Short course of oral prednisolone on disappearance of lesion and seizure recurrence in patients of solitary cysticercal granuloma with single small enhancing CT lesion: an open label randomized prospective study.
OBJECTIVE
To evaluate the effect of a short course of oral prednisolone on disappearance of lesion and seizure recurrence in newly diagnosed patients with single small enhancing CT lesion.


METHODS
In this open-label, randomized, prospective follow-up study, 100 patients of new-onset seizures and a cysticercus granuloma presenting as single enhancing computed tomography detected lesion were randomly divided in two groups to receive either antiepileptic monotherapy (Group A) or antiepileptic drugs with oral prednisolone in a dose of 1 mg/kg body weight for 7 days and tapering off dose in next 3 days (Group B). Repeat CT scan was performed on 8th-12th week to know radiological state of lesion. The patients were followed up for 1 year for seizure recurrence.


RESULTS
The majority of patients were in second decade. Male: female ratio 1.56:1. Mean number of seizure episodes was 4.33 +/- 3.50 in group A and 4.23 +/- 3.97 in group B. Partial seizure were the most common presentation (85%). 72% patients presented with single seizure or seizure in cluster. Solitary ring lesion was the commonest (69%) CT finding, most of them were located in parietal lobe (52%). Follow up CT scan showed complete resolution of lesion in 60.86% of total [group A (n = 47), 32 patients, 68.08%; group B (n = 45), 24 patients, 53.33%]. Significant difference in group A and B regarding lesion resolution was observed (chi2 = 5.926, d.f. = 1) p < 0.05. Clinical follow up showed seizure recurrence in group A - 5 patients (10.63%), in group B - 12 patients (26.66%). Statistically significant higher number of seizure recurrences were noted in group B as compared to group A (chi2 = 3.93, d.f. = 1) p < 0.05.


CONCLUSIONS
Short-term oral prednisolone along with antiepileptic drugs helps in rapid resolution of single small enhancing lesions in patient with newly diagnosed seizure disorder with good clinical outcome.
Kishore
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Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi -221 005, India.
Misra
S
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D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D003287:Contrast Media; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D015745:Granuloma, Foreign-Body / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007194:India; D008297:Male; D020019:Neurocysticercosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010243:Paralysis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000927:Anticonvulsants; D003287:Contrast Media; D011239:Prednisolone