Treatment of neurocysticercosis: is it beneficial?

Abstract

Evaluation of: Carpio A, Kelvin EA, Bagiella E et al.; Neurocysticercosis Group TE. The effects of albendazole treatment on neurocysticercosis: a randomized controlled trial. J. Neurol. Neurosurg. Psychiatry DOI: 10.1136/jnnp.2008.144899 (2008) (Epub ahead of print).Neurocysticercosis is the most common parasitic disease of the CNS. Intracranial neurocysticercosis is classified into cerebral parenchymal and extraparenchymal forms (subarachnoidal and intraventricular). Current medical therapy for parenchymal and extraparenchymal neurocysticercosis invovles the use of anticysticercal drugs. Albendazole and praziquantel are two commonly used drugs. Most experts prefer to always use oral or parenteral corticosteroids along with anticysticercal drugs. The role of anticysticercal drugs in the treatment of parenchymal neurocysticercosis has always been a subject of intense controversy. Whether therapy with anticysticercal drugs results in improved seizure-related prognosis remains a major concern. A recent meta-analysis evaluating six controlled trials suggests that treatment with anticysticercal drugs results in better resolution of colloidal and vesicular cysticerci; in patients taking anticysticercal drugs, there was a lower risk of seizure reccurence in patients with colloidal cysticerci and a significant reduction in the rate of generalized seizures in patients with vesicular cysticerci. However, the findings of the study by Carpio et al. have revived the controversy regarding this treatment. These authors noted that the effect of a single dose of albendazole is, at best, only modest. Only a minority of patients with parenchymal neurocysticercosis benefitted and became cyst free and there was a lack of effectiveness toward the associated seizure disorders. No response was seen in patients with degenerative parenchymal or extraparenchymal forms of neurocysticercosis. Carpio et al. suggest that there is a need for further studies that employ different approaches, such as the use of high initial doses of albendazole, the use of two anticysticercal drugs or repeated prolonged courses of albendazole.