A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis.
BACKGROUND
Neurocysticercosis is the main cause of adult-onset seizures in the developing world. Whether therapy with antiparasitic agents results in improved seizure control has been questioned because of the lack of adequate, controlled studies.


METHODS
We conducted a double-blind, placebo-controlled trial in which 120 patients who had living cysticerci in the brain and seizures treated with antiepileptic drugs were randomly assigned to receive either 800 mg of albendazole per day and 6 mg of dexamethasone per day for 10 days (60 patients) or two placebos (60 patients). The patients were followed for 30 months or until they had been seizure-free for 6 months after the doses of the antiepileptic drugs had been tapered. The efficacy of treatment was measured as the decrease in the number of seizures after treatment.


RESULTS
In the albendazole group, there was a 46 percent reduction in the number of seizures (95 percent confidence interval, -74 to 83 percent) during months 2 to 30 after treatment. This reduction, which was not statistically significant, was composed of a nonsignificant reduction of 41 percent in the number of partial seizures (95 percent confidence interval, -124 to 84 percent) and a significant 67 percent reduction in the number of seizures with generalization (95 percent confidence interval, 20 to 86 percent). Most of the difference in the number of partial seizures was attributable to a few patients who had many seizures during follow-up. The proportions of patients who had partial seizures during follow-up were similar in the two groups (19 of 57 in the albendazole group and 16 of 59 in the placebo group), but the patients in the placebo group had a greater tendency to have seizures with generalization (22 of 59, vs. 13 of 57 in the albendazole group; risk ratio, 1.63; 95 percent confidence interval, 0.91 to 2.92). More of the intracranial cystic lesions resolved in the albendazole group than in the placebo group. With the sole exception of abdominal pain, side effects did not differ significantly between the two groups.


CONCLUSIONS
In patients with seizures due to viable parenchymal cysts, antiparasitic therapy decreases the burden of parasites and is safe and effective, at least in reducing the number of seizures with generalization.
Garcia
Héctor H
HH
Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurologicas, Barrios Altos, Lima, Peru. hgarcia@jhsph.edu
Pretell
E Javier
EJ
Gilman
Robert H
RH
Martinez
S Manuel
SM
Moulton
Lawrence H
LH
Del Brutto
Oscar H
OH
Herrera
Genaro
G
Evans
Carlton A W
CA
Gonzalez
Armando E
AE
D000293:Adolescent; D000328:Adult; D000368:Aged; D015766:Albendazole / Q000009:adverse effects / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000923:Anticestodal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D001927:Brain Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D003907:Dexamethasone / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020019:Neurocysticercosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D012640:Seizures / Q000188:drug therapy* / Q000209:etiology
D000893:Anti-Inflammatory Agents; D000923:Anticestodal Agents; D000927:Anticonvulsants; D003907:Dexamethasone; D015766:Albendazole