1984; Moodley & Moosa, 1989; Kramer, 1990; Rajshekhar, 1991; Carpio et al. 1995). Apart from dosages of anti-parasitic drugs and its duration; whether or not to use albendazole or praziquantel and how to use it, as part of the treatment for NC, is not certain. Based on findings from other researchers and our