Methotrexate as a corticosteroid-sparing agent in complicated neurocysticercosis.
BACKGROUND
A subset of patients with neurocysticercosis developed chronic or recurrent perilesional inflammation and required long-term and high-dose corticosteroid therapy. Such therapy frequently results in severe adverse effects. The purpose of this study was to determine whether methotrexate can be used as an effective corticosteroid-sparing or replacement agent in patients with complicated neurocysticercosis.


METHODS
This study was a nonblinded, prospective, observational trial. Patients with neurocysticercosis who required prednisone (15 mg/day) or its equivalent for > or =2 months, were likely to require long-term corticosteroid therapy by nature of their disease, developed serious complications due to corticosteroid use, or presented with a long-term history of corticosteroid use and had continued evidence of ongoing inflammation were eligible for methotrexate treatment.


RESULTS
Four patients are described in this study: 2 with subarachnoid neurocysticercosis, 1 with severe intraventricular and parenchymal disease, and 1 with recurrent perilesional edema around calcified lesions. Chronic inflammation due to neurocysticercosis resulted in lacunar infarcts, visual impairment, hydrocephalus, and seizures in these patients and necessitated long-term treatment with corticosteroids, which resulted in multiple adverse effects. The addition of methotrexate, prescribed at < or =20 mg/week, allowed for the successful reduction of corticosteroid use in all 4 patients and resulted in the improvement of many corticosteroid-associated adverse effects.


CONCLUSIONS
Methotrexate is a beneficial corticosteroid-sparing or replacement agent for patients with neurocysticercosis who develop chronic or recurrent perilesional inflammation.
Mitre
Edward
E
Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, USA.
Talaat
Kawsar R
KR
Sperling
Michael R
MR
Nash
Theodore E
TE
D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D002552:Cerebral Ventricles / Q000503:physiopathology; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D020019:Neurocysticercosis / Q000175:diagnosis* / Q000188:drug therapy*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013346:Subarachnoid Space / Q000503:physiopathology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D008727:Methotrexate