The effect of penicillin therapy on cognitive outcomes in neurosyphilis: a systematic review of the literature

Medial temporal lobe atrophy as a predictor of poor cognitive outcomes in general paresis

“…However, in NS, unlike AD, the cognitive impairment caused by T. pallidum is considered to be “reversible dementia” because improvements in cognitive function have been found in NS patients after treatment with penicillin (Moulton & Koychev, ). However, as Moulton's system review has indicated, the overall quality of previous studies on the effect of penicillin therapy on cognitive outcomes in NS was relatively poor, because of the lack of objective and systematic neuropsychological examinations, inappropriate length of follow‐up, small sample sizes and large amounts of missing data (Moulton & Koychev, ). Moreover, the conclusions for NS may not be suitable for GP because NS includes different clinical types (GP, asymptomatic NS, syphilitic meningitis, meningovascular syphilis and tabes dorsalis) (Ghanem, ).…”

“…The clinical manifestations of GP are characterized by various psychiatric symptoms and progressive cognitive declines Costiniuk & MacPherson, 2013;Jantzen et al, 2012;Rao et al, 2015;Wang et al, 2011;Wang et al, 2016;Zheng, Webster, et al, 2011). After treatment with penicillin, a resolution of clinical abnormalities has been found among both NS patients and GP patients (Hahn et al, 1959;Moulton & Koychev, 2015;Wilner & Brody, 1968). However, previous studies have suggested that the effects of penicillin therapy on clinical outcomes vary among patients with GP and that recrudescence and deterioration should be considered (Hahn et al, 1959;Kodama et al, 2000;Wilner & Brody, 1968).…”

“…General paresis (GP) was previously thought to be an uncommon cause of dementia (Rao, Ariba, Kanwardeep, Anderson, & Malone, 2015). However, as the incidence of syphilis increased rapidly in the recent years, increasing numbers of GP patients were reported worldwide, and increasing attention has been paid to this disease (Moulton & Koychev, 2015;Wang et al, 2016;Zheng, Zhou, et al, 2011). The GP is a clinical type of neurosyphilis (NS) resulting from invasion of the central nervous system by Treponema pallidum (Ghanem, 2010).…”

Neuropsychiatric Aspects of Infectious Diseases

“…There is no consensus that antibiotic treatment of neurosyphilis produces a persistent improvement in cognition in persons with general paresis. 129 A recent study by Sanchez and Zisselman 124 recommended use of a typical antipsychotic, haloperidol, or the atypical agents, quetiapine or risperidone, to treat psychosis in patients with NS. An anticonvulsant, such as divalproex sodium, also was recommended to address agitation and for mood stabilization.…”

Neurobehavioral Manifestations of Human Immunodeficiency Virus/AIDS

“…There is no consensus that antibiotic treatment of neurosyphilis produces a persistent improvement in cognition in persons with general paresis (note: most of the patients studied were HIV-negative) 93 . Further, although neurosyphilis remains associated with psychiatric and behavioral symptoms even in HIV-negative patients 94 , there is no consensus or RCT describing how to best manage these symptoms.…”