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Neurology-asia.org

Neurology Asia 2004; 9 (Supplement 1) : 118 – 119 A comparative study of seizure frequency and
neuroimaging changes in patients with
neurocysticercosis with and without albendazole
therapy

K Das, S Basu, GP Mondal, BB Mukherjee, KK Dey, B Mukherjee Neurology Department, Burdwan Medical College and Hospital, Burdwan, West Bengal, India Objective: Neurocysticercosis is a common cause of acquired epilepsy in developing countries. InIndia, 5.3 to 11 % of patients with epilepsy have neurocysticercosis. The role of antiparasiticalbendazole therapy remains controversial due to lack of adequately controlled studies. This study aimsto evaluate the role of albendazole therapy in the neurocysticercosis patients with two or more lesionsto achieve seizure free status and complete resolution of lesions.
Methods: This was a retrospective-prospective cohort study from January 1997 to January 2004comprising of 120 neurocysticercosis patients with more than one lesion in contrast CT or MRI brainscan. The patient had history of seizure within two weeks of enrolment. Exclusion criterias wereprimary seizure disorder, family history of seizure, preexisting focal neurological deficit, anymetabolic or hereditary diseases.
The patients were divided in two groups. Group A (n = 60) received albendazole 15 mg/Kg/day for 14days, dexamethasone 2 mg 8 hourly for 14 days and then tapered off, and antiepileptic drugs atappropriate doses. Group B (n = 60) received antiepileptic drugs only (control). Each patient wasfollowed up at monthly intervals for first 6 months and then at 3 monthly intervals for 4 years. Theoutcomes were evaluated by recurrence of seizure, encephalopathy (presence of headache, vomitingand altered sensorium), hospital readmission, death, resolution of lesions in the follow up CT brain.
Results: The albendazole group consisted of 32 males and 28 females, mean age of 28 + 2 years. Thecontrol group consisted of 34 males, 26 females, mean age of 30 ± 2 years. Table 1 shows the clinicaland imaging results from 3 months to 4 years. At 3 months, there was increased seizure, encephalopathyand hospital readmission in patients treated with albendazole. Two patients on albendazole expired dueto intractable seizure and encephalopathy. More seizures and hospital readmission continued to beobserved in the albendazole group at 6 months.
Discussion and Conclusion: The role of albendazole in neurocysticercosis for resolution of lesions andseizure control is controversial for more than 20 years. An open controlled trial in 1995 showed nosignificant differences between the albendazole group and control in seizures and radiological changesof cysts.1 A recent trial however, showed that albendazole decreased the burden of parasites andreduced the number of seizures.2 Our study showed increased seizure, encephalopathy and hospitalreadmission in patients treated with albendazole. Acute perilesional inflammation and edema fromexposure to parasitic antigen as the drugs act on the cysts may be the possible mechanism. There is alsono evidence of long term benefit to use of albendazole based on clinical evaluation and imaging.
References
1. Carpio A, Santillan F, Leon P, et al. Is the course of neurocysticercosis modified by treatment with antihelminthic agents? Arch Intern Med 1995; 155: 1982-8 2. Garcia HH, Pretell EJ, Gilman RH, et al. A trial of antiparasitic treatment to reduce the rate of seizure due to cerebral cysticercosis. N Engl J Med 2004; 350: 249-58 Table 1: Status of patients after 3 months to 4 years of albendazole
Encephalopathy
Readmission
Imaging:
Complete Resolution

Partial Resolution
Calcification
No Changes
Encephalopathy
Readmission
Imaging:
Complete Resolution

Partial Resolution
Calcification
No Changes
Encephalopathy
Readmission
Imaging:
Complete Resolution

Partial Resolution
Calcification
No Changes
Group A: Albendazole and dexamethasone for 14 days, antiepileptic drugsGroup B: Antiepileptic drugs only

Source: http://www.neurology-asia.org/articles/20043_118.pdf

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