Therapy for Neurocysticercosis: Comparison Between ...

Abstract

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&#; Praziquantel and albendazole have been recently described as effective drugs for treatment of intraparenchymal brain cysticercosis. We performed a prospective study comparing the efficacy of these drugs. Twenty-two patients were treated with praziquantel and 21 with albendazole. In addition, 16 patients were treated with symptomatic drugs only and used as controls. Treatment was discontinued in two patients receiving praziquantel and one patient receiving albendazole owing to acute decompensation of the increased intracranial pressure, and one of them died. Albendazole and praziquantel were effective when compared with the control group. However, albendazole was significantly more effective than praziquantel in reducing the total number of cysts in the computed tomographic scans (88% vs 50%). Despite these results, however, analysis of clinical course showed a high frequency of neurologic sequelae. Considering the risks and fallibility of anticysticercal therapy, the real solution for this serious disease continues to be prophylaxis of infestation.

Treatment options

Praziquantel is the medication most often used to treat active taeniasis, given at 5-10 mg/kg orally once for adults and 5-10 mg/kg orally once for children. Available evidence suggests that using 10mg/kg once orally may have a higher rate of cure than the 5mg/kg dose. Niclosamide is an alternative, given at 2 g orally once for adults and 50 mg/kg orally once for children. Albendazole, given as 400mg daily for three days, may be used as another option for the treatment of taeniasis, although this is based on studies treating small numbers of infected individuals with T. solium or T. saginata. Stools may be collected for 3 days after treatment to search for proglottids or scolices for species identification if necessary. Stools should be re-examined for Taenia eggs 1 and 3 months after treatment to be sure the infection is cleared.

Both praziquantel and albendazole should be used cautiously in patients suspected to have cysticercosis. There are case reports of seizures that may have been temporally associated with treatment.

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Oral praziquantel is available for human use in the United States.

Niclosamide is NOT available for human use in the United States.

Oral albendazole is available for human use in the United States.

Praziquantel and albendazole are not approved by the U.S. Food and Drug Administration for the treatment of taeniasis.

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