Antiparasitic drugs in neurocysticercosis: albendazole or praziquantel?

This article evaluates the findings and conclusions of a recent meta-analysis of published data comparing the efficacy of the treatment of neurocysticercosis with albendazole and praziquantel in terms of both resolution of brain cysts and seizure control. From 103 related articles indexed in PubMed and the Cochrane Database of Controlled Trials, and quoted in reference lists, six prospective trials comparing albendazole with praziquantel (including patients infected with parasites in their cystic stage without perilesional inflammation and examining partial or total disappearance of cysts and/or control of seizures) were evaluated. The small number and heterogeneity of the included studies makes it difficult to assess the analyses provided. One of the studies was a pilot trial, at least three had grossly inadequate sample sizes and, owing to the way in which the data are presented in one of the studies, it is not possible to extract the proportion of parasites that resolved. None of the studies was designed to evaluate seizure control. The current published data does not provide enough basis to determine conclusively the superiority of either albendazole or praziquantel as first-line treatment of neurocysticercosis, and the choice of an antiparasitic drug is still guided by collateral factors, including drug availability and costs.