OBJECTIVE: The effectiveness of anthelminthic and corticosteroid drug therapy in parenchymal neurocysticercosis is well established. The treatment of parenchymal solitary cysticercus granuloma (SCG), however, remains controversial. We attempted to obtain a consistent estimate of the efficacy of anthelminthic and corticosteroid drug treatment in SCG. METHODS: Randomized-controlled trials (RCTs) comparing rates of seizure freedom, granuloma resolution, and residual calcification in individuals with SCG treated with anthelminthic or corticosteroid drugs with those treated with antiepileptic drugs (AEDs) alone were systematically reviewed and quantified using fixed- or random-effects meta-analysis. RESULTS: Fifteen RCTs were identified for inclusion. Ten RCTs assigned 765 people with SCG to AED treatment with or without anthelminthic drug (albendazole) treatment. A further 5 RCTs assigned 457 people with SCG to AED treatment with or without corticosteroid drugs. Anthelminthic treatment was associated with significantly increased rates of seizure freedom (nonevent odds ratio: 2.45; 95% confidence interval: 1.49-4.03; p = 0.0004) and significantly higher rates of granuloma resolution (odds ratio: 2.09; 95% confidence interval: 1.41-3.00; p = 0.0003), but did not alter the risk of residual calcification. Corticosteroid treatment was not significantly associated with any outcome. CONCLUSIONS: Anthelminthic treatment with albendazole provides improved rates of seizure freedom and hastens resolution of the granuloma. The role of corticosteroid treatment remains uncertain. The benefits (or lack thereof in the case of corticosteroids) are consistent when measured across different time points after treatment.
OBJECTIVE: The effectiveness of anthelminthic and corticosteroid drug therapy in parenchymal neurocysticercosis is well established. The treatment of parenchymal solitary cysticercus granuloma (SCG), however, remains controversial. We attempted to obtain a consistent estimate of the efficacy of anthelminthic and corticosteroid drug treatment in SCG. METHODS: Randomized-controlled trials (RCTs) comparing rates of seizure freedom, granuloma resolution, and residual calcification in individuals with SCG treated with anthelminthic or corticosteroid drugs with those treated with antiepileptic drugs (AEDs) alone were systematically reviewed and quantified using fixed- or random-effects meta-analysis. RESULTS: Fifteen RCTs were identified for inclusion. Ten RCTs assigned 765 people with SCG to AED treatment with or without anthelminthic drug (albendazole) treatment. A further 5 RCTs assigned 457 people with SCG to AED treatment with or without corticosteroid drugs. Anthelminthic treatment was associated with significantly increased rates of seizure freedom (nonevent odds ratio: 2.45; 95% confidence interval: 1.49-4.03; p = 0.0004) and significantly higher rates of granuloma resolution (odds ratio: 2.09; 95% confidence interval: 1.41-3.00; p = 0.0003), but did not alter the risk of residual calcification. Corticosteroid treatment was not significantly associated with any outcome. CONCLUSIONS: Anthelminthic treatment with albendazole provides improved rates of seizure freedom and hastens resolution of the granuloma. The role of corticosteroid treatment remains uncertain. The benefits (or lack thereof in the case of corticosteroids) are consistent when measured across different time points after treatment.
Authors: H H Garcia; R H Gilman; J Horton; M Martinez; G Herrera; J Altamirano; J M Cuba; N Rios-Saavedra; M Verastegui; J Boero; A E Gonzalez Journal: Neurology Date: 1997-05 Impact factor: 9.910
Authors: Kriti Thapa; Matthew L Romo; Arturo Carpio; Denise Leslie; Howard Andrews; W Allen Hauser; Elizabeth A Kelvin Journal: Trans R Soc Trop Med Hyg Date: 2018-02-01 Impact factor: 2.184
Authors: Arturo Carpio; Mindy Chang; Hongbin Zhang; Matthew L Romo; Alex Jaramillo; W Allen Hauser; Elizabeth A Kelvin Journal: Epilepsia Date: 2019-07-29 Impact factor: 5.864
Authors: Hector H Garcia; Isidro Gonzales; Andres G Lescano; Javier A Bustos; E Javier Pretell; Herbert Saavedra; Theodore E Nash Journal: Epilepsia Date: 2014-08-04 Impact factor: 5.864
Authors: Hector H Garcia; Isidro Gonzales; Andres G Lescano; Javier A Bustos; Mirko Zimic; Diego Escalante; Herbert Saavedra; Martin Gavidia; Lourdes Rodriguez; Enrique Najar; Hugo Umeres; E Javier Pretell Journal: Lancet Infect Dis Date: 2014-07-03 Impact factor: 25.071