Anthelmintics for people with neurocysticercosis
If people eat eggs from the pork tapeworm (Taenia solium), these eggs can move from the gut and then lodge in different tissues of the body forming cysts. When these cysts form in the brain, this is called neurocysticercosis. Some people may have no symptoms if this happens, but others may suffer from seizures, headaches, or more rarely from confusion, loss of balance or brain swelling. More rarely still, someone may die. The condition is mainly found where people live in close contact with pigs and where the sanitation is poor. It affects around 50 million people worldwide, and in some areas is the leading cause of adult-onset epilepsy. The number, size and location of the cysts help to guide treatment of neurocysticercosis, as do the patient’s symptoms; for example, giving anticonvulsants to someone with seizures. Two drugs, praziquantel and albendazole, can be used specifically in neurocysticercosis to help kill the parasite; these drugs are known as anthelmintics. Some cysts, called non-viable lesions are generally in the process of degenerating and resolving spontaneously; many experts recommend not treating this type of cyst. However, treating viable lesions (ie those lesions that may or may not resolve spontaneously) with these drugs may help kill the parasite, although treatment remains controversial due to the potential side effects and the fact the parasite may die without treatment.
In this review of 21 relevant randomized controlled trials, most studies examined the effects of albendazole. In patients with viable lesions, there is only evidence available for adult patients; this suggests that albendazole may reduce the number of lesions. In patients with non-viable lesions, there is only evidence available for children; this suggests that seizure recurrence was lower with albendazole, which goes against the opinions of some experts. There is insufficient evidence available to assess praziquantel.
Abba, K.; Ramaratnam, S.; Ranganathan, L. N. Anthelmintics for people with neurocysticercosis. Cochrane Database of Systematic Reviews (2010) (Issue 1) Art. No.: CD000215. [DOI: 10.1002/14651858.CD000215.pub3]