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Chakrabarty B, Gulati S, Kumar A, Jauhari P, Saini S, Pandey T, Pandey RM, Panda P, Anand V, Singh S, Kamila G. Incident Breakthrough Seizures, Serum Matrix Metalloproteinase-9 and Perfusion Magnetic Resonance Imaging Parameters in a Cohort of Children and Adolescents With Neurocysticercosis: A Longitudinal Observational Study. Pediatr Neurol 2024; 151:45-52. [PMID: 38101307 DOI: 10.1016/j.pediatrneurol.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/21/2023] [Accepted: 11/19/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND The current study estimated incident breakthrough seizures, serum matrix metalloproteinase-9 (MMP-9), and perfusion magnetic resonance imaging (MRI) parameters in five- to 18-year-olds with neurocysticercosis (NCC) from colloidal or vesicular through calcified stages over at least 24 months' follow-up. METHODS Single, colloidal, or vesicular parenchymal NCC cases were treated with albendazole and steroids and followed at a tertiary care north Indian hospital. Serum MMP-9 was estimated in colloidal or vesicular treatment-naive state and in a subset of calcified cases at six-month follow-up. The same subset of calcified cases also underwent perfusion MRI of the brain at six-month follow-up. RESULTS Among 70 cases, 70% calcified at six-month follow-up. Over a median follow-up of 30 months, the incidence of breakthrough seizures was 48.6% (61.2% in calcified and 19.2% in resolved, P = 0.001; 32.9% early [within six months] and 15.7% late [beyond six months], P = 0.02). Serum MMP-9 levels were higher in colloidal and vesicular compared with calcified stage (242.5 vs 159.8 ng/mL, P = 0.007); however, there was no significant association with breakthrough seizures and/or calcification in follow-up. In a subgroup of calcified cases (n = 31), the median relative cerebral blood volume on perfusion MRI in and around the lesion was lower in those with seizures (n = 12) than in those without (n = 19) (10.7 vs 25.2 mL/100 g, P = 0.05). CONCLUSIONS In post-treatment colloidal or vesicular NCC, incident breakthrough seizures decrease beyond six months. In calcified NCC with remote breakthrough seizures, significant perilesional hypoperfusion is seen compared with those without seizures.
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Affiliation(s)
- Biswaroop Chakrabarty
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India.
| | - Sheffali Gulati
- Child Neurology Division, Department of Pediatrics, Centre of Excellence and Advanced Research on Childhood Neurodevelopmental Disorders, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Prashant Jauhari
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Savita Saini
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Tapish Pandey
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Prateek Panda
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Vaishakh Anand
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Sonali Singh
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Gautam Kamila
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
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Ardakani R, Jia L, Matthews E, Thakur KT. Therapeutic advances in neuroinfectious diseases. Ther Adv Infect Dis 2024; 11:20499361241274246. [PMID: 39314743 PMCID: PMC11418331 DOI: 10.1177/20499361241274246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/05/2024] [Indexed: 09/25/2024] Open
Abstract
There have been several major advances in therapeutic options for the treatment of neurological infections over the past two decades. These advances encompass both the development of new antimicrobial therapies and the repurposing of existing agents for new indications. In addition, advances in our understanding of the host immune response have allowed for the development of new immunomodulatory strategies in the treatment of neurological infections. This review focuses on the key advances in the treatment of neurological infections, including viral, bacterial, fungal, and prion diseases, with a particular focus on immunomodulatory treatment options. This review also highlights the process by which clinicians can request access to therapeutic agents on a compassionate or emergency basis when they may not be commercially available. While many therapeutic advances have been achieved in the past several years, there remains a pressing need for the continued development of additional therapeutic agents in the treatment of neurological infections.
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Affiliation(s)
- Rumyar Ardakani
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lucy Jia
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth Matthews
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kiran T. Thakur
- Department of Neurology, Columbia University Irving Medical Center, 177 Fort Washington Avenue, Milstein Hospital, 8GS-300, New York, NY 10032, USA
- Program in Neuroinfectious Diseases, Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital
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3
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Singla A, Lekhwani S, Vaswani ND, Kaushik JS, Dabla S. Fourteen Days vs 28 Days of Albendazole Therapy for Neurocysticercosis in Children: An Open Label Randomized Controlled Trial. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2662-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Espino P, Couper R, Burneo J. An update on Neurocysticercosis-related epilepsy. Clin Neurol Neurosurg 2022; 213:107139. [DOI: 10.1016/j.clineuro.2022.107139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/07/2021] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
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Abstract
BACKGROUND Neurocysticercosis is a parasitic infection of the central nervous system by the larval stage of the pork tapeworm and is a common cause of seizures and epilepsy in endemic areas. Anthelmintics (albendazole or praziquantel) may be given alongside supportive treatment (antiepileptics/analgesia) with the aim of killing these larvae (cysticerci), with or without corticosteroid treatment. However, there are potential adverse effects of these drugs, and the cysticerci may eventually die without directed anthelminthic treatment. OBJECTIVES To assess the effects of anthelmintics on people with neurocysticercosis. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS, the WHO ICTRP, and ClinicalTrials.gov, up to 21 October 2020. SELECTION CRITERIA Randomized controlled trials comparing anthelmintics and supportive treatment (+/- corticosteroids) with supportive treatment alone (+/- corticosteroids) for people with neurocysticercosis. DATA COLLECTION AND ANALYSIS Two review authors independently screened the title and abstract of all articles identified by the search. We obtained full-text articles to confirm the eligibility of all studies that passed screening. One review author extracted data, which a second review author checked. Two review authors assessed the risk of bias of each trial and performed GRADE assessments. In cases of disagreement at consensus discussion stage between review authors, we consulted a third review author. We calculated risk ratios (RR) for dichotomous variables, with 95% confidence intervals (CIs) for pooled data from studies with similar interventions and outcomes. MAIN RESULTS We included 16 studies in the review. Only two studies investigated praziquantel and did not report data in a format that could contribute to meta-analysis. Most results in this review are therefore applicable to albendazole versus placebo or no anthelmintic. The aggregate analysis across all participants with neurocysticercosis did not demonstrate a difference between groups in seizure recurrence, but heterogeneity was marked (RR 0.94, 95% CI 0.78 to 1.14; 10 trials, 1054 participants; I2 = 67%; low-certainty evidence). When stratified by participants with a single cyst or multiple cysts, pooled analysis suggests that albendazole probably improves seizure recurrence for participants with a single cyst (RR 0.61, 95% CI 0.4 to 0.91; 5 trials, 396 participants; moderate-certainty evidence). All studies contributing to this analysis recruited participants with non-viable, intraparenchymal cysts only, and most participants were children. We are uncertain whether or not albendazole reduces seizure recurrence in participants with multiple cysts, as the certainty of the evidence is very low, although the direction of effect is towards albendazole causing harm (RR 2.05, 95% CI 1.28 to 3.31; 2 trials, 321 participants; very low-certainty evidence). This analysis included a large study containing a highly heterogeneous population that received an assessment of unclear risk for multiple 'Risk of bias' domains. Regarding radiological outcomes, albendazole probably slightly improves the complete radiological clearance of lesions (RR 1.22, 95% CI 1.07 to 1.39; 13 trials, 1324 participants; moderate-certainty evidence) and the evolution of cysts (RR 1.27, 95% CI 1.10 to 1.47; 6 trials, 434 participants; moderate-certainty evidence). More adverse events appeared to be observed in participants treated with either albendazole or praziquantel compared to those receiving placebo or no anthelmintic. The most commonly reported side effects were headache, abdominal pain, and nausea/vomiting. AUTHORS' CONCLUSIONS For participants with a single cyst, there was less seizure recurrence in the albendazole group compared to the placebo/no anthelmintic group. The studies contributing to this evidence only recruited participants with a non-viable intraparenchymal cyst. We are uncertain whether albendazole reduces seizure recurrence for participants with multiple cysts. We also found that albendazole probably increases radiological clearance and evolution of lesions. There were very few studies reporting praziquantel outcomes, and these findings apply to albendazole only.
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Affiliation(s)
- Edward J M Monk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Katharine Abba
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Abraham A, Bustos JA, Carabin H, de Meijere R, Sahu PS, Rajshekhar V, Singh G, White AC, Chiodini PL, Gabriël S, Homeida M, Nash T, Ngowi B, Zhou XN, Coyle C, Garcia HH, Winkler AS. The effectiveness of anti-inflammatory and anti-seizure medication for individuals with single enhancing lesion neurocysticercosis: A meta-analysis and expert group-based consensus recommendations. PLoS Negl Trop Dis 2021; 15:e0009193. [PMID: 33788843 PMCID: PMC8057605 DOI: 10.1371/journal.pntd.0009193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/20/2021] [Accepted: 02/02/2021] [Indexed: 11/18/2022] Open
Abstract
Single brain enhancing lesions (SEL) are the most common presentation of neurocysticercosis (NCC) observed on neuroimaging in people presenting with epileptic seizures not only on the Indian sub-continent and in travelers returning from cysticercosis-endemic regions, but are also present in other parts of the world. The aim of this study, which consisted of a systematic review (CRD42019087665), a meta-analysis and an expert group consultation, was to reach consensus on the best anti-seizure medication and anti-inflammatory treatment for individuals with SEL NCC. Standard literature review methods were used. The Cochrane risk of bias tool was used and random effects model meta-analyses were performed. The quality of the body of evidence was rated using GRADE tables. The expert committee included 12 gender and geographically balanced members and recommendations were reached by applying the GRADE framework for guideline development. The 1-1.5-year cumulative incidence of seizure recurrence, cyst resolution or calcification following anti-seizure medication (ASM) withdrawal was not statistically different between ASM of 6, 12 or 24 months. In contrast, in persons whose cyst calcified post treatment, longer ASM decreased seizure recurrence. The cumulative incidence ratio (CIR) 1-1.5 years after stopping ASM was 1.79 95% CI: (1.00, 3.20) for patients given 6 versus 24 months treatment. Anti-inflammatory treatment with corticosteroids in patients treated with ASM compared to patients treated with ASM only showed a statistically significant beneficial effect on seizure reduction (CIR 0.44, 95% CI 0.23, 0.85) and cyst resolution (CIR 1.37, 95%CI: 1.07, 1.75). Our results indicate that ASM in patients with SEL NCC whose cysts resolved can be withdrawn, while patients whose cysts calcified seem to benefit from prolonged anti-seizure medication. Additional corticosteroid treatment was found to have a beneficial effect both on seizure reduction and cyst resolution.
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Affiliation(s)
- Annette Abraham
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Javier A. Bustos
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru, and Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Hélène Carabin
- Département de Pathologie et de Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Canada
- Département de médecine sociale et préventive, École de santé publique, université de Montréal, Montréal, Canada
- Centre de Recherche en Santé Publique de l’Université de Montréal et du Centre Intégré Universitaire de Santé et des Services Sociaux de sud de l’île de Montréal, Montréal, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Montréal, Canada
| | - Robert de Meijere
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
| | - Priyadarshi S. Sahu
- Department of Microbiology & Immunology, Medical University of the Americas, Nevis, West Indies
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | | | - A. Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Peter L. Chiodini
- Hospital for Tropical Diseases and the London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Mamoun Homeida
- University of Medical Sciences and Technology, Khartoum, Sudan
| | - Theodore Nash
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institute of Health, United States of America
| | - Bernard Ngowi
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
- University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - Xiao Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
| | - Christina Coyle
- Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Hector H. Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru, and Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Andrea S. Winkler
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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7
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Gundamraj S, Hasbun R. The Use of Adjunctive Steroids in Central Nervous Infections. Front Cell Infect Microbiol 2020; 10:592017. [PMID: 33330135 PMCID: PMC7719626 DOI: 10.3389/fcimb.2020.592017] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 01/02/2023] Open
Abstract
Central nervous system (CNS) infections continue to be associated with significant neurological morbidity and mortality despite various existing therapies. Adjunctive steroid therapy has been employed clinically to reduce inflammation in the treatment of CNS infections across various causative pathogens. Steroid therapy can potentially improve clinical outcomes including reducing mortality rates, provide no significant benefit, or cause worsened outcomes, based on the causative agent of infection. The data on benefits or harms of adjunctive steroid therapy is not consistent in outcome or density through CNS infections, and varies based on the disease diagnosis and pathogen. We summarize the existing literature on the effects of adjunctive steroid therapy on outcome for a number of CNS infections, including bacterial meningitis, herpes simplex virus, West Nile virus, tuberculosis meningitis, cryptococcal meningitis, Angiostrongylus cantonensis, neurocysticercosis, autoimmune encephalitis, toxoplasmosis, and bacterial brain abscess. We describe that while steroid therapy is beneficial and supported in pathogens such as pneumococcal meningitis and tuberculosis, for other diseases, like Listeria monocytogenes and Cryptococcus neoformans they are associated with worse outcomes. We highlight areas of consistent and proven findings and those which need more evidence for supported beneficial clinical use of adjunctive steroid therapy.
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Affiliation(s)
| | - Rodrigo Hasbun
- Department of Internal Medicine, UT Health McGovern Medical School, Houston, TX, United States
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8
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Del Brutto OH. Current approaches to cysticidal drug therapy for neurocysticercosis. Expert Rev Anti Infect Ther 2020; 18:789-798. [DOI: 10.1080/14787210.2020.1761332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo, Ecuador, Samborondón, Ecuador
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Histopathologic evaluation of experimental murine neurocysticercosis after treatment with albendazole/nitazoxanide combination. Parasitology 2020; 147:822-827. [PMID: 32234089 DOI: 10.1017/s0031182020000505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neurocysticercosis (NCC) is the most common helminthic brain infection related to epilepsy. Only albendazole (ABZ) and praziquantel are used in its treatment. The development of new therapeutics has been encouraged. Taenia crassiceps cysticerci intracranial infection is the experimental model used in NCC studies. This study evaluated the histopathology of the brains of BALB/c mice experimentally infected with T. crassiceps cysticerci after the treatment with the ABZ/nitazoxanide (NTZ) combination. Thirty days after the inoculation the mice received an oral single dose of the ABZ/NTZ combination (40 mg kg-1 each). The control groups were treated with: NaCl 0.9%; ABZ or NTZ. The histopathologic evaluation of the brains was performed 24 h after treatment. The ABZ treatment induced discrete mononuclear inflammatory infiltration, meningitis, gliosis, hyperaemia and hippocampus compression; moderate ependimitis and oedema. The NTZ treatment induced accentuated inflammatory infiltration, foamy macrophages, ependimitis, choroiditis, gliosis and hyperaemia and moderate oedema. The ABZ/NTZ combination treatment induced a significant decrease in the polymorphonuclear inflammatory infiltration, ependimitis, choroiditis, gliosis, hyperaemia and ventriculomegaly in comparison with the other groups. The cysticerci showed destruction of the tegument not observed in other groups. The ABZ/NTZ combination is efficient as the parasite showed signs of destruction and lower damage to the host's tissue.
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Modak A, Suthar R, Sharawat IK, Sankhyan N, Sahu JK, Malhi P, Khandelwal N. An Ambispective Cohort Study to Assess Seizure Recurrences in Children with Calcified Parenchymal Neurocysticercosis. Am J Trop Med Hyg 2020; 101:812-820. [PMID: 31452498 DOI: 10.4269/ajtmh.19-0278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Calcified neurocysticercosis (NCC), previously thought to be a dead end, is an important risk factor for seizure recurrences. We studied the pattern of seizure recurrences and associated radiological findings in children with calcified NCC. In this ambispective cohort study, we enrolled children (age 1-15 years) with calcified NCC attending the pediatric NCC clinic between January 2017 and December 2017. Retrospective data were collected from the hospital records, and all enrolled children were prospectively followed up till June 2018. The study group divided into two groups: 1) children first presenting with calcified granuloma and 2) children presented with ring-enhancing lesion (REL) and transformed into the calcified lesion during follow-up imaging. During the study period (January 2017-December 2017), 520 children with NCC were screened and 128 with calcified NCC were enrolled. The mean age was 10.8 ± 3.2 years, and 63% were boys. Among 128 children, 40 (31%) had calcified granuloma and 88 (69%) had REL transformed to calcified granuloma. Sixty-one (49%) children had seizure recurrence: 22 (58%) within calcified granuloma group and 39 (45%) within REL transformed to calcified granuloma group (P = 0.18). Seizure recurrence was associated with the presence of perilesional edema (PE) in 35 (57.4%) children on computed tomography scan. The median interval between two seizure recurrences was 30 (17-56) months, and the median antiepileptic drug-free interval was 17 (12-22) months. The total duration of continued seizures was 42 (26-58) months, slightly longer in children with REL transformed to calcified granuloma group (42, 95% CI: 18-66 months) in comparison to calcified granuloma group (35, 95% CI: 10-60 months, P = 0.32). To conclude, children with calcified NCC have seizure recurrences over a prolonged period. Seizure recurrences are intermittent and may be interspersed with a prolonged period of quiescence in between. The presence of PE and contrast enhancement around the lesion during seizure recurrence suggests lesion reactivation.
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Affiliation(s)
- Abhijit Modak
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Indar Kumar Sharawat
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Jitendra Kumar Sahu
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Prahbhjot Malhi
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Del Brutto OH. Twenty-five years of evolution of standard diagnostic criteria for neurocysticercosis. How have they impacted diagnosis and patient outcomes? Expert Rev Neurother 2019; 20:147-155. [DOI: 10.1080/14737175.2020.1707667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo – Ecuador, Samborondón, Ecuador
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12
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White AC, Coyle CM, Rajshekhar V, Singh G, Hauser WA, Mohanty A, Garcia HH, Nash TE. Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2019; 66:e49-e75. [PMID: 29481580 DOI: 10.1093/cid/cix1084] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/19/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Hector H Garcia
- Instituto Nacional de Ciencias Neurologicas and Universidad Peruana Cayetano Heredia, Lima, Peru
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13
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Zammarchi L, Angheben A, Fantoni T, Chiappini E, Mantella A, Galli L, Marchese V, Zavarise G, Bisoffi Z, Bartoloni A. Screening for neurocysticercosis in internationally adopted children: yield, cost and performance of serological tests, Italy, 2001 to 2016. ACTA ACUST UNITED AC 2019; 23. [PMID: 30301492 PMCID: PMC6178589 DOI: 10.2807/1560-7917.es.2018.23.40.1700709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Neurocysticercosis (NCC) is one of the leading causes of epilepsy worldwide. The majority of cases in Europe are diagnosed in immigrants. Currently in Italy, routine serological screening for cysticercosis is recommended for internationally adopted children (IAC) coming from endemic countries. Methods: We retrospectively analyse the results of the serological screening for cysticercosis in IAC 16 years old or younger, attending two Italian third level paediatric clinics in 2001–16. Results: Of 2,973 children included in the study, 2,437 (82.0%) were screened by enzyme-linked immune electro transfer blot (EITB), 1,534 (51.6%) by ELISA, and 998 (33.6%) by both tests. The seroprevalence of cysticercosis ranged between 1.7% and 8.9% according to EITB and ELISA, respectively. Overall, 13 children were diagnosed with NCC accounting for a NCC frequency of 0.4% (95% confidence interval (CI): 0.2–0.6%). Among the 168 seropositive children, only seven (4.2%) were diagnosed with NCC. Of these children, three were asymptomatic and four presented epilepsy. Among seronegative children (n = 2,805), seven presented with neurological symptoms that lead to the diagnosis of NCC in six cases. The sensitivity, specificity, positive and negative predictive value for the diagnosis of NCC were 54.5%, 98.6%, 14.6%, 99.8% for EITB and 22.2%, 91.1%, 1.4%, 99.5% for ELISA. The yield of the screening programme was 437 NCC cases per 100,000. The number needed to screen to detect one NCC case was 228. The cost per NCC case detected was EUR 10,372. Conclusion: On the base of our findings we suggest the ongoing serological screening for cysticercosis to be discontinued, at least in Italy, until further evidence in support will be available.
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Affiliation(s)
- Lorenzo Zammarchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Angheben
- Centre for Tropical Diseases, Sacro Cuore - Don Calabria Hospital, Negrar, Italy
| | - Teresa Fantoni
- Health Human Sciences School, Medicine and Surgery Degree Course, University of Florence, Florence, Italy
| | - Elena Chiappini
- Infectious Disease Unit, Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Antonia Mantella
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luisa Galli
- Infectious Disease Unit, Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Valentina Marchese
- University Department of Infectious and Tropical Diseases & WHO Collaborating Centre for TB/HIV and TB elimination, University of Brescia, Brescia, Italy.,Centre for Tropical Diseases, Sacro Cuore - Don Calabria Hospital, Negrar, Italy
| | - Giorgio Zavarise
- Department of Pediatrics, Hospital Sacro Cuore - Don Calabria, Negrar, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore - Don Calabria Hospital, Negrar, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Abstract
Neurocysticercosis is the most common helminth infection of nervous system in humans caused by the encysted larvae of Taenia solium. It is a major cause of epilepsy in tropical areas and the most common cause of focal-onset seizures in North Indian children. Children with neurocysticercosis have pleomorphic manifestations depending on the location, number and viability of the cysts and host response. In endemic areas, neurocysticercosis should be clinically suspected in any child with recent-onset seizures, headache or focal motor deficits where there is no other suggestion of an underlying neurological disorder. Diagnosis of neurocysticercosis is essentially based on neuroimaging; visualization of a scolex is diagnostic. Management includes use of cysticidal drugs usually albendazole, which seems to be effective for lesion resolution and seizure remission, use of steroids and anti-epileptic drugs. Single lesions portend good prognosis with resolution of lesions in >60% of the cases within 6 mo and good seizure control. Prognosis is guarded in cysticercus encephalitis, racemose and extraparenchymal neurocysticercosis.
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Affiliation(s)
- Pratibha Singhi
- Pediatric Neurology and Neurodevelopment Unit, Medanta, The Medicity, Gurgaon, Haryana, India.
| | - Arushi Gahlot Saini
- Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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White AC, Coyle CM, Rajshekhar V, Singh G, Hauser WA, Mohanty A, Garcia HH, Nash TE. Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Am J Trop Med Hyg 2018; 98:945-966. [PMID: 29644966 PMCID: PMC5928844 DOI: 10.4269/ajtmh.18-88751] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | | | | | | | - Aaron Mohanty
- University of Texas Medical Branch, Galveston, Texas
| | - Hector H Garcia
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto Nacional de Ciencias Neurologicas, Lima, Peru
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Garcia HH, Del Brutto OH. Antiparasitic treatment of neurocysticercosis - The effect of cyst destruction in seizure evolution. Epilepsy Behav 2017; 76:158-162. [PMID: 28606690 PMCID: PMC5675823 DOI: 10.1016/j.yebeh.2017.03.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/20/2022]
Abstract
Antiparasitic agents against Taenia solium cysticercosis have been in use since 1979, although its use has been questioned on the basis that cysts would die naturally and thus treatment-induced inflammation is unnecessary. In addition, isolated reports have also questioned whether neurocysticercosis (NCC) is a cause of epilepsy. After more than three and a half decades, a large body of evidence is available. Little if any doubt exists about NCC as a cause of seizures - NCC is consistently associated with seizures when appropriate groups are compared, and in a large subset of cases, seizure semiology correlates with the anatomical location of lesions. Cyst degeneration and the subsequent inflammatory reaction increase seizure expression, although patients with non-inflamed cysts may have seizures, as do patients with long-standing, not inflamed calcified scars. Assessment of the evidence on cysticidal efficacy, safety, and the impact of cyst destruction in decreasing seizures leads to the conclusion that the benefits of antiparasitic treatment in parenchymal brain cysticercosis clearly outweigh the risks, and have provided substantive evidence of the role of NCC as a cause of seizures and epilepsy. Antiparasitic therapy should be considered a primary option in the management of patients with live or degenerating brain NCC cysts. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy".
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Affiliation(s)
- Hector H Garcia
- Center for Global Health, Tumbes and the Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
| | - Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
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Abstract
Neurocysticercosis (NCC) is the most common single cause of seizures/epilepsy in India and several other endemic countries throughout the world. It is also the most common parasitic disease of the brain caused by the cestode Taenia solium or pork tapeworm. The diagnosis of NCC and the tapeworm carrier (taeniasis) can be relatively inaccessible and expensive for most of the patients. In spite of the introduction of several new immunological tests, neuroimaging remains the main diagnostic test for NCC. The treatment of NCC is also mired in controversy although, there is emerging evidence that albendazole (a cysticidal drug) may be beneficial for patients by reducing the number of seizures and hastening the resolution of live cysts. Currently, there are several diagnostic and management issues which remain unresolved. This review will highlight some of these issues.
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Affiliation(s)
- Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College & Hospital, Vellore, India
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Abstract
BACKGROUND Our aim was to study long-term clinical and radiologic outcome in children with parenchymal neurocysticercosis (NCC) and its predictors. METHOD Five hundred children with NCC registered in the pediatric NCC clinic between January 1996 and December 2002 and followed till December 2009 were enrolled. Demographic details, clinical presentations and therapy received were recorded. Outcome was evaluated in terms of seizure recurrence and resolution of lesions on neuroimaging. Various factors that could influence outcome were studied. RESULTS Mean age at presentation was 8 ± 2.7 years, and the mean duration of follow-up was 8.8 ± 2.03 years; 79.6% (398) had single lesion, and 20.4% (102) had multiple lesions at presentation; 14.5% (58) of children with single lesion, and 28.4% (29) of children with multiple lesions had recurrent seizures (P < 0.001) during follow-up. At 6-month follow-up neuroimaging, resolution was seen in 52.7% (210) and 31.3% (32) of children with single and multiple lesions, respectively (P < 0.001). On prolonged follow-up, 94.6% (384) of single-lesion NCC and 88% (90) of multiple-lesion NCC (P < 0.001) had radiologic resolution. Single-lesion NCC, radiologic resolution and cysticidal therapy were associated with better seizure outcome (P < 0.05). Children with multiple lesions had significantly higher percentage of calcified lesions on long-term follow-up compared with those with a single lesion (11.7% vs. 3.6%, P < 0.05). CONCLUSIONS Children with a single-lesion NCC have favorable outcome with resolution of most of the lesions and few seizure recurrences. Cysticidal therapy leads to better seizure control and increased resolution of lesions on short-term follow-up.
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Del Brutto OH, Nash TE, White AC, Rajshekhar V, Wilkins PP, Singh G, Vasquez CM, Salgado P, Gilman RH, Garcia HH. Revised diagnostic criteria for neurocysticercosis. J Neurol Sci 2016; 372:202-210. [PMID: 28017213 DOI: 10.1016/j.jns.2016.11.045] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/29/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND A unified set of criteria for neurocysticercosis (NCC) has helped to standardize its diagnosis in different settings. METHODS Cysticercosis experts were convened to update current diagnostic criteria for NCC according to two principles: neuroimaging studies are essential for diagnosis, and all other information provides indirect evidence favoring the diagnosis. Recent diagnostic advances were incorporated to this revised set. RESULTS This revised set is structured in absolute, neuroimaging and clinical/exposure criteria. Absolute criteria include: histological confirmation of parasites, evidence of subretinal cysts, and demonstration of the scolex within a cyst. Neuroimaging criteria are categorized as major (cystic lesions without scolex, enhancing lesions, multilobulated cysts, and calcifications), confirmative (resolution of cysts after cysticidal drug therapy, spontaneous resolution of single enhancing lesions, and migrating ventricular cysts on sequential neuroimaging studies) and minor (hydrocephalus and leptomeningeal enhancement). Clinical/exposure criteria include: detection of anticysticercal antibodies or cysticercal antigens by well-standardized tests, systemic cysticercosis, evidence of a household Taenia carrier, suggestive clinical manifestations, and residency in endemic areas. Besides patients having absolute criteria, definitive diagnosis can be made in those having two major neuroimaging criteria (or one major plus one confirmative criteria) plus exposure. For patients presenting with one major and one minor neuroimaging criteria plus exposure, definitive diagnosis of NCC requires the exclusion of confounding pathologies. Probable diagnosis is reserved for individuals presenting with one neuroimaging criteria plus strong evidence of exposure. CONCLUSIONS This revised set of diagnostic criteria provides simpler definitions and may facilitate its more uniform and widespread applicability in different scenarios.
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Affiliation(s)
- O H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
| | - T E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, United States
| | - A C White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - V Rajshekhar
- Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| | - P P Wilkins
- Parasitology Services, Marathon, FL, United States
| | - G Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - C M Vasquez
- Department of Neurosurgery, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - P Salgado
- Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
| | - R H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - H H Garcia
- Center for Global Health, Tumbes, Peru; Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Peru; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
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Bustos JA, García HH, Del Brutto OH. Antiepileptic drug therapy and recommendations for withdrawal in patients with seizures and epilepsy due to neurocysticercosis. Expert Rev Neurother 2016; 16:1079-85. [PMID: 27228190 DOI: 10.1080/14737175.2016.1194757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Neurocysticercosis (NCC) is a leading causes of secondary epilepsy worldwide. There is increasing evidence on the epileptogenic role of NCC, and the presence of edema, calcified scars, gliosis and hippocampal sclerosis support this phenomenon. AREAS COVERED We summarized principles of antiepileptic drug (AED) therapy as well as risk factors associated with seizure recurrence after AED withdrawal in patients with NCC. Expert commentary: First-line AED monotherapy is effective as a standard approach to control seizures in most NCC patients. Risks and benefits of AED withdrawal have not been systematically studied, and this decision must be individualized. However, a seizure-free period of at least two years seem prudent before attempting withdrawal. Risk factors for seizure recurrence after AED withdrawal include a history of status epilepticus, poor seizure control during treatment, neuroimaging evidence of perilesional gliosis, hippocampal sclerosis and calcified lesions, as well as persistence of paroxysmal activity in the EEG.
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Affiliation(s)
- Javier A Bustos
- a Center for Global Health - Tumbes , Lima , Peru.,b Department of Microbiology, Universidad Peruana Cayetano Heredia, and Cysticercosis Unit , Instituto Nacional de Ciencias Neurológicas , Lima , Peru
| | - Héctor H García
- a Center for Global Health - Tumbes , Lima , Peru.,b Department of Microbiology, Universidad Peruana Cayetano Heredia, and Cysticercosis Unit , Instituto Nacional de Ciencias Neurológicas , Lima , Peru
| | - Oscar H Del Brutto
- c School of Medicine , Universidad Espíritu Santo - Ecuador , Guayaquil , Ecuador
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Singhi P, Saini AG. Pediatric neurocysticercosis: current challenges and future prospects. Pediatric Health Med Ther 2016; 7:5-16. [PMID: 29388588 PMCID: PMC5683283 DOI: 10.2147/phmt.s79058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Neurocysticercosis (NCC) is an acquired infection of the nervous system caused by encysted larvae of Taenia solium. It is a major cause of epilepsy in the tropics and the commonest cause of focal seizures in North Indian children. T. solium teniasis-cysticercosis is considered a parasitic "Neglected Tropical Diseases" endemic throughout Southeast Asia. NCC in children has pleomorphic manifestations depending on the location, number and viability of the cysts, and host response. Even with advancing knowledge of the disease manifestations, many aspects related to diagnosis and treatment, particularly in children, still remain controversial and pose challenges to clinical practice. There is no gold standard test to diagnose NCC and the management recommendations are still emerging. This review provides an overview of diagnosis of NCC in children and its management with special focus on current challenges and future prospects.
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Affiliation(s)
- Pratibha Singhi
- Department of Pediatrics, Pediatric Neurology and Neurodevelopment Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Gahlot Saini
- Department of Pediatrics, Pediatric Neurology and Neurodevelopment Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Zhao BC, Jiang HY, Ma WY, Jin DD, Li HM, Lu H, Nakajima H, Huang TY, Sun KY, Chen SL, Chen KB. Albendazole and Corticosteroids for the Treatment of Solitary Cysticercus Granuloma: A Network Meta-analysis. PLoS Negl Trop Dis 2016; 10:e0004418. [PMID: 26849048 PMCID: PMC4744042 DOI: 10.1371/journal.pntd.0004418] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/10/2016] [Indexed: 11/30/2022] Open
Abstract
Background Solitary cysticercus granuloma (SCG) is the commonest form of neurocysticercosis in the Indian subcontinent and in travelers. Several different treatment options exist for SCG. We conducted a Bayesian network meta-analysis of randomized clinical trials (RCTs) to identify the best treatment option to prevent seizure recurrence and promote lesion resolution for patients with SCG. Methods and Principal Findings PubMed, EMBASE and the Cochrane Library databases (up to June 1, 2015) were searched for RCTs that compared any anthelmintics or corticosteroids, alone or in combination, with placebo or head to head and reported on seizure recurrence and lesion resolution in patients with SCG. A total of 14 RCTs (1277 patients) were included in the quantitative analysis focusing on four different treatment options. A Bayesian network model computing odds ratios (OR) with 95% credible intervals (CrI) and probability of being best (Pbest) was used to compare all interventions simultaneously. Albendazole and corticosteroids combination therapy was the only regimen that significantly decreased the risk of seizure recurrence compared with conservative treatment (OR 0.32, 95% CrI 0.10–0.93, Pbest 73.3%). Albendazole and corticosteroids alone or in combination were all efficacious in hastening granuloma resolution, but the combined therapy remained the best option based on probability analysis (OR 3.05, 95% CrI 1.24–7.95, Pbest 53.9%). The superiority of the combination therapy changed little in RCTs with different follow-up durations and in sensitivity analyses. The limitations of this study include high risk of bias and short follow-up duration in most studies. Conclusions Dual therapy of albendazole and corticosteroids was the most efficacious regimen that could prevent seizure recurrence and promote lesion resolution in a follow-up period of around one year. It should be recommended for the management of SCG until more high-quality evidence is available. Neurocysticercosis is an infection of the central nervous system by the larva of Taenia solium (pork tapeworm). It is a leading cause of epilepsy in the world. The disease takes many different forms, each with different optimal treatment. In this study, we focused on the treatment of solitary cysticercus granuloma (SCG), previous evidence on which is inconclusive. Since many different regimens have been compared in clinical trials of SCG, we conducted a network meta-analysis. This method is powerful as it can analyze quantitatively all of the data from all comparisons together. The result can tell us how different treatments perform against each other and how treatments should be ranked. The outcomes of our meta-analysis suggest that the combination of albendazole and corticosteroids is the most efficacious regimen to control seizures in affected patients and to promote the total disappearance of the lesion, compared with albendazole alone, corticosteroids alone, and conservative treatment.
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Affiliation(s)
- Bing-Cheng Zhao
- Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hong-Ye Jiang
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory for Tropical Disease Control, Sun Yat-sen University, Guangzhou, China
| | - Wei-Ying Ma
- Department of Anesthesiology, the Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Da-Di Jin
- Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hao-Miao Li
- Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hai Lu
- Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hideaki Nakajima
- Department of Orthopedics and Rehabilitation Medicine, Fukui University of Medical Sciences, Fukui, Japan
| | - Tong-Yi Huang
- Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Kai-Yu Sun
- Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Shu-Ling Chen
- Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Ke-Bing Chen
- Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- * E-mail:
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Romo ML, Wyka K, Carpio A, Leslie D, Andrews H, Bagiella E, Hauser WA, Kelvin EA. The effect of albendazole treatment on seizure outcomes in patients with symptomatic neurocysticercosis. Trans R Soc Trop Med Hyg 2015; 109:738-46. [PMID: 26433183 DOI: 10.1093/trstmh/trv078] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/24/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Randomized controlled trials have found an inconsistent effect of anthelmintic treatment on long-term seizure outcomes in neurocysticercosis. The objective of this study was to further explore the effect of albendazole treatment on long-term seizure outcomes and to determine if there is evidence for a differential effect by seizure type. METHODS In this trial, 178 patients with active or transitional neurocysticercosis cysts and new-onset symptoms were randomized to 8 days of treatment with albendazole (n=88) or placebo (n=90), both with prednisone, and followed for 24 months. We used negative binomial regression and logistic regression models to determine the effect of albendazole on the number of seizures and probability of recurrent or new-onset seizures, respectively, over follow-up. RESULTS Treatment with albendazole was associated with a reduction in the number of seizures during 24 months of follow-up, but this was only significant for generalized seizures during months 1-12 (unadjusted rate ratio [RR] 0.19; 95% CI: 0.04-0.91) and months 1-24 (unadjusted RR 0.06; 95% CI: 0.01-0.57). We did not detect a significant effect of albendazole on reducing the number of focal seizures or on the probability of having a seizure, regardless of seizure type or time period. CONCLUSIONS Albendazole treatment may be associated with some symptomatic improvement; however, this association seems to be specific to generalized seizures. Future research is needed to identify strategies to better reduce long-term seizure burden in patients with neurocysticercosis.
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Affiliation(s)
- Matthew L Romo
- Epidemiology & Biostatistics Program, School of Urban Public Health at Hunter College, City University of New York, 2180 Third Avenue, New York, New York 10035, USA CUNY School of Public Health, 2180 Third Avenue, New York, New York 10035, USA
| | - Katarzyna Wyka
- Epidemiology & Biostatistics Program, School of Urban Public Health at Hunter College, City University of New York, 2180 Third Avenue, New York, New York 10035, USA CUNY School of Public Health, 2180 Third Avenue, New York, New York 10035, USA Doctor of Public Health Program, The Graduate Center, City University of New York, 365 5th Avenue, New York, New York 10016, USA
| | - Arturo Carpio
- Facultad de Ciencias Médicas, Universidad de Cuenca, Av. 12 de Abril s/n, Cuenca, Ecuador Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, New York 10032, USA
| | - Denise Leslie
- MRI Diagnostics of Westchester, 503 Grasslands Road, Suite 100, Valhalla, New York 10595, USA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, New York 10032, USA
| | - Emilia Bagiella
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, New York 10032, USA
| | - W Allen Hauser
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, New York 10032, USA Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, New York 10032, USA
| | - Elizabeth A Kelvin
- Epidemiology & Biostatistics Program, School of Urban Public Health at Hunter College, City University of New York, 2180 Third Avenue, New York, New York 10035, USA CUNY School of Public Health, 2180 Third Avenue, New York, New York 10035, USA Doctor of Public Health Program, The Graduate Center, City University of New York, 365 5th Avenue, New York, New York 10016, USA
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Singh AK, Singh SK, Singh A, Gupta KK, Khatoon J, Prasad A, Rai RP, Gupta RK, Tripathi M, Husain N, Prasad KN. Immune response to Taenia solium cysticerci after anti-parasitic therapy. Int J Parasitol 2015; 45:749-59. [DOI: 10.1016/j.ijpara.2015.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/14/2015] [Accepted: 05/18/2015] [Indexed: 01/11/2023]
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Mehta V, Ferrie CD, Cross JH, Vadlamani G. Corticosteroids including ACTH for childhood epilepsy other than epileptic spasms. Cochrane Database Syst Rev 2015; 2015:CD005222. [PMID: 26086765 PMCID: PMC7390481 DOI: 10.1002/14651858.cd005222.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane review published in Issue 1, 2007.Epilepsy is a disorder with recurrent epileptic seizures. Corticosteroids have been used in the treatment of children with epilepsy and have significant adverse effects. Their efficacy and tolerability have not been clearly established. OBJECTIVES To determine the efficacy, in terms of seizure control, improvements in cognition and in quality of life and tolerability of steroids compared to placebo or other antiepileptic drugs in children with epilepsy, excluding epileptic spasms. SEARCH METHODS We searched the following databases: The Cochrane Epilepsy Group Specialized Register (1 August 2014); CENTRAL, (The Cochrane Library Issue 7, July 2014); MEDLINE (1946 to 1 August 2014); EMBASE (1966 to December 2004); Database of Abstracts of Reviews of Effectiveness (DARE; Issue 3 of the database published in The Cochrane Library Issue 7, July 2014); ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform ICTRP (1 August 2014).We checked the reference lists of retrieved studies for additional reports of relevant studies. SELECTION CRITERIA All randomised controlled trials of administration of corticosteroids to children (less than 16 years) with epilepsy. DATA COLLECTION AND ANALYSIS For this update two review authors independently selected trials for inclusion and extracted data. Outcomes included cessation of seizures, reduction in seizure frequency, improvement in cognition, quality of life and adverse effects of steroids. MAIN RESULTS A single RCT was included that recruited five children in a double blind cross-over trial. One child was withdrawn prematurely from the study and another had infantile spasms and hence was excluded from further analysis. Adrenocorticotrophin hormone (ACTH 4-9) was administered. Of the three children analysed, one showed a reduction in seizures of 25% to 50% at both the low and higher doses of corticosteroids compared to placebo; one child showed a reduction in seizures at the higher dose only and one child showed no reduction in seizures at either dose. No adverse effects were reported. AUTHORS' CONCLUSIONS Since the last version of this review no new evidence has been found for the efficacy of corticosteroids in treating childhood epilepsies. Clinicians using steroids in childhood epilepsies, other than for epileptic spasms, should take this into account before using these agents.
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Affiliation(s)
- Vishal Mehta
- Hull and East Yorkshire Hospitals NHS TrustDepartment of PaediatricsAnlaby RoadHullWest YorkshireUKHU3 2JZ
| | - Colin D Ferrie
- Leeds General InfirmaryDepartment of Paediatric NeurologyClarendon WingBelmont GroveLeedsUKLS2 9NS
| | - J Helen Cross
- UCL Institute of Child Health4/5 Long YardLondonUKWC1N 3LU
- The Neville Childhood Epilepsy CentreSt Piers LaneLingfieldSurreyUKRH7 6PW
| | - Gayatri Vadlamani
- Leeds General InfirmaryDepartment of Paediatric NeurologyClarendon WingBelmont GroveLeedsUKLS2 9NS
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Gulati S, Jain P, Sachan D, Chakrabarty B, Kumar A, Pandey R, Gupta AK. Seizure and radiological outcomes in children with solitary cysticercous granulomas with and without albendazole therapy: A retrospective case record analysis. Epilepsy Res 2014; 108:1212-20. [DOI: 10.1016/j.eplepsyres.2014.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 03/14/2014] [Accepted: 04/27/2014] [Indexed: 11/16/2022]
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Pediatric neurocysticercosis: usefulness of antibody response in cysticidal treatment follow-up. BIOMED RESEARCH INTERNATIONAL 2014; 2014:904046. [PMID: 25215297 PMCID: PMC4158118 DOI: 10.1155/2014/904046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/09/2014] [Accepted: 07/10/2014] [Indexed: 11/17/2022]
Abstract
Serum and urine samples were collected from 33 NCC patients before the albendazole treatment, 3-6 and 12 months PT. At 3 months PT, 24 (72.7%) patients had no detectable CT/MRI lesions and 9 (27.2%) patients had persistent lesions. Antibody response to crude soluble extract (CSE), excretory secretory (ES), and lower molecular mass (LMM) (10-30 KDa) antigenic fraction of T. solium cysticerci was detected in serum and urine samples by ELISA. Before the treatment, out of 33 NCC children, 14 (42.4%), 22 (66.6%), and 11 (33.3%) serum samples were found positive with the use of CSE, ES, and LMM antigen, respectively. At 3-6 months PT, positivity rate was 5 (15.1%), 2 (6%), and 4 (12.1%) and at 12 months PT, positivity rate was 5 (15.1%), 0, and 3 (9%) with the use of CSE, ES, and LMM antigen, respectively. There was no significant difference in the positivity with the use of three antigens in pretreatment and PT urine samples. The study suggests that the use of ES antigen to detect antibody in serum samples may serve better purpose to evaluate the therapeutic response in patients with NCC.
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Abstract
Parasites infect the central nervous system of children, particularly in resource-poor areas and tropical countries. However, these infections are increasingly seen in the West with the increase in children travelling to these areas and immigrant populations. These conditions are important in the differential diagnosis of common neurological syndromes. Falciparum malaria is a common cause of seizures and coma in endemic areas. Neurocysticercosis is a common cause of acquired epilepsy in some areas. Schistosomiasis is an important cause of spinal cord disease. Toxocara is ubiquitous and may cause encephalitis and retinal changes, and may be associated with epilepsy. Other parasitic conditions tend to be localized to specific regions of the world. Parasitic diseases are often associated with eosinophilia, and some cause an eosinophilic meningoencephalitis, although there are many nonparasitic causes of this syndrome. Most parasitic conditions can be treated, but in some diseases it is unclear whether the treatment influences outcome.
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Del Brutto OH. Neurocysticercosis in infants and toddlers: report of seven cases and review of published patients. Pediatr Neurol 2013; 48:432-5. [PMID: 23668866 DOI: 10.1016/j.pediatrneurol.2013.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/31/2013] [Accepted: 02/05/2013] [Indexed: 11/25/2022]
Abstract
Neurocysticercosis in infants and toddlers has received little attention in the literature, and little is known about the mechanisms of disease acquisition and clinical forms of presentation of the disease in this age group. All patients aged ≤3 years with neurocysticercosis evaluated at Hospital-Clínica Kennedy, Guayaquil, over a 22-year period were included in this study. Their household contacts were screened to detect Taenia solium carriers, which may represent the source of infection. A literature search on neurocysticercosis in infants and toddlers was also performed to compare personal cases with those described elsewhere. A total of 25 infants and toddlers with neurocysticercosis were included (seven from our institution and 18 from the literature). All patients had seizures as the primary manifestation of the disease, and neuroimaging studies showed one or two parenchymal brain cysticerci in the colloidal stage in 88% of patients. The source of infection was investigated in 11 houses, including the seven households of the present series, and only four of the 18 reported in the literature. A Taenia carrier was found in five (45%) of these households, including three from the present series and two from the literature. A sizable proportion of infants and toddlers with neurocysticercosis have been infected at home. Compulsory search of Taenia carriers among household contacts will allow the detection of the potential source of infection and will reduce further spread of the disease. The search must not be limited to family members, but also extended to domestic employees who are in daily contact with the children.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad de Especialidades Espíritu Santo, and Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
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Baird RA, Wiebe S, Zunt JR, Halperin JJ, Gronseth G, Roos KL. Evidence-based guideline: treatment of parenchymal neurocysticercosis: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013; 80:1424-9. [PMID: 23568997 DOI: 10.1212/wnl.0b013e31828c2f3e] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review the evidence base for different treatment strategies in intraparenchymal neurocysticercosis in adults and children. METHOD A literature search of Medline, EMBASE, LILACS, and the Cochrane Database from 1980 to 2008, updated in 2012, resulted in the identification of 10 Class I or Class II trials of cysticidal drugs administered with or without corticosteroids in the treatment of neurocysticercosis. RESULTS The available data demonstrate that albendazole therapy, administered with or without corticosteroids, is probably effective in decreasing both long-term seizure frequency and the number of cysts demonstrable radiologically in adults and children with neurocysticercosis, and is well-tolerated. There is insufficient information to assess the efficacy of praziquantel. RECOMMENDATIONS Albendazole plus either dexamethasone or prednisolone should be considered for adults and children with neurocysticercosis, both to decrease the number of active lesions on brain imaging studies (Level B) and to reduce long-term seizure frequency (Level B). The evidence is insufficient to support or refute the use of steroid treatment alone in patients with intraparenchymal neurocysticercosis (Level U).
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Affiliation(s)
- Ruth Ann Baird
- Department of Clinical Neurology, Indiana University School of Medicine, Indianapolis, USA
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Corticosteroids for neurocysticercosis: a systematic review and meta-analysis of randomized controlled trials. Int J Infect Dis 2013; 17:e583-92. [PMID: 23339852 DOI: 10.1016/j.ijid.2012.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 11/29/2012] [Accepted: 12/14/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Neurocysticercosis is an infection of the central nervous system by the larval stage of Taenia solium. It is a major cause of epileptic seizures in low- and middle-income countries. Corticosteroids are frequently used to reduce inflammation and perilesional edema. We aimed to evaluate their efficacy for reducing the rate of seizures and lesion persistence in imaging studies. METHODS We searched randomized controlled trials in Medline, Central, EMBASE, LILACS, and the gray literature without language restrictions. We assessed eligibility, extracted data, and assessed the risk of bias in the included studies. The main outcomes included seizure recurrence and lesion persistence on imaging studies at 6-12 months of follow-up. Risk ratios (RR) were used for evaluating the main outcomes. RESULTS Thirteen studies involving 1373 participants were included. The quality of the evidence was deemed low to very low. Corticosteroids alone versus placebo/no drug (five trials) reduced the rate of seizure recurrence at 6-12 months (RR 0.46, 95% confidence interval (CI) 0.27-0.77; 426 participants) and the persistence of lesions in imaging studies (RR 0.63, 95% CI 0.43-0.92; 417 participants). No differences were noted in other comparisons, including the use of corticosteroids and albendazole combined. Corticosteroids plus albendazole increased the risk of abdominal pain, rash, and headaches (odds ratio 8.73, 95% CI 2.09-36.5; 116 participants, one trial). CONCLUSIONS Although the evidence suggest corticosteroids can reduce the rate of seizure recurrence and speed up resolution of lesions at 6-12 months of follow-up, there remains uncertainty on the effect estimate due to a high risk of methodological and publication bias. More adequately performed randomized trials that evaluate the use of anthelmintics, corticosteroids, and both combined against placebo are needed.
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Otte WM, Singla M, Sander JW, Singh G. Drug therapy for solitary cysticercus granuloma: a systematic review and meta-analysis. Neurology 2013; 80:152-62. [PMID: 23269591 PMCID: PMC3589189 DOI: 10.1212/wnl.0b013e31827b90a8] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 08/23/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The effectiveness of anthelminthic and corticosteroid drug therapy in parenchymal neurocysticercosis is well established. The treatment of parenchymal solitary cysticercus granuloma (SCG), however, remains controversial. We attempted to obtain a consistent estimate of the efficacy of anthelminthic and corticosteroid drug treatment in SCG. METHODS Randomized-controlled trials (RCTs) comparing rates of seizure freedom, granuloma resolution, and residual calcification in individuals with SCG treated with anthelminthic or corticosteroid drugs with those treated with antiepileptic drugs (AEDs) alone were systematically reviewed and quantified using fixed- or random-effects meta-analysis. RESULTS Fifteen RCTs were identified for inclusion. Ten RCTs assigned 765 people with SCG to AED treatment with or without anthelminthic drug (albendazole) treatment. A further 5 RCTs assigned 457 people with SCG to AED treatment with or without corticosteroid drugs. Anthelminthic treatment was associated with significantly increased rates of seizure freedom (nonevent odds ratio: 2.45; 95% confidence interval: 1.49-4.03; p = 0.0004) and significantly higher rates of granuloma resolution (odds ratio: 2.09; 95% confidence interval: 1.41-3.00; p = 0.0003), but did not alter the risk of residual calcification. Corticosteroid treatment was not significantly associated with any outcome. CONCLUSIONS Anthelminthic treatment with albendazole provides improved rates of seizure freedom and hastens resolution of the granuloma. The role of corticosteroid treatment remains uncertain. The benefits (or lack thereof in the case of corticosteroids) are consistent when measured across different time points after treatment.
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Affiliation(s)
- Willem M Otte
- Department of Pediatric Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands.
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Sinha S, Sharma BS. Intraventricular neurocysticercosis: a review of current status and management issues. Br J Neurosurg 2011; 26:305-9. [PMID: 22168964 DOI: 10.3109/02688697.2011.635820] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sumit Sinha
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
Central nervous system (CNS) infections are the main cause of seizures and acquired epilepsy in the developing world. Geographical variations determine the common causes in a particular region. Acute seizures are common in severe meningitis, viral encephalitis, malaria, and neurocysticercosis, and in most cases are associated with increased mortality and morbidity, including subsequent epilepsy. Neuronal excitability secondary to proinflammatory signals induced by CNS infections are an important common mechanism for the generation of seizures, in addition to various other specific mechanisms. Newer insights into the neurobiology of these infections and the associated epilepsy could help in developing neuroprotective interventions. Management issues include prompt treatment of acute seizures and the underlying CNS infection, correction of associated predisposing factors, and decisions regarding the appropriate choice and duration of antiepileptic therapy. Strategies for the prevention of epilepsy in CNS infections such as early anti-infective and anti-inflammatory therapy need scientific exploration. Prevention of CNS infections is the only definitive way forward to reduce the burden of epilepsy in developing countries.
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Affiliation(s)
- Pratibha Singhi
- Department of Paediatrics, Advanced Paediatrics Centre, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India.
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Abstract
Neurocysticercosis (NCC) is the most common cause of acquired epilepsy in developing countries. It can present variably depending on the location and stage of cysts in the nervous system, and the host immune response. The most common presentation of parenchymal NCC is with seizures that are usually focal and brief; status epilepticus occurs in some cases. About a third of cases have headache and vomiting. Diagnosis is made by either CT or MRI. Single, small, contrast enhancing lesions are the most common; visualization of a scolex is diagnostic. Some cases have multiple cysts with a characteristic starry-sky appearance. Although treatment with cysticidal therapy continues to be debated, there is increasing evidence that it helps through increased and faster resolution of CT lesions; whether there is any improvement in long-term seizure control needs further study. It should not be used in cysticercus encephalitis or in ophthalmic NCC and used with caution in extraparenchymal NCC. It is of no use in calcified lesions. Corticosteroids are used simultaneously to reduce cerebral oedema. Seizures respond well to a single antiepileptic, and the seizure recurrence rate is low in cases with single lesions; those with multiple, persistent or calcified lesions usually have recurrent seizures. Extraparenchymal NCC is often associated with intracranial hypertension, hydrocephalous and chronic meningitis; it has a guarded prognosis; surgical intervention is required in many cases. Management of NCC needs to be individualized. NCC is potentially eradicable; proper sanitation, hygiene and animal husbandry are warranted.
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Affiliation(s)
- Pratibha Singhi
- Chief Pediatric Neurology and Neuro Development, Advanced Pediatrics Centre, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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Singh G, Rajshekhar V, Murthy JMK, Prabhakar S, Modi M, Khandelwal N, Garcia HH. A diagnostic and therapeutic scheme for a solitary cysticercus granuloma. Neurology 2011; 75:2236-45. [PMID: 21172847 DOI: 10.1212/wnl.0b013e31820202dc] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Solitary cysticercus granuloma (SCG) is one of the most common forms of presentation of neurocysticercosis (NCC). The diagnostic workup and management approach to this condition remain uncertain and controversial. OBJECTIVE To review evidence and develop a consensus approach to the diagnosis and treatment of SCG. METHODS A multidisciplinary expert group meeting was convened in order to review and discuss various aspects of management of patients with SCG. Evidence reviewed was classified and a consensus was evolved according to standard protocols. RESULTS SCG is commonly recognized on CT as an enhancing lesion measuring <20 mm. Further evaluation with MRI does not add much information. The use of antihelminthic agents (specifically, albendazole in combination with corticosteroids) and corticosteroids alone have been shown to improve radiologic resolution and seizure outcome in patients with SCG. However, the sizes of the effects are modest. By convention, all patients with SCG presenting with seizures are initiated on antiepileptic drugs (AEDs). Available evidence suggests that withdrawal of AEDs after complete resolution of the SCG is safe. There is a high risk of seizure relapse after AED withdrawal in patients with calcific residue following resolution of the SCG. The duration of AED prophylaxis in these individuals is unclear. CONCLUSIONS It is desirable to have large, multicenter trials with sufficiently long follow-up, comparing outcomes with the use of antihelminthics with or without corticosteroids and corticosteroids alone in order to dissect out the benefits accrued due to each of these classes of drugs.
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Affiliation(s)
- G Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, Punjab, India
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Abstract
BACKGROUND Neurocysticercosis is an infection of the brain by the larval stage of the pork tapeworm. In endemic areas it is a common cause of epilepsy. Anthelmintics (albendazole or praziquantel) may be given to kill the parasites. However, there are potential adverse effects, and the parasites may eventually die without treatment. OBJECTIVES To assess the effectiveness and safety of anthelmintics for people with neurocysticercosis. SEARCH STRATEGY In May 2009 we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE, EMBASE, LILACS, and the mRCT. SELECTION CRITERIA Randomized controlled trials comparing anthelmintics with placebo, no anthelmintic, or other anthelmintic regimen for people with neurocysticercosis. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, extracted data, and assessed each trial's risk of bias. We calculated risk ratios (RR) for dichotomous variables, with 95% confidence intervals (CI). We pooled data from trials with similar interventions and outcomes. MAIN RESULTS For viable lesions in children, there were no trials. For viable lesions in adults, no difference was detected for albendazole compared with no treatment for recurrence of seizures (116 participants, one trial); but fewer participants with albendazole had lesions at follow up (RR 0.56, 95% CI 0.45 to 0.70; 192 participants, two trials).For non-viable lesions in children, seizures recurrence was less common with albendazole compared with no treatment (RR 0.49, 95% CI 0.32 to 0.75; 329 participants, four trials). There was no difference detected in the persistence of lesions at follow up (570 participants, six trials). For non-viable lesions in adults, there were no trials.In trials including viable, non-viable or mixed lesions (in both children and adults), headaches were more common with albendazole alone (RR 9.49, 95% CI 1.40 to 64.45; 106 participants, two trials), but no difference was detected in one trial giving albendazole with corticosteroids (116 participants, one trial). AUTHORS' CONCLUSIONS In patients with viable lesions, evidence from trials of adults suggests albendazole may reduce the number of lesions. In trials of non-viable lesions, seizure recurrence was substantially lower with albendazole, which is counter-intuitive. It may be that steroids influence headache during treatment, but further research is needed to test this.
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Affiliation(s)
- Katharine Abba
- Liverpool School of Tropical MedicineInternational Health GroupPembroke PlaceLiverpoolMerseysideUKL3 5QA
| | - Sridharan Ramaratnam
- Apollo HospitalsDepartment of Neurology21 Greams LaneOff Greams RoadChennaiTamil NaduIndia600006
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Abstract
BACKGROUND Neurocysticercosis is an infection of the brain by the larval stage of the pork tapeworm. In endemic areas it is a common cause of epilepsy. Anthelmintics (albendazole or praziquantel) may be given to kill the parasites. However, there are potential adverse effects, and the parasites may eventually die without treatment. OBJECTIVES To assess the effectiveness and safety of anthelmintics for people with neurocysticercosis. SEARCH STRATEGY In May 2009 we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE, EMBASE, LILACS, and the mRCT. SELECTION CRITERIA Randomized controlled trials comparing anthelmintics with placebo, no anthelmintic, or other anthelmintic regimen for people with neurocysticercosis. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, extracted data, and assessed each trial's risk of bias. We calculated risk ratios (RR) for dichotomous variables, with 95% confidence intervals (CI). We pooled data from trials with similar interventions and outcomes. MAIN RESULTS For viable lesions in children, there were no trials. For viable lesions in adults, no difference was detected for albendazole compared with no treatment for recurrence of seizures (116 participants, one trial); but fewer participants with albendazole had lesions at follow up (RR 0.56, 95% CI 0.45 to 0.70; 192 participants, two trials).For non-viable lesions in children, seizures recurrence was less common with albendazole compared with no treatment (RR 0.49, 95% CI 0.32 to 0.75; 329 participants, four trials). There was no difference detected in the persistence of lesions at follow up (570 participants, six trials). For non-viable lesions in adults, there were no trials.In trials including viable, non-viable or mixed lesions (in both children and adults), headaches were more common with albendazole alone (RR 9.49, 95% CI 1.40 to 64.45; 106 participants, two trials), but no difference was detected in one trial giving albendazole with corticosteroids (116 participants, one trial). AUTHORS' CONCLUSIONS In patients with viable lesions, evidence from trials of adults suggests albendazole may reduce the number of lesions. In trials of non-viable lesions, seizure recurrence was substantially lower with albendazole, which is counter-intuitive. It may be that steroids influence headache during treatment, but further research is needed to test this.
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Affiliation(s)
- Katharine Abba
- International Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, Merseyside, UK, L3 5QA
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40
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Sinha S, Sharma B. Neurocysticercosis: A review of current status and management. J Clin Neurosci 2009; 16:867-76. [DOI: 10.1016/j.jocn.2008.10.030] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Revised: 10/28/2008] [Accepted: 10/31/2008] [Indexed: 10/20/2022]
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Randomized controlled trial of albendazole in new onset epilepsy and MRI confirmed solitary cerebral cysticercal lesion: Effect on long-term seizure outcome. J Neurol Sci 2009; 276:108-14. [DOI: 10.1016/j.jns.2008.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 09/03/2008] [Accepted: 09/11/2008] [Indexed: 11/17/2022]
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Singh G, Prabhakar S. The effects of antimicrobial and antiepileptic treatment on the outcome of epilepsy associated with central nervous system (CNS) infections. Epilepsia 2008; 49 Suppl 6:42-6. [DOI: 10.1111/j.1528-1167.2008.01755.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Garg RK. Antiparasitic treatment for solitary cysticercus granuloma: to treat or not to treat? Expert Rev Anti Infect Ther 2008; 6:15-19. [DOI: 10.1586/14787210.6.1.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Mazumdar M, Pandharipande P, Poduri A. Does albendazole affect seizure remission and computed tomography response in children with neurocysticercosis? A Systematic review and meta-analysis. J Child Neurol 2007; 22:135-42. [PMID: 17621473 DOI: 10.1177/0883073807300295] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A recent trial suggested that albendazole reduces seizures in adults with neurocysticercosis. There is still no consensus regarding optimal management of neurocysticercosis in children. The authors conducted a systematic review and meta-analysis to assess the efficacy of albendazole in children with neurocysticercosis, by searching the Cochrane Databases, MEDLINE, EMBASE, and LILACS. Three reviewers extracted data using an intent-to-treat analysis. Random effects models were used to estimate relative risks. Four randomized trials were selected for meta-analysis, and 10 observational studies were selected for qualitative review. The relative risk of seizure remission in treatment versus control was 1.26 (1.09, 1.46). The relative risk of improvement in computed tomography in these trials was 1.15 (0.97, 1.36). Review of observational studies showed conflicting results, likely owing to preferential administration of albendazole to sicker children.
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Affiliation(s)
- Maitreyi Mazumdar
- Department of Neurology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
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45
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Nash TE, Singh G, White AC, Rajshekhar V, Loeb JA, Proaño JV, Takayanagui OM, Gonzalez AE, Butman JA, DeGiorgio C, Del Brutto OH, Delgado-Escueta A, Evans CAW, Gilman RH, Martinez SM, Medina MT, Pretell EJ, Teale J, Garcia HH. Treatment of neurocysticercosis: current status and future research needs. Neurology 2006; 67:1120-7. [PMID: 17030744 PMCID: PMC2923067 DOI: 10.1212/01.wnl.0000238514.51747.3a] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Here we put forward a roadmap that summarizes important questions that need to be answered to determine more effective and safer treatments. A key concept in management of neurocysticercosis is the understanding that infection and disease due to neurocysticercosis are variable and thus different clinical approaches and treatments are required. Despite recent advances, treatments remain either suboptimal or based on poorly controlled or anecdotal experience. A better understanding of basic pathophysiologic mechanisms including parasite survival and evolution, nature of the inflammatory response, and the genesis of seizures, epilepsy, and mechanisms of anthelmintic action should lead to improved therapies.
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Affiliation(s)
- T E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA.
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Abstract
Since international travel has become widespread, clinicians increasingly have been confronted with the diagnosis of symptomatic and incidental neurocysticercosis. The difficulty with managing this disease lies in its varied clinical presentations. The treatment of neurocysticercosis depends upon anatomic locations, stages of cysts, and overall cyst burden. Despite recent clinical and laboratory advances, experts are divided on many key management questions. This article reviews the pathophysiology and experimental data underlying treatment recommendations for this emerging and complex condition.
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Affiliation(s)
- Vincent C Marconi
- Medicine Education Office, Brigham and Women's Hospital,PBB-B4 Suite 413, 75 Francis Street, Boston, MA 02115, USA
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Prakash S, Garg RK, Kar AM, Shukla R, Agarwal A, Verma R, Singh MK. Intravenous methyl prednisolone in patients with solitary cysticercus granuloma: A random evaluation. Seizure 2006; 15:328-32. [PMID: 16621618 DOI: 10.1016/j.seizure.2006.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 02/19/2006] [Accepted: 03/10/2006] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the role of intravenous methyl prednisolone in patients with solitary cysticercus granuloma with new-onset seizures. METHODS In this open-label, randomized, prospective, follow-up study, 52 patients with new-onset seizures and a single enhancing CT lesion of cysticercus were randomly divided in two groups to receive either intravenous methyl prednisolone for 5 days along with antiepileptic drug (n=25) or antiepileptic drug monotherapy (n=27) alone. The patients were followed up for at least for 9 months. Repeat CT scans were performed after 2 months. RESULTS After 2 months, lesion disappeared in 60% patients of intravenous methyl prednisolone group and 18.5% patients receiving only antiepileptic drug (p=0.001). As far as seizure recurrence was concerned, a lower number (16% versus 33%) of intravenous methyl prednisolone treated patient had recurrence, the difference was insignificant. CONCLUSION Intravenous methyl prednisolone therapy helps in early resolution of solitary cysticercus granuloma.
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Affiliation(s)
- S Prakash
- Department of Neurology, King George Medical University, Lucknow-226003, India
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Garg RK, Potluri N, Kar AM, Singh MK, Shukla R, Agrawal A, Verma R. Short course of prednisolone in patients with solitary cysticercus granuloma: a double blind placebo controlled study. J Infect 2005; 53:65-9. [PMID: 16269179 DOI: 10.1016/j.jinf.2005.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Accepted: 09/02/2005] [Indexed: 11/23/2022]
Abstract
The study was conducted to confirm the role of a short course of oral corticosteroids in patients with solitary cysticercus granuloma with seizures by a double-blind placebo-controlled study. In an open-label trial we, in past, had demonstrated a beneficial role of prednisolone. A short course of prednisolone helped in early resolution of solitary cysticercus granuloma. In this double-blind placebo-controlled randomized study, 60 patients with new-onset seizures and a single enhancing computed tomography (CT)-detected lesion of cysticercosis were randomly divided in two groups to receive either anti-epileptic monotherapy with prednisolone (n=30) or anti-epileptic monotherapy along with placebo (n=30). The patients received prednisolone, 1mg/kg/day for 10 days, followed by tapering over next 4 days. None of the patients received albendazole therapy. The patients were followed up monthly, at least for 9 months. A repeat CT scan was performed after 6 months. The data were analysed by chi-square test. The majority of patients were young. Simple partial seizure, with or without secondary generalization, was the commonest seizure type encountered. Follow-up CT scans at 6 months demonstrated non-significantly better response for prednisolone treated patients. In prednisolone group the lesion disappeared in 52% of patients and in 48% patients who received placebo. However, a significantly lesser number of prednisolone treated patients (n=12%) than controls (n=48%), had seizure recurrence. Our study suggests that short-term prednisolone therapy may not help in rapid resolution of solitary cysticercus granuloma, however, prednisolone therapy improves seizure-related prognosis.
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Affiliation(s)
- R K Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar pradesh 226003, India.
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49
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Abstract
Neurocysticercosis, the infection of the human brain by the larvae of Taenia solium, is a major cause of acquired epilepsy in most low-income countries. Cases of neurocysticercosis are becoming more common in high-income countries because of increased migration and travel. Diagnosis by neuroimaging and serological assessment has greatly improved over the past decade, and the natural progression of the disease and response to antiparasitic drugs is now much better understood. Neurocysticercosis is potentially eradicable, and control interventions are underway to eliminate this infection. Meanwhile, updated information on diagnosis and management of neurocysticercosis is required, especially for clinicians who are unfamiliar with its wide array of clinical presentations.
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Affiliation(s)
- Hector H Garcia
- Cysticercosis Unit, Institute of Neurological Sciences, Lima, Peru.
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50
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Abstract
Prevalence studies from India suggest that epilepsy prevalence is similar to developed nations. Neurocysticercosis (NCC) predominates as an etiology. A large treatment gap is still a public health problem. Benign epilepsies and West syndrome appear to be underrepresented in studies on classification of seizures/syndromes. Febrile seizures prevalence in India is similar to other countries and appear to be as benign. Risk factors of intractable epilepsy (IE) in Indian studies include early age of onset, neurodevelopmental abnormalities and certain seizure types. Perinatal injuries underlie many IE. Many IE are not truly intractable and respond to simple therapeutic measures. The ketogenic diet and surgery are other methods now being used in Indian centers. Neurocysticercosis and neonatal hypoglycemic brain injury, two widely prevalent etiologies are reviewed in detail.
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Affiliation(s)
- Vrajesh Udani
- Grant Medical College & JJ Group of Hospitals, PD Hinduja National Hospital and Bf Wadia Hospital for Children, Mumbai, India.
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