Quantitative assessment of lesion load and efficacy of 3 cycles of albendazole in disseminated cysticercosis: a prospective evaluation

Abstract

Background: The management of disseminated cysticercosis is unclear and largely considered hazardous. The role of albendazole remains controversial in such patients. Methods: A tertiary care, University hospital-based prospective intervention study was conducted from December 2015 to December 2017. Patients with disseminated cysticercosis, defined as the presence of multiple viable neurocysticerci (≥ 3) in the brain along with involvement of an additional extra site, were included in the study. Patients with cysticercal encephalitis were excluded. A detailed evaluation, including ophthalmoscopy, ocular B scans, ultrasound abdomen, and X-rays were done. Albendazole was administered at a dose of 15 mg/kg/day in 3 cycles of 28 days each. All patients were also given adjuvant corticosteroids and anti-epileptic drugs. Clinical and radiological follow up was carried out at a difference of 3 months between each treatment cycle. For radiological quantification, lesions were counted at 10 pre-specified levels. Statistical analysis was done to estimate the difference in seizure frequency and lesion load. Results: Twenty-nine patients (21 with > 20 lesions; 8 with ≤ 20 lesions) were given albendazole as per the protocol. There was a significant reduction in the occurrence of seizures (P < 0.001) and headache (P < 0.001). A significant reduction in lesion load from baseline to third follow-up was seen in the estimations done at different levels (P < 0.001). No patient developed serious side-effect warranting cessation of therapy. Conclusion: Cyclical use of albendazole appears efficacious in treating disseminated cysticercosis. The method of quantification described may be used in future studies for objective assessment.

Disseminated cysticercosis: a case report and review of treatment protocols

“…Treatment of optic nerve cysticercosis is controversial due to the limited number of cases described. For patients with myocysticercosis with ≥3 lesions/ orbit, or >2 lesions in a single muscle, cysticidal therapy may be avoided 13…”

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

“…Clinical criteria for cure, improvement or failure were total disappearance, significant improvement or no significant improvement in symptoms/signs. Criteria for the changes on MRI were complete, partial or no resolution applied for patients being free of active (stage 1, 2 or 3) cysts, showing a significant resolution (disappearance or calcification in > 50% of cysts) or no resolution of cysts (changes in less than 50% of cysts) (Kalra et al, 2003;Pandey et al, 2020). The normal range for liver enzymes (aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was 1-35 U/L (Walker et al, 1990).…”

Cysticidal Therapy for Diffuse Parenchymal and Calcific Neurocysticercosis

“…2 However, in these clinical trials, patients with lesion load of > 20 were excluded because of fear of posttreatment inflammation triggering complications. 14,15 Pandey et al 16 studied the effect of albendazole monotherapy in patients with a combined CNS and non-CNS lesion load of more than 20 viable cysts (median 25) with a favorable clinical and radiological outcome. The brain load of cysticerci in their patients is not mentioned.…”