Corticosteroids Versus Albendazole for Treatment of Single Small Enhancing Computed Tomographic Lesions in Children With Neurocysticercosis

Abstract

Single small enhancing computed tomographic (CT) lesions representing cysticercus granuloma are a common cause of focal seizures in children. Controversy exists regarding the efficacy of various modalities of treatment. We conducted a randomized prospective trial to evaluate the efficacy of corticosteroids, albendazole, and corticosteroids with albendazole in children with focal seizures and single small enhancing CT lesions. The study population consisted of 133 children with focal seizures of recent onset (< 3 months) and single small enhancing CT lesions who presented to the Neurocysticercosis Clinic of Pediatric Neurology Services at the Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, an urban teaching and tertiary care hospital in Chandigarh, North India. All children were randomly assigned to receive corticosteroids (group S), albendazole (group A), or both corticosteroids and albendazole (group SA) for 28 days. CT was done at 3 and 6 months after enrollment in the study. Of the 133 patients enrolled, 23 were lost to follow-up. Of the remaining 110 patients, 38 patients were in group S, 37 in group A, and 35 in group SA. All children were followed up for at least 18 months. Disappearance of the lesion on CT scan was noted in 52.6% of patients in group S, 59.5% in group A, and 62.9% in Group SA (P > .1) at the 3-month follow-up. After the 6-month follow-up, disappearance of the lesion was noted in 76.3% in group S, 75.7% in group A, and 74.2% in group SA (P > .1). Twenty-three patients had seizure recurrence while on antiepilepsy drugs: 36.8% of patients in group S, 13.5% in group A, and 11.4% in group SA (P < .05). Seizure recurrence after antiepilepsy drug withdrawal was seen in seven children (three in group S and two each in groups A and SA). In conclusion, there was no significant difference in resolution of CT lesions in the three therapy groups at 3 and 6 months of follow-up. Children in the corticosteroid group had significantly more seizure recurrences while on antiepilepsy drugs. (J Child Neurol 2004;19:323-327).

References

Singhi S. , Singhi P. : Clinical profile and etiology of partial seizures in North Indian Infants and children. J Epilepsy 1997;10:32-36.

Carpio A. , Escobar A. , Hauser AW : Cysticercosis and epilepsy: A critical review. Epilepsia 1998;39:1025-1040.

Singhi P. , Singhi S. , Ramnathan RP , Bharti S. : Neurocysticercosis in focal epilepsy in North India. Epilepsia 1995;36(Suppl 4):156.

Rajshekhar V. : Etiology and management of single CT lesions in patients with seizures: Understanding a controversy. Acta Neurol Scand 1991;84:465-470.

Singhi PD , Baranwal AK : Single small enhancing computed tomographic lesion in Indian children―I: Evolution of current concepts. J Trop Pediatr 2001;47:204-207.

Baranwal AK , Singhi P. , Khandelwal N. , Singhi S. : Albendazole therapy in children with focal seizures and single small enhancing computerized tomographic lesions: A randomized, placebo-controlled, double blind trial. Pediatr Infect Dis J 1998 ;17:696-700.

Del Brutto OH : Medical treatment of cysticercosis: Effective . Arch Neurol 1995;52:102-104.

Del Brutto OH : The use of albendazole in patients with single lesion enhanced on contrast CT. N Engl J Med 1993;32:356-357.

Rajashekhar V. : Albendazole therapy for persistent, solitary cysticercus granuloma in patients with seizures. Neurology 1993;43:1238-1240.

10.

Padma MV , Behari M. , Misra NK : Albendazole therapy in single CT ring lesions in epilepsy. Neurology 1994;44:1344-1346.

11.

Kramer LD : Medical treatment of cysticercosis: Ineffective. Arch Neurol 1995;52:101-102.

12.

Garcia HH , Evans Caw , Nash TE , et al: Current consensus guidelines for treatment of neurocysticercosis . Clin Microbiol Rev 2002;15:747-756.

13.

White AC : Neurocysticercosis: A major cause of neurological disease worldwide . Clin Infect Dis 1997;24:101-115.

14.

De Ghetaldi LD , Norman RM , Douville AW Jr : Cerebral cysticercosis treated biphasically with dexamethasone and praziquantel. Ann Intern Med 1983;99:179-181.

15.

Kupuswamy B. : Manual of Socio-economic Status. Delhi, Manasayan, 1976.

16.

Carpio A. , Santillan F. , Leon P. , et al: Is the course of neurocysticercosis modified by treatment with antihelminthic agents? Arch Intern Med 1995 ;155:1982-1988.

17.

Takayanugui OM , Jardim E. : Therapy for neurocysticercosis. Comparison between albendazole and praziquantel. Arch Neurol 1992;49:290-294.

18.

Aluja AS , Vargas G. : The histopathology of porcine cysticercosis. Vet Parasitol 1988;28:65-77.

19.

Ridaura Sanz C. : Host response in childhood neurocysticercosis . Childs Nerv Syst 1987;3:206-207.

20.

Singhi PD : Concomitant steroid and albendazole for treating neurocysticercosis . Indian Pediatr 1999;36:1176.

21.

Baranwal AK , Singhi PD , Singhi SC : Seizure recurrence in children with focal seizures and single small enhancing computed tomographic lesions: Prognostic factors on long term follow-up. J Child Neurol 2001;16:443-445.

22.

Singhi P. , Dinakaran J. , Khandelwal N. , Singhi S. : One versus two years of antiepileptic therapy in children with single small enhancing CT lesions. J Trop Pediatr 2003;49:274-278.