Treatment of schistosomal myeloradiculopathy with praziquantel and corticosteroids and evaluation by magnetic resonance imaging: a longitudinal study.
BACKGROUND
The best treatment for schistosomal myeloradiculopathy (SMR) remains undefined. There is also no longitudinal study to estimate the value of magnetic resonance imaging (MRI) in the diagnosis and follow-up of this disease.


METHODS
Patients with the following presentation were considered for study: lumbar and/or lower limb pain; lower limb weakness; anesthesia, hypoesthesia, or paresthesia; bladder and/or intestinal dysfunction; and sexual impotence. Sixteen patients with SMR were treated with oral praziquantel (50 mg/kg in a single dose) and methylprednisolone (15 mg/kg/day intravenously for 5 days) followed by prednisone (1 mg/kg/day orally for 6 months). Clinical outcome was prospectively evaluated in months 2 and 6 of treatment.


RESULTS
Image alterations were detected by MRI at diagnosis for all patients, and normalization or improvement was reported at the end of treatment. There was statistically significant clinical melioration at both the second and sixth months of therapy for most neurological alterations. However, the best clinical outcome was achieved when the steroid was given for >2 months.


CONCLUSIONS
Treatment with praziquantel associated with corticosteroids was successful in all cases. MRI proved to be a good method for the diagnosis of SMR and helpful in the evaluation of response to treatment.
Silva
Luciana C S
LC
Infectious and Parasitic Diseases Branch, Medical School, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Maciel
Pedro E
PE
Ribas
João G R
JG
Souza-Pereira
Silvio R
SR
Antunes
Carlos M
CM
Lambertucci
José R
JR
D000293:Adolescent; D000328:Adult; D000871:Anthelmintics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D020818:Neuroschistosomiasis / Q000175:diagnosis* / Q000188:drug therapy*; D011223:Praziquantel / Q000627:therapeutic use*; D011446:Prospective Studies; D011843:Radiculopathy / Q000175:diagnosis* / Q000188:drug therapy* / Q000469:parasitology
D000871:Anthelmintics; D005938:Glucocorticoids; D011223:Praziquantel; D008775:Methylprednisolone