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A new evidence-based guideline for adults and children with neurocysticercosis—tapeworm larvae seeded in the brain parenchyma—suggests that clinicians should consider treating patients with albendazole and either dexamethasone or prednisolone.
The combination of the cysticidal drug albendazole and a corticosteroid is intended to reduce the number of active brain lesions and the frequency of the seizures they cause, according to Ruth Ann Baird, MD, Professor of Neurology at Indiana University in Indianapolis, lead author of the guideline. The American Academy of Neurology’s guideline development subcommittee drafted the document.
The optimal treatment for neurocysticercosis has been controversial, and experts have debated the usefulness and potential dangers of cysticidal therapy, steroid therapy, and antiepileptic therapy. Dr. Baird and her colleagues performed a systematic review of the English- and Spanish-language medical literature to clarify the issue.
Unfortunately, even a close review of the best 123 articles available did little to resolve the controversy. The studies used widely varying methodologies and different criteria for judging improvement on brain imaging, thus making comparisons and data pooling difficult. Also, the quality of the data in most of the available studies was suboptimal.
The committee, however, was able to reach some conclusions. “Based on imaging findings in four class I studies (three concordant, one underpowered study failing to show an effect) and a meta-analysis of two class I and four class II studies, albendazole (400 mg b.i.d. for adults or weight-based dosing for either adults or children) is probably safe and effective in reducing both the number of cysts and long-term seizure frequency,” said Dr. Baird.
“In most studies, corticosteroids were coadministered in varying dosages, and this combination appears effective, [but] the evidence is insufficient to support or refute the use of steroid treatment alone in patients with intraparenchymal neurocysticercosis,” noted the committee. The group also found no evidence on which to base a recommendation regarding the optimal timing of steroid therapy.
—Mary Ann Moon
IMNG Medical News
Suggested Reading
Baird RA, Wiebe S, Zunt JR, et al. Evidence-based guideline: Treatment of parenchymal neurocysticercosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(15):1424-1429.
A new evidence-based guideline for adults and children with neurocysticercosis—tapeworm larvae seeded in the brain parenchyma—suggests that clinicians should consider treating patients with albendazole and either dexamethasone or prednisolone.
The combination of the cysticidal drug albendazole and a corticosteroid is intended to reduce the number of active brain lesions and the frequency of the seizures they cause, according to Ruth Ann Baird, MD, Professor of Neurology at Indiana University in Indianapolis, lead author of the guideline. The American Academy of Neurology’s guideline development subcommittee drafted the document.
The optimal treatment for neurocysticercosis has been controversial, and experts have debated the usefulness and potential dangers of cysticidal therapy, steroid therapy, and antiepileptic therapy. Dr. Baird and her colleagues performed a systematic review of the English- and Spanish-language medical literature to clarify the issue.
Unfortunately, even a close review of the best 123 articles available did little to resolve the controversy. The studies used widely varying methodologies and different criteria for judging improvement on brain imaging, thus making comparisons and data pooling difficult. Also, the quality of the data in most of the available studies was suboptimal.
The committee, however, was able to reach some conclusions. “Based on imaging findings in four class I studies (three concordant, one underpowered study failing to show an effect) and a meta-analysis of two class I and four class II studies, albendazole (400 mg b.i.d. for adults or weight-based dosing for either adults or children) is probably safe and effective in reducing both the number of cysts and long-term seizure frequency,” said Dr. Baird.
“In most studies, corticosteroids were coadministered in varying dosages, and this combination appears effective, [but] the evidence is insufficient to support or refute the use of steroid treatment alone in patients with intraparenchymal neurocysticercosis,” noted the committee. The group also found no evidence on which to base a recommendation regarding the optimal timing of steroid therapy.
—Mary Ann Moon
IMNG Medical News
Suggested Reading
Baird RA, Wiebe S, Zunt JR, et al. Evidence-based guideline: Treatment of parenchymal neurocysticercosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(15):1424-1429.
A new evidence-based guideline for adults and children with neurocysticercosis—tapeworm larvae seeded in the brain parenchyma—suggests that clinicians should consider treating patients with albendazole and either dexamethasone or prednisolone.
The combination of the cysticidal drug albendazole and a corticosteroid is intended to reduce the number of active brain lesions and the frequency of the seizures they cause, according to Ruth Ann Baird, MD, Professor of Neurology at Indiana University in Indianapolis, lead author of the guideline. The American Academy of Neurology’s guideline development subcommittee drafted the document.
The optimal treatment for neurocysticercosis has been controversial, and experts have debated the usefulness and potential dangers of cysticidal therapy, steroid therapy, and antiepileptic therapy. Dr. Baird and her colleagues performed a systematic review of the English- and Spanish-language medical literature to clarify the issue.
Unfortunately, even a close review of the best 123 articles available did little to resolve the controversy. The studies used widely varying methodologies and different criteria for judging improvement on brain imaging, thus making comparisons and data pooling difficult. Also, the quality of the data in most of the available studies was suboptimal.
The committee, however, was able to reach some conclusions. “Based on imaging findings in four class I studies (three concordant, one underpowered study failing to show an effect) and a meta-analysis of two class I and four class II studies, albendazole (400 mg b.i.d. for adults or weight-based dosing for either adults or children) is probably safe and effective in reducing both the number of cysts and long-term seizure frequency,” said Dr. Baird.
“In most studies, corticosteroids were coadministered in varying dosages, and this combination appears effective, [but] the evidence is insufficient to support or refute the use of steroid treatment alone in patients with intraparenchymal neurocysticercosis,” noted the committee. The group also found no evidence on which to base a recommendation regarding the optimal timing of steroid therapy.
—Mary Ann Moon
IMNG Medical News
Suggested Reading
Baird RA, Wiebe S, Zunt JR, et al. Evidence-based guideline: Treatment of parenchymal neurocysticercosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(15):1424-1429.