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January 08, 2013; 80 (2) Article

Drug therapy for solitary cysticercus granuloma

A systematic review and meta-analysis

Willem M. Otte, Monika Singla, Josemir W. Sander, Gagandeep Singh
First published December 26, 2012, DOI: https://doi.org/10.1212/WNL.0b013e31827b90a8
Willem M. Otte
From the Department of Pediatric Neurology (W.M.O.), Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Image Sciences Institute, University Medical Center Utrecht, The Netherlands; Department of Neurology (M.S., G.S.), Dayanand Medical College, Ludhiana, Punjab, India; UCL Institute of Neurology (J.W.S.), Queen Square, London, UK; and SEIN (J.W.S.), Epilepsy Institutes in the Netherlands Foundation, Heemstede, The Netherlands.
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Monika Singla
From the Department of Pediatric Neurology (W.M.O.), Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Image Sciences Institute, University Medical Center Utrecht, The Netherlands; Department of Neurology (M.S., G.S.), Dayanand Medical College, Ludhiana, Punjab, India; UCL Institute of Neurology (J.W.S.), Queen Square, London, UK; and SEIN (J.W.S.), Epilepsy Institutes in the Netherlands Foundation, Heemstede, The Netherlands.
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Josemir W. Sander
From the Department of Pediatric Neurology (W.M.O.), Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Image Sciences Institute, University Medical Center Utrecht, The Netherlands; Department of Neurology (M.S., G.S.), Dayanand Medical College, Ludhiana, Punjab, India; UCL Institute of Neurology (J.W.S.), Queen Square, London, UK; and SEIN (J.W.S.), Epilepsy Institutes in the Netherlands Foundation, Heemstede, The Netherlands.
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Gagandeep Singh
From the Department of Pediatric Neurology (W.M.O.), Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Image Sciences Institute, University Medical Center Utrecht, The Netherlands; Department of Neurology (M.S., G.S.), Dayanand Medical College, Ludhiana, Punjab, India; UCL Institute of Neurology (J.W.S.), Queen Square, London, UK; and SEIN (J.W.S.), Epilepsy Institutes in the Netherlands Foundation, Heemstede, The Netherlands.
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Citation
Drug therapy for solitary cysticercus granuloma
A systematic review and meta-analysis
Willem M. Otte, Monika Singla, Josemir W. Sander, Gagandeep Singh
Neurology Jan 2013, 80 (2) 152-162; DOI: 10.1212/WNL.0b013e31827b90a8

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Abstract

Objective: The effectiveness of anthelminthic and corticosteroid drug therapy in parenchymal neurocysticercosis is well established. The treatment of parenchymal solitary cysticercus granuloma (SCG), however, remains controversial. We attempted to obtain a consistent estimate of the efficacy of anthelminthic and corticosteroid drug treatment in SCG.

Methods: Randomized-controlled trials (RCTs) comparing rates of seizure freedom, granuloma resolution, and residual calcification in individuals with SCG treated with anthelminthic or corticosteroid drugs with those treated with antiepileptic drugs (AEDs) alone were systematically reviewed and quantified using fixed- or random-effects meta-analysis.

Results: Fifteen RCTs were identified for inclusion. Ten RCTs assigned 765 people with SCG to AED treatment with or without anthelminthic drug (albendazole) treatment. A further 5 RCTs assigned 457 people with SCG to AED treatment with or without corticosteroid drugs. Anthelminthic treatment was associated with significantly increased rates of seizure freedom (nonevent odds ratio: 2.45; 95% confidence interval: 1.49–4.03; p = 0.0004) and significantly higher rates of granuloma resolution (odds ratio: 2.09; 95% confidence interval: 1.41–3.00; p = 0.0003), but did not alter the risk of residual calcification. Corticosteroid treatment was not significantly associated with any outcome.

Conclusions: Anthelminthic treatment with albendazole provides improved rates of seizure freedom and hastens resolution of the granuloma. The role of corticosteroid treatment remains uncertain. The benefits (or lack thereof in the case of corticosteroids) are consistent when measured across different time points after treatment.

GLOSSARY

AED=
antiepileptic drug;
CI=
confidence interval;
OR=
odds ratio;
RCT=
randomized-controlled trial;
SCG=
solitary cysticercus granuloma

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at www.neurology.org

  • Received February 16, 2012.
  • Accepted August 23, 2012.
  • © 2013 American Academy of Neurology
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