Anthelmintics for people with neurocysticercosis

Abstract

Background Neurocysticercosis is a parasitic infection of the central nervous system by the larval stage of the pork tapeworm and is a common cause of seizures and epilepsy in endemic areas. Anthelmintics (albendazole or praziquantel) may be given alongside supportive treatment (antiepileptics/analgesia) with the aim of killing these larvae (cysticerci), with or without corticosteroid treatment. However, there are potential adverse effects of these drugs, and the cysticerci may eventually die without directed anthelminthic treatment. Objectives To assess the effects of anthelmintics on people with neurocysticercosis. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS, the WHO ICTRP, and ClinicalTrials.gov, up to 21 October 2020. Selection criteria Randomized controlled trials comparing anthelmintics and supportive treatment (+/‐ corticosteroids) with supportive treatment alone (+/‐ corticosteroids) for people with neurocysticercosis. Data collection and analysis Two review authors independently screened the title and abstract of all articles identified by the search. We obtained full‐text articles to confirm the eligibility of all studies that passed screening. One review author extracted data, which a second review author checked. Two review authors assessed the risk of bias of each trial and performed GRADE assessments. In cases of disagreement at consensus discussion stage between review authors, we consulted a third review author. We calculated risk ratios (RR) for dichotomous variables, with 95% confidence intervals (CIs) for pooled data from studies with similar interventions and outcomes. Main results We included 16 studies in the review. Only two studies investigated praziquantel and did not report data in a format that could contribute to meta‐analysis. Most results in this review are therefore applicable to albendazole versus placebo or no anthelmintic. The aggregate analysis across all participants with neurocysticercosis did not demonstrate a difference between groups in seizure recurrence, but heterogeneity was marked (RR 0.94, 95% CI 0.78 to 1.14; 10 trials, 1054 participants; I 2 = 67%; low‐certainty evidence). When stratified by participants with a single cyst or multiple cysts, pooled analysis suggests that albendazole probably improves seizure recurrence for participants with a single cyst (RR 0.61, 95% CI 0.4 to 0.91; 5 trials, 396 participants; moderate‐certainty evidence). All studies contributing to this analysis recruited participants with non‐viable, intraparenchymal cysts only, and most participants were children. We are uncertain whether or not albendazole reduces seizure recurrence in participants with multiple cysts, as the certainty of the evidenc...

Efficacy and safety of praziquantel in the treatment of neurocysticercosis in Vietnam

“…Nevertheless, Garcia et al (2016) observed a better outcome of treatment in patients with multiple cysts compared to those with single (or two) cysts. The absence of association between treatment outcome and the number of cysts in the present study could be due to the effects of other variables causing the heterogeneity in the response to treatment (cyst viability, size or host immunity) (Cárdenas et al, 2014;Monk et al, 2021). Therefore, proper characterisation of patients is very important before planning the treatment of NCC (Garcia et al, 2014b).…”

Efficacy and safety of praziquantel in the treatment of neurocysticercosis in Vietnam

“…Nevertheless, Garcia et al (2016) observed a better outcome of treatment in patients with multiple cysts compared to those with single (or two) cysts. The absence of association between treatment outcome and the number of cysts in the present study could be due to the effects of other variables causing the heterogeneity in the response to treatment (cyst viability, size or host immunity) (Cárdenas et al, 2014;Monk et al, 2021). Therefore, proper characterisation of patients is very important before planning the treatment of NCC (Garcia et al, 2014b).…”

Impact of albendazole treatment on the symptom profile of neurocysticercosis patients 14–16 years following diagnosis

“…Importantly, there was little difference in the proportion experiencing symptoms by treatment arm, suggesting that treating NCC with anthelminthic medication like albendazole may kill some of the parasites sooner, but it has minimal impact on the symptoms experienced by NCC patients over the long-term. A meta-analysis on the impact of albendazole on symptoms over a shorter follow-up (2–7 years), reported seizure recurrence in 28% of patients (Monk et al., 2021 ). While 2 studies did find a significant benefit from albendazole on the number of seizures with generalization (Garcia et al., 2004 ; Romo et al., 2015 ), in 1 study the benefit declined over time and was only significant between 1 and 12 months post-treatment but not between 13 and 24 months post-treatment (Romo et al., 2015 ).…”

Neurocysticercosis in a Nigerian woman -missed diagnosis of a neglected disease and surgical management

“…In cases where the diagnosis is made based on clinical history and neuro-radiology, anthelmintics have been noted to significantly help in symptom resolution. 7 , 9 , 17 , 18 There are however indications for surgical management especially when the diagnosis is made clinically as well as radiologically. Indication for surgical management include large lesions with mass effect in a symptomatic patient 8 9 .…”

Efficacy and safety of praziquantel in the treatment of neurocysticercosis in Vietnam

“…Nevertheless, Garcia et al (2016) observed a better outcome of treatment in patients with multiple cysts compared to those with single (or two) cysts. The absence of association between treatment outcome and the number of cysts in the present study could be due to the effects of other variables causing the heterogeneity in the response to treatment (cyst viability, size or host immunity) (Cárdenas et al, 2014;Monk et al, 2021). Therefore, proper characterisation of patients is very important before planning the treatment of NCC (Garcia et al, 2014b).…”

Impact of albendazole treatment on the symptom profile of neurocysticercosis patients 14–16 years following diagnosis

“…Importantly, there was little difference in the proportion experiencing symptoms by treatment arm, suggesting that treating NCC with anthelminthic medication like albendazole may kill some of the parasites sooner, but it has minimal impact on the symptoms experienced by NCC patients over the long-term. A meta-analysis on the impact of albendazole on symptoms over a shorter follow-up (2–7 years), reported seizure recurrence in 28% of patients (Monk et al., 2021 ). While 2 studies did find a significant benefit from albendazole on the number of seizures with generalization (Garcia et al., 2004 ; Romo et al., 2015 ), in 1 study the benefit declined over time and was only significant between 1 and 12 months post-treatment but not between 13 and 24 months post-treatment (Romo et al., 2015 ).…”

Neurocysticercosis in a Nigerian woman -missed diagnosis of a neglected disease and surgical management

“…In cases where the diagnosis is made based on clinical history and neuro-radiology, anthelmintics have been noted to significantly help in symptom resolution. 7 , 9 , 17 , 18 There are however indications for surgical management especially when the diagnosis is made clinically as well as radiologically. Indication for surgical management include large lesions with mass effect in a symptomatic patient 8 9 .…”

Efficacy and safety of praziquantel in the treatment of neurocysticercosis in Vietnam

“…Nevertheless, Garcia et al (2016) observed a better outcome of treatment in patients with multiple cysts compared to those with single (or two) cysts. The absence of association between treatment outcome and the number of cysts in the present study could be due to the effects of other variables causing the heterogeneity in the response to treatment (cyst viability, size or host immunity) (Cárdenas et al, 2014;Monk et al, 2021). Therefore, proper characterisation of patients is very important before planning the treatment of NCC (Garcia et al, 2014b).…”

Impact of albendazole treatment on the symptom profile of neurocysticercosis patients 14–16 years following diagnosis

“…Importantly, there was little difference in the proportion experiencing symptoms by treatment arm, suggesting that treating NCC with anthelminthic medication like albendazole may kill some of the parasites sooner, but it has minimal impact on the symptoms experienced by NCC patients over the long-term. A meta-analysis on the impact of albendazole on symptoms over a shorter follow-up (2–7 years), reported seizure recurrence in 28% of patients (Monk et al., 2021 ). While 2 studies did find a significant benefit from albendazole on the number of seizures with generalization (Garcia et al., 2004 ; Romo et al., 2015 ), in 1 study the benefit declined over time and was only significant between 1 and 12 months post-treatment but not between 13 and 24 months post-treatment (Romo et al., 2015 ).…”

Neurocysticercosis in a Nigerian woman -missed diagnosis of a neglected disease and surgical management

“…In cases where the diagnosis is made based on clinical history and neuro-radiology, anthelmintics have been noted to significantly help in symptom resolution. 7 , 9 , 17 , 18 There are however indications for surgical management especially when the diagnosis is made clinically as well as radiologically. Indication for surgical management include large lesions with mass effect in a symptomatic patient 8 9 .…”