Corticosteroids versus albendazole for treatment of single small enhancing computed tomographic lesions in children with neurocysticercosis.
Single small enhancing computed tomographic (CT) lesions representing cysticercus granuloma are a common cause of focal seizures in children. Controversy exists regarding the efficacy of various modalities of treatment. We conducted a randomized prospective trial to evaluate the efficacy of corticosteroids, albendazole, and corticosteroids with albendazole in children with focal seizures and single small enhancing CT lesions. The study population consisted of 133 children with focal seizures of recent onset (< 3 months) and single small enhancing CT lesions who presented to the Neurocysticercosis Clinic of Pediatric Neurology Services at the Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, an urban teaching and tertiary care hospital in Chandigarh, North India. All children were randomly assigned to receive corticosteroids (group S), albendazole (group A), or both corticosteroids and albendazole (group SA) for 28 days. CT was done at 3 and 6 months after enrollment in the study. Of the 133 patients enrolled, 23 were lost to follow-up. Of the remaining 110 patients, 38 patients were in group S, 37 in group A, and 35 in group SA. All children were followed up for at least 18 months. Disappearance of the lesion on CT scan was noted in 52.6% of patients in group S, 59.5% in group A, and 62.9% in Group SA (P > .1) at the 3-month follow-up. After the 6-month follow-up, disappearance of the lesion was noted in 76.3% in group S, 75.7% in group A, and 74.2% in group SA (P > .1). Twenty-three patients had seizure recurrence while on antiepilepsy drugs: 36.8% of patients in group S, 13.5% in group A, and 11.4% in group SA (P < .05). Seizure recurrence after antiepilepsy drug withdrawal was seen in seven children (three in group S and two each in groups A and SA). In conclusion, there was no significant difference in resolution of CT lesions in the three therapy groups at 3 and 6 months of follow-up. Children in the corticosteroid group had significantly more seizure recurrences while on antiepilepsy drugs.
Singhi
Pratibha
P
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India. drsinghi@glide.net.in
Jain
Vivek
V
Khandelwal
Narendra
N
D000293:Adolescent; D015766:Albendazole / Q000008:administration & dosage / Q000627:therapeutic use*; D000923:Anticestodal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging; D001927:Brain Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D020019:Neurocysticercosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D011859:Radiography; D012640:Seizures / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology
D000923:Anticestodal Agents; D005938:Glucocorticoids; D011239:Prednisolone; D015766:Albendazole