FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 350:249-258 January 15, 2004 Number 3 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Perspective by Maguire, J. H. Editorial by Sotelo, J. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Neurocysticercosis is the main cause of adult-onset seizures in the developing world. Whether therapy with antiparasitic agents results in improved seizure control has been questioned because of the lack of adequate, controlled studies.

Methods We conducted a double-blind, placebo-controlled trial in which 120 patients who had living cysticerci in the brain and seizures treated with antiepileptic drugs were randomly assigned to receive either 800 mg of albendazole per day and 6 mg of dexamethasone per day for 10 days (60 patients) or two placebos (60 patients). The patients were followed for 30 months or until they had been seizure-free for 6 months after the doses of the antiepileptic drugs had been tapered. The efficacy of treatment was measured as the decrease in the number of seizures after treatment.

Results In the albendazole group, there was a 46 percent reduction in the number of seizures (95 percent confidence interval, –74 to 83 percent) during months 2 to 30 after treatment. This reduction, which was not statistically significant, was composed of a nonsignificant reduction of 41 percent in the number of partial seizures (95 percent confidence interval, –124 to 84 percent) and a significant 67 percent reduction in the number of seizures with generalization (95 percent confidence interval, 20 to 86 percent). Most of the difference in the number of partial seizures was attributable to a few patients who had many seizures during follow-up. The proportions of patients who had partial seizures during follow-up were similar in the two groups (19 of 57 in the albendazole group and 16 of 59 in the placebo group), but the patients in the placebo group had a greater tendency to have seizures with generalization (22 of 59, vs. 13 of 57 in the albendazole group; risk ratio, 1.63; 95 percent confidence interval, 0.91 to 2.92). More of the intracranial cystic lesions resolved in the albendazole group than in the placebo group. With the sole exception of abdominal pain, side effects did not differ significantly between the two groups.

Conclusions In patients with seizures due to viable parenchymal cysts, antiparasitic therapy decreases the burden of parasites and is safe and effective, at least in reducing the number of seizures with generalization.

Source Information

From the Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurologicas (H.H.G., E.J.P., S.M.M.); the Departments of Microbiology (H.H.G., R.H.G., C.A.W.E.) and Radiology (G.H.), Universidad Peruana Cayetano Heredia; and the Department of Public Health, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos (A.E.G.) — all in Lima, Peru; the Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore (H.H.G., R.H.G., L.H.M., C.A.W.E., A.E.G.); the Department of Neurologic Sciences, Hospital–Clinica Kennedy, Guayaquil, Ecuador (O.H.D.); and the Department of Infectious Diseases and Microbiology, Imperial College London, London (C.A.W.E.).

Address reprint requests to Dr. Garcia at the Cysticercosis Unit, Instituto de Ciencias Neurologicas, Jiron Ancash 1271, Barrios Altos, Lima 1, Peru, or at hgarcia{at}jhsph.edu.

Full Text of this Article

Related Letters:

A Trial of Antiparasitic Treatment for Cerebral Cysticercosis
Rojas-Flores I., Kumar S., Garcia H. H., Gilman R. H., Gonzalez A. E.
Extract | Full Text | PDF  
N Engl J Med 2004; 350:1686-1687, Apr 15, 2004. Correspondence

This article has been cited by other articles:

• Rangel-Castilla, L., Serpa, J. A., Gopinath, S. P., Graviss, E. A., Diaz-Marchan, P., White, A. C. Jr (2009). Contemporary Neurosurgical Approaches to Neurocysticercosis. Am J Trop Med Hyg 80: 373-378 [Abstract] [Full Text]  
• Castillo, Y., Rodriguez, S., Garcia, H. H., Brandt, J., Van Hul, A., Silva, M., Rodriguez-Hidalgo, R., Portocarrero, M., Melendez, D. P., Gonzalez, A. E., Gilman, R. H., Dorny, P., for The Cysticercosis Working Group in Peru, (2009). Urine Antigen Detection for the Diagnosis of Human Neurocysticercosis. Am J Trop Med Hyg 80: 379-383 [Abstract] [Full Text]  
• Carpio, A, Kelvin, E A, Bagiella, E, Leslie, D, Leon, P, Andrews, H, Hauser, W A, the Ecuadorian Neurocysticercosis Group, (2008). Effects of albendazole treatment on neurocysticercosis: a randomised controlled trial. J. Neurol. Neurosurg. Psychiatry 79: 1050-1055 [Abstract] [Full Text]  
• Thussu, A, Chattopadhyay, A, Sawhney, I M S, Khandelwal, N (2008). Albendazole therapy for single small enhancing CT lesions (SSECTL) in the brain in epilepsy. J. Neurol. Neurosurg. Psychiatry 79: 272-275 [Abstract] [Full Text]  
• Mamkin, I., Sood, N., Ramanan, S. V. (2007). Taenia solium Neurocysticercosis. NEJM 357: 1666-1667 [Full Text]  
• Bastos, A L, Marchiori, E, Gasparetto, E L, Andrade, B H, Junior, G C, Carvalho, R C, Escuissato, D L, Souza,, A S (2007). Pulmonary and cardiac cysticercosis: helical CT findings. Br. J. Radiol. 80: e58-e60 [Abstract] [Full Text]  
• Mazumdar, M., Pandharipande, P., Poduri, A. (2007). Does Albendazole Affect Seizure Remission and Computed Tomography Response in Children With Neurocysticercosis? A Systematic Review and Meta-analysis. J Child Neurol 22: 135-142 [Abstract]  
• Bhigjee, A. I., Rosemberg, S. (2006). Optimizing therapy of seizures in patients with HIV and cysticercosis. Neurology 67: S19-S22 [Abstract] [Full Text]  
• Nash, T. E., Singh, G., White, A. C., Rajshekhar, V., Loeb, J. A., Proano, J. V., Takayanagui, O. M., Gonzalez, A. E., Butman, J. A., DeGiorgio, C., Del Brutto, O. H., Delgado-Escueta, A., Evans, C.A.W., Gilman, R. H., Martinez, S. M., Medina, M. T., Pretell, E. J., Teale, J., Garcia, H. H. (2006). Treatment of neurocysticercosis: current status and future research needs.. Neurology 67: 1120-1127 [Abstract] [Full Text]  
• Garcia, H. H, Gonzalez, A. E, Tsang, V. C W, Gilman, R. H, for the Cysticerocosis Working Group in Peru, (2006). Neurocysticercosis: some of the essentials. PN 6: 288-297 [Full Text]  
• Baig, S., Damian, R. T., Morales-Montor, J., Thazhath, R., Ghaleb, A., Welch, M., Talhouk, J., White, A. C. Jr. (2006). Cysteine proteinase inhibitors in murine cysticercosis.. Antimicrob. Agents Chemother. 50: 2886-2888 [Abstract] [Full Text]  
• Del Brutto, O. H., Roos, K. L., Coffey, C. S., Garcia, H. H. (2006). Meta-Analysis: Cysticidal Drugs for Neurocysticercosis: Albendazole and Praziquantel. ANN INTERN MED 145: 43-51 [Abstract] [Full Text]  
• Poeschl, P., Janzen, A., Schuierer, G., Winkler, J., Bogdahn, U., Steinbrecher, A. (2006). Calcified Neurocysticercosis Lesions Trigger Symptomatic Inflammation During Antiparasitic Therapy. Am. J. Neuroradiol. 27: 653-655 [Abstract] [Full Text]  
• GARCIA, H. H., DEL BRUTTO, O. H., NASH, T. E., WHITE, A. C. JR., TSANG, V. C. W., GILMAN, R. H. (2005). NEW CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF NEUROCYSTICERCOSIS (TAENIA SOLIUM). Am J Trop Med Hyg 72: 3-9 [Abstract] [Full Text]  
• Rojas-Flores, I., Kumar, S., Garcia, H. H., Gilman, R. H., Gonzalez, A. E. (2004). A Trial of Antiparasitic Treatment for Cerebral Cysticercosis. NEJM 350: 1686-1687 [Full Text]  
• (2004). Antiparasitic Drug Reduces Some Seizures in Neurocysticercosis with Viable Cysts. JWatch Neurology 2004: 3-3 [Full Text]  
• Sotelo, J. (2004). Neurocysticercosis -- Is the Elimination of Parasites Beneficial?. NEJM 350: 280-282 [Full Text]