Severe forms of neurocysticercosis: treatment with albendazole

Abstract

-Study of 22 patients with the severe form of neurocysticercosis treated with albendazole (ABZ) administered in 6 different schedules ranging from 15 to 30 mg/kg/day for 21 to 60 days. Dextrochloropheniramine and ketoprofen were the adjuvant drugs. Multiple symptoms were observed in 90.9% of patients. Intracranial hypertension was manifested in 90.9%. Hydrocephaly occurred in 86.4%. Evolution was satisfactory in 10 patients, 8 died and 4 had sequelae. Tomographic studies showed the appearance of an isolated IV th ventricle in 9 patients, after ventriculoperitoneal shunt, before ABZ treatment in 3 of them, during in 5 and after treatment in one. Median clinical follow-up duration was 10 months for the patients who died and 3-4 years for survivors. In 3 patients there was an increase in cyst size during the administration of the 15 mg/kg/day ABZ dose, which was not observed in any patient when the 30 mg/kg/day dose was used.KEY WORDS: cysticercosis, neurocysticercosis, severe forms, treatment, albendazole, dextrochloropheniramine, ketoprofen. Formas graves da neurocisticercose: tratamento com albendazolRESUMO -Estudo de 22 doentes, com a forma grave de neurocisticercose, tratados com albendazol (ABZ), administrado em 6 diferentes esquemas, que variaram de 15 a 30 mg/kg/dia, durante 21 a 60 dias. A dextroclorofeniramina e o cetoprofeno foram as drogas coadjuvantes. Múltiplos sintomas ocorreram em 20 doentes. Hipertensão intracraniana foi manifestação mais comum em 20. Hidrocefalia foi detectada em 19. A evolução foi satisfatória em 45,4%, faleceram 36,4% e 18,2% ficaram com sequelas. Na evolução tomográfica apareceu IV o ventrículo isolado em 40,9%, após derivação ventriculoperitoneal, em 3 deles antes do tratamento com ABZ, em 5 durante e, em um, após o tratamento. A mediana estatística do período de seguimento clínico foi 10 meses para aqueles que faleceram e 3-4 anos para os sobreviventes. Em 3 doentes houve aumento no tamanho dos cistos durante a dose de 15 mg/kg/dia de ABZ, não observado na vigência de 30 mg/kg/dia. PALAVRAS-CHAVE: cisticercose, neurocisticercose, formas graves, tratamento, albendazol, dextroclorofeniramina, cetoprofeno.

Treatment of cerebral cysticercosis with albendazole in elevated dosages

“…Neurocysticercosis treatment is still surrounded by doubts. The decision about whether to have a clinical or a surgical treatment is, most of the times, very difficult, especially when the location is ventricular or subarachnoidal 5 .…”

“…It passes through the capillar wall in the encephalic parenchyma, develops into the cystic form and then turns into Cisticercus celullosae, a benign form of the disease 2,5 . In this period, it shows a thin membrane with a colorless liquid in the inside associated with the scolex.…”

“…When a choice must be made between a surgical or a pharmacological conduct, there is still much controversy, especially if the location of the cyst is at the ventricular or subarachnoidal space. The conduct must be individualized for each case 5 .…”

“…The exactly time of the terapy with albendazole still remains unclear 3 . Other authors recommended the treatment with albendazole for 28 to 30 days and that can reach even 60 days of treatment 1,4,5 . Controversy arises also over the dose of treatment.…”

“…Comparative studies between the treatment of subarachnoidal and intraventricular forms of the parasite with a 15 and a 30 mg dose of albendazole, had shown an involution of the cysticercus much more significant in the groups treated with higher doses of the cysticid 5,8,9 . In our patient we used 30 mg/Kg dose, for 30 days.…”