Meta-Analysis: Cysticidal Drugs for Neurocysticercosis: Albendazole and Praziquantel

4 July 2006 | Volume 145 Issue 1 | Pages 43-51

Background: Conflicting reports have caused controversy on whether cysticidal drugs modify the natural course of neurocysticercosis.

Purpose: To perform a meta-analysis of randomized trials assessing the effect of cysticidal drugs on neuroimaging and clinical outcomes of patients with neurocysticercosis.

Data Sources: Search of MEDLINE, Cochrane Database of Systematic Reviews, and Literatura Latino-Americana y del Caribe en Ciencias de la Salud (LILACS) between 1979 and 2005. There were no language restrictions.

Study Selection: Randomized trials of cysticidal drug therapy for neurocysticercosis that met predefined criteria designed to allow characterization of the disease and objective evaluation of therapy.

Data Abstraction: The authors independently reviewed articles. Abstracted data included study design, number of randomly assigned patients and withdrawals, intervention, adverse events, timing of neuroimaging studies, and outcomes.

Data Synthesis: Eleven studies met the inclusion criteria. Six trials randomly assigned 464 patients with cystic lesions (vesicular cysticerci), and 5 trials randomly assigned 478 patients with enhancing lesions (colloidal cysticerci). Parasites were located in the brain parenchyma or subarachnoid space at the convexity of the cerebral hemispheres. Cysticidal drug therapy was associated with complete resolution of cystic lesions (44% vs. 19%; P = 0.025). Trials on enhancing lesions showed a trend toward lesion resolution favoring the use of cysticidal drugs (72% vs. 63%; P = 0.38) that became statistically significant when an outlier trial was excluded from the analysis (69% vs. 55%; P = 0.006). Risk for seizure recurrence was lower after cysticidal treatment in patients with enhancing lesions (14% vs. 37%; P < 0.001). The single trial evaluating the frequency of seizures in patients with cystic lesions showed a 67% reduction in the rate of generalized seizures with treatment (P = 0.006).

Limitations: Not all studies focused on the control of seizures as an outcome.

Conclusions: Cysticidal drug therapy results in better resolution of colloidal and vesicular cysticerci, lower risk for recurrence of seizures in patients with colloidal cysticerci, and a reduction in the rate of generalized seizures in patients with vesicular cysticerci.

Editors' Notes Context Neurocysticercosis (tapeworm [Taenia solium] infection of the brain and meninges) is a common cause of acquired epilepsy worldwide. The efficacy of treatment with praziquantel and albendazole is controversial. Contribution The authors identified 11 randomized, controlled trials. All trials used neuroimaging end points to compare albendazole and nonspecific therapy, and 4 compared seizure outcomes. The effects on neuroimaging end points were relatively small (odds ratios <2.2). Treatment reduced the frequency of seizures (odds ratio, 0.36 [95% CI, 0.21 to 0.62]). Safety information was limited and inconclusive. Cautions The studies were small and heterogeneous, and only 5 of 11 were good quality. Implications These studies provide limited evidence of a modest effect of drug treatment in patients with neurocysticercosis. —The Editors

 

Author and Article Information

From Hospital-Clínica-Kennedy, Guayaquil, Ecuador; Indiana University School of Medicine, Indianapolis, Indiana; University of Alabama at Birmingham, Birmingham, Alabama; and Instituto de Ciencias Neurológicas and Universidad Peruana Cayetano Heredia, Lima, Peru.

Grant Support: None.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Oscar H. Del Brutto, MD, Air Center 3542, PO Box 522970, Miami, FL 33152-2970; e-mail, odb{at}gye.satnet.net.

Current Author Addresses: Dr. Del Brutto: Department of Neurological Sciences, Hospital-Clíníca-Kennedy, Seccion Delta, Sotano, Oficina 7, Cuidadela Nueva Kennedy, Calle 9 na s/n y Avenue San Jorge, Guayaquil, Ecuador.

Dr. Roos: Department of Neurology, Indiana University School of Medicine, 550 North University Boulevard, Suite 4411, Indianapolis, IN 46202.

Dr. Coffey: Department of Biostatistics, University of Alabama at Birmingham, Ryals Public Health Building, Room 327M, Birmingham, AL 35294.

Dr. García: Department of Microbiology, Universidad Peruana Cayetano Heredia, Avenue H. Delgado 430, SMP, Lima 31, Peru.

Read all Rapid Responses

Making Difficult Choices

Susan Galandiuk, et al.

Annals Online, 31 Jul 2006 [Full text]