Combination Therapy for Diffuse or Calcific Neurocysticercosis: A Proof-of-Concept Study
Venkata Vamshi Krish Dondapati1, Ankur Vivek2, Abhishek Pathak3
1Neurology, 2Dept of Neurology, Institute of Medical Sciences, Varanasi, 3Dept of Neurology
Objective:
To evaluate the efficacy and safety of dual cysticidal therapy in conjunction with steroid use for treating diffuse or calcific parenchymal neurocysticercosis (NCC)
Background:
The fear of complications such as diffuse cerebral edema and severe inflammation has often led to withhold cysticidal therapy in patients with diffuse or calcific NCC. Striking a balance between the benefits and risks of treatment for these patients presents a complex clinical challenge.
Design/Methods:
After obtaining informed consent, seven patients with a high load of parenchymal NCC were enrolled in the study. MRI of the brain was done to rule out subarachnoid/intraventricular NCC, hydrocephalus, and diffuse cerebral edema. Following routine neurologic examinations, ultrasonography B-mode was conducted to exclude intraocular cysts. Intravenous dexamethasone administered at a dosage of 0.2 mg/kg/body weight as a pretreatment and continued throughout the antiparasitic therapy. Three days later, oral antiparasitic medications were initiated. Starting with 200 mg albendazole, the dose was increased in 200 mg increments every three days until the targeted dose of 15 mg/kg/day. Praziquantel commenced at 300 mg and was increased by 300 mg every three days until a target dose of 50 mg/kg/day was achieved. Both were continued for twelve weeks, after which dexamethasone was tapered for three weeks. Patients underwent a follow-up MRI scan two weeks post-treatment, and routine liver, kidney, and hemogram functions were monitored weekly
Results:
Baseline MRI scans revealed that patients had multiple (ranging from 12 to over 400) diffuse or calcific parenchymal lesions. Three out of the seven patients exhibited a "starry sky" appearance. After 12 weeks of treatment, neuroimaging demonstrated near-complete resolution of lesions and a decreased frequency of seizures in six patients. Unfortunately, one patient passed away mid-treatment after eight weeks
Conclusions:
Evidence-based guidelines and randomized controlled trials of the larger population are needed to test the safety and efficacy of this combination therapy