Short course of albendazole therapy for neurocysticercosis

Albendazole is now used for therapy of neurocysticercosis; however, duration of treatment has usually been empirically determined. In this study we shortened the length of therapy from one month in previous reports, to one week. Twelve patients with parenchymal brain cysticercosis were treated with albendazole for eight days at daily doses of 15 mg/kg of body weight. After three months of treatment the number of cysts on computed tomography had decreased from 185 to six; a 97% reduction in the number of lesions. Total remission of all cysts was seen in nine patients. Two cases had been unsuccessfully treated before with praziquantel, in both instances albendazole therapy was effective with 100% improvement. Our results indicated that a short course of albendazole is highly effective for treatment of neurocysticercosis.     

Neurocysticercosis. Short course of treatment with albendazole

Eighteen patients with nonenhancing parenchymal brain cysts were treated with albendazole; 9 patients were treated for 3 days and 9 patients for 1 month at daily doses of 15 mg/kg of body weight. Three months after starting therapy, results showed that in both groups the treatment was highly effective. Control studies carried out in the same group before the trial did not show any significant improvement. Five patients were controls and were treated only with symptomatic drugs. The total diameter of the lesions was reduced from 220.1 mm to 52.1 mm, which signifies a reduction of 76.3% in patients treated for a period of 3 days, and from 278.5 mm to 82.1 mm, which is 70.5%, in patients treated for 30 days. We conclude that albendazole administered according to the 3-day therapeutic scheme proposed above is as highly effective for the treatment of parenchymal brain cysticercosis as the 30-day scheme.     

Albendazole trial at 15 or 30 mg/kg/day for subarachnoid and intraventricular cysticercosis

Thirty-six patients with subarachnoid and intraventricular cysticercosis were randomly assigned to receive albendazole at 15 or 30 mg/kg/day plus dexamethasone for 8 days. Results favored a higher dose, with larger cyst reduction on MRI at 90 and 180 days and higher albendazole sulfoxide levels in plasma. An albendazole course at 30 mg/kg/day combined with corticosteroids is safe and more effective than the usual dose. A single treatment was insufficient in intraventricular and giant cysts.     

Determination of praziquantel levels in cerebrospinal fluid and plasma in patients with cysticercosis of the central nervous system treated with praziquantel

The CSF and plasma concentrations of praziquantel (PZQ) were determined with high pressure liquid chromatography in 37 patients with cysticercosis of the central nervous system during a dosing regimen of PZQ 20 mg/kg p o q 8h for 3 days. The pharmacokinetic parameters were estimated using the nonlinear least squares method. The results showed that PZQ could pass through the blood-brain barrier. The absorption and elimination rates in CSF were slower than those in plasma, the corresponding mean levels being 0.1 and 0.27 micrograms/ml, which were lower than those in plasma. There was a linear correlation between CSF and plasma concentrations (r = 0.87, P less than 0.01). The neurological complications during the period of therapy were not related to the CSF level of PZQ. The cure rates of muscular and cerebral cysticerci were 14/14 and 5/37 respectively. The difference in susceptibility was considered to be caused by the pharmacokinetic behavior of PZQ and CSF and plasma. It was suggested that in general favorable regimens had better be adjusted with adequate increase of the dosage of PZQ, shortening the dosing interval, and prolong the period of PZQ treatment, but individualization of the PZQ dosing regiment would be necessary in accordance with the plasma concentration of the PZQ.     

Praziquantel in the treatment of neurocysticercosis: long-term follow-up

Thirty-five patients with active neurocysticercosis were treated with praziquantel and followed for 1 year after therapy. CT and CSF analysis showed that 91% of patients with parenchymal cysts improved, and 47% of patients with chronic arachnoiditis had remission. A single treatment with praziquantel for 2 weeks, administered in a daily dose of 50 mg/kg of body weight, was highly effective in parenchymal cysticercosis but less effective in meningeal cysticercosis. The benefits were sustained for at least 1 year.     

Treatment of epilepsy with electrical status epilepticus during slow sleep and its related disorders

To elucidate an effective therapeutic strategy for 'ESES syndrome', epilepsy with electrical status epilepticus during slow sleep (ESES) and its related epileptic disorders, we studied the effect of treatment on the EEG pattern of continuous spike-waves during slow wave sleep (CSWS) in 15 afflicted patients. Basically performed in the following order, the employed therapies included (1) high-dose valproate (VPA) therapy (serum level >100 microg/ml); (2) a combination therapy of VPA and ethosuximide (ESM); (3) short cycles of high-dose diazepam (oral or intrarectal DZP, 0.5-1 mg/kg per day for 6-7 days); and (4) intramuscular synthetic ACTH-Z therapy (0.01-0.04 mg/kg per day for 11-43 days). Regarding the initial EEG effect, a remission of CSWS was achieved by high-dose VPA therapy in 7 of 15 trials (47%), by the combination therapy of VPA and ESM in 3/7 trials (43%), by short cycles of high-dose DZP in 2/4 trials (50%), and by ACTH-Z therapy in 2/5 trials (40%). A permanent remission of ESES syndrome was achieved by high-dose VPA therapy and/or combination therapy of VPA and ESM in 10 patients (67%). The effects of short cycles of high-dose DZP and ACTH-Z therapy were at best temporary. Our strategy for the treatment of ESES syndrome is therefore considered valid.     

Albendazole vs praziquantel for therapy for neurocysticercosis. A controlled trial

Praziquantel and albendazole have been recently described as effective drugs for treating cysticercosis of the brain. In this study, effectiveness of each drug for therapy for parenchymal brain cysticercosis was compared. Twenty patients were treated either with albendazole or with praziquantel; in addition, five patients were taken as controls and treated only with symptomatic drugs. Three months after therapy, results showed that both drugs, albendazole and praziquantel, were highly effective, as seen by the disappearance of cystic lesions in computed tomographic scans. All lesions in control patients remained unchanged. Albendazole, when compared with praziquantel, showed a 76% vs 73% disappearance of lesions, respectively. It was concluded that both drugs have similar equivalent efficacy and greatly improve the therapeutics of cysticercosis.     

Albendazole therapy for giant subarachnoid cysticerci.

Albendazole is considered to be the drug of choice for treatment of parenchymal brain cysticercosis. Its efficacy, however, for treatment of subarachnoid cysticerci has not been established, to our knowledge. In this study, we treated four patients who had giant subarachnoid cysticerci with albendazole at daily doses of 15 mg/kg of body weight for 8 days. Computed tomographic studies showed that all cysts disappeared 3 months after the end of treatment. This was associated with marked clinical improvement in every case. Our results indicated that albendazole is highly effective for treatment of this form of the disease.     

Neurocysticercosis. II. Evaluation of treatment with praziquantel

The results of the use of praziquantel (PZQ) for the etiologic treatment of neurocysticercosis (NC) are presented. The drug was administered to 45 patients (24 women and 21 men) at increasing doses of 10 to 50 mg/kg/day during the first week and with maintenance on the last dose for two additional weeks, preferentially for patients that presented intraparenchymatous cystic lesions in the computed axial tomography. Follow-up ranged from 8 months to 4 years and a half (median, 2.7 years). During PZQ administration 27 patients (60%) presented side effects which required interruption of treatment in three cases. Decompensation of the increased ICP occurred in two cases (one of them fatal). Exacerbation of CSF pleocytosis occurred in 26 patients (57.7%). Evaluation of the results of PZQ treatment showed a lower clinical-laboratory rate of success than reported in the literature. The most appropriate indications for the use of PZQ are discussed on the basis of the present data and of reports by other investigators. In view of the risks and fallibility of treatment with PZQ, the solution of NC resides in the prevention of infestation.     

A follow-up study of 420 cases of cerebral cysticercosis]

420 patients with cerebral cysticercosis, including 97 with intracranial hypertension, were treated by praziquantel 30-50 mg/kg a day, 7-10 days a course. Of the 420 patients, 252, 144 and 24 were treated for one, two and three courses respectively. 1-6 years' follow-up study showed 366 were completely recovered (87.14%) and 399 had effect (95.00%); 12 had inefficacy and 9 died (5.00%). It is believed that the serious acute allergic reactions might be eliminated by "desensitization" of a small dose of praziquantel; intracranial hypertension can be lowered by intrathecal injection of dexamethasone; and ventricular and intra-ocular cysticercosis can also be treated by praziquantel.