Seizure Outcomes after Antiparasitic Treatment in Patients with Neurocysticercosis: Systematic Review and Meta-analysis
Sharon Sofia Guevara Lazo1, Lucero Brigitte Diaz Capcha1, Andrea Lagunas Gutierrez1, Maricielo Huayaney Rojas1, Arantxa Sanchez Boluarte2, Wilfor Aguirre Quispe3, Sofia Sanchez Boluarte4, William Tatum5
1Universidad Peruana Cayetano Heredia, 2University of Washington, 3Universidad Cientifica del Sur, 4Universidad Cesar Vallejo, 5Mayo Clinic
Objective:
This review aimed to synthesize existing evidence on the efficacy of antiparasitic therapy in reducing seizure recurrence among patients with neurocysticercosis.
Background:
Neurocysticercosis is a leading cause of acquired epilepsy in endemic regions and remains the most common parasitic infection of the central nervous system (CNS). Recent evidence suggests that antiparasitic treatment, used in combination with corticosteroids, may reduce seizure frequency in some patients.
Design/Methods:
We conducted a systematic review and meta-analysis according to PRISMA guidelines. Literature searches were performed in PubMed, Embase, Global Index Medicus, Web of Science, CINAHL, and Scielo from inception to August 8, 2025. We included randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) comparing antiparasitic treatment (albendazole and/or praziquantel) with placebo and/or standard therapy. Primary outcome was seizure recurrence within 12 months of follow-up. Subgroup analyses were performed according to age group, number of lesions and use of corticosteroid. Pooled effect estimates were calculated using a fixed-effects meta-analysis.
Results:
A total of 680 articles were screened, of which 38 studies met the eligibility criteria, including 3,662 patients. The meta-analysis found no significant difference between albendazole and placebo in seizure recurrence within 12 months of follow-up (20 studies; RR = 0.75, 95% CI 0.50–1.10; p = 0.14). However, subgroup analyses revealed that albendazole significantly reduced seizure recurrence in children (6 studies; RR = 0.45, 95% CI 0.31–0.65; p < 0.001) and in patients with single enhancing lesions (8 studies; RR = 0.59, 95% CI 0.40–0.86; p = 0.01), while concomitant corticosteroid use did not demonstrate a significant effect (5 studies; RR = 0.62, 95% CI 0.33–1.16; p = 0.13).
Conclusions:
Our findings indicate that albendazole did not significantly reduce seizure recurrence, subgroup analyses show relevant benefit in children and patients with single enhancing lesions.
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