Transcranial Doppler ultrasonography to evaluate cerebral hemodynamic changes in neurocysticercosis.

BACKGROUND: Arteritis is a complication of neurocysticercosis (NCC), which is not well known and could trigger strokes. The transcranial Doppler ultrasound (TCD) is a noninvasive method for detecting, staging, and monitoring cerebrovascular diseases. Nonetheless, the utility of TCD to evaluate cerebral hemodynamic changes, suggesting vasculitis associated with NCC remains uncertain. OBJECTIVE: To evaluate cerebral hemodynamic changes using TCD in patients with subarachnoid and parenchymal NCC. METHODS: There were 53 patients with NCC evaluated at a reference hospital for neurological diseases included (29 with subarachnoid and 24 with parenchymal). Participants underwent a clinical interview and serology for cysticercosis and underwent TCD performed within 2 weeks of enrollment. Mean flow velocity, peak systolic velocity, end diastolic velocity, and pulsatility index were recorded. RESULTS: Among the participants, there were 23 (43.4%) women, with a median age of 37 years (IQR: 29-48). Cerebral hemodynamic changes suggesting vasculitis were detected in 12 patients (22.64%); the most compromised vessel was the middle cerebral artery in 11 (91.67%) patients. There were more females in the group with sonographic signs of vasculitis (10/12, 83.33% vs. 13/41, 31.71%; p = 0.002), and this was more frequent in the subarachnoid NCC group (9/29, 31.03% vs. 3/24, 12.5%; p = 0.187), although this difference did not reach statistical significance. CONCLUSION: Cerebral hemodynamic changes suggestive of vasculitis are frequent in patients with NCC and can be evaluated using TCD.

ANTECEDENTES: La arteritis es una complicación de la neurocisticercosis (NCC), que no siempre se conoce y podría desencadenar enfermedad cerebrovascular. La ultrasonografía Doppler transcraneal (DTC) es un método no invasivo que sirve para detectar y monitorizar enfermedades cerebrovasculares. No obstante, la utilidad de la DTC para evaluar los cambios hemodinámicos cerebrales que sugieren vasculitis asociada a NCC sigue siendo incierta. OBJETIVO: Evaluar los cambios hemodinámicos cerebrales utilizando DTC en pacientes con NCC subaracnoidea y parenquimal. MéTODOS: Se incluyeron 53 pacientes con NCC (29 con subaracnoidea y 24 con parenquimal) evaluados en un hospital de referencia para enfermedades neurológicas. Los participantes se sometieron a una entrevista clínica y serología para cisticercosis y a una DTC realizada dentro de las 2 semanas posteriores a la inscripción. Se registraron la velocidad media del flujo, la velocidad sistólica máxima, la velocidad diastólica final y el índice de pulsatilidad. RESULTADOS: Los participantes incluyeron 23 (43,4%) mujeres con una mediana de edad de 37 años (rango intercuartílico [RIC]: 29­48). Se detectaron cambios hemodinámicos cerebrales sugestivos de vasculitis en 12 pacientes (22,64%); el vaso más comprometido fue la arteria cerebral media, en 11 (91,67%) pacientes. Hubo más mujeres en el grupo con signos ecográficos de vasculitis (10/12, 83,33% versus 13/41, 31,71%; p = 0,002), y esto fue más frecuente en el grupo de NCC subaracnoidea (9/29, 31,03% versus 3/24, 12,5%; p = 0,187), aunque esta diferencia no alcanzó significancia estadística. CONCLUSIóN: Los cambios hemodinámicos cerebrales sugestivos de vasculitis son frecuentes en pacientes con NCC y pueden evaluarse mediante DTC.

Increased Prevalence of Antibodies to Hepatitis E Virus in Patients with Neurocysticercosis.

We explored the association between serological status for hepatitis E and neurocysticercosis (NCC) in neurologic patients attending a national neurological referral center in Lima, Perú, between the years 2008 and 2012. Anti-hepatitis E antibodies were evaluated in patients with and without NCC, and a control group of rural general population. Anti-hepatitis E IgG was found in 23.8% of patients with NCC, compared with 14.3% in subjects without NCC from a general rural population (P = 0.023) and 14.4% in subjects with neurological complaints without NCC (P = 0.027). Seropositive patients had a median age of 44 years compared with 30 years in seronegative patients (P <0.001). No significant differences in sex, region of residence, or liver enzyme values were found. Seropositivity to hepatitis E was frequent in this Peruvian population and higher in patients with NCC, suggesting shared common routes of infection.

Transcranial Doppler ultrasonography to evaluate cerebral hemodynamic changes in neurocysticercosis / Ultrasonografía Doppler transcraneal para evaluar cambios hemodinámicos cerebrales en neurocisticercosis

Abstract Background Arteritis is a complication of neurocysticercosis (NCC), which is not well known and could trigger strokes. The transcranial Doppler ultrasound (TCD) is a noninvasive method for detecting, staging, and monitoring cerebrovascular diseases. Nonetheless, the utility of TCD to evaluate cerebral hemodynamic changes, suggesting vasculitis associated with NCC remains uncertain. Objective To evaluate cerebral hemodynamic changes using TCD in patients with subarachnoid and parenchymal NCC. Methods There were 53 patients with NCC evaluated at a reference hospital for neurological diseases included (29 with subarachnoid and 24 with parenchymal). Participants underwent a clinical interview and serology for cysticercosis and underwent TCD performed within 2 weeks of enrollment. Mean flow velocity, peak systolic velocity, end diastolic velocity, and pulsatility index were recorded. Results Among the participants, there were 23 (43.4%) women, with a median age of 37 years (IQR: 29-48). Cerebral hemodynamic changes suggesting vasculitis were detected in 12 patients (22.64%); the most compromised vessel was the middle cerebral artery in 11 (91.67%) patients. There were more females in the group with sonographic signs of vasculitis (10/12, 83.33% vs. 13/41, 31.71%; p = 0.002), and this was more frequent in the subarachnoid NCC group (9/29, 31.03% vs. 3/24, 12.5%; p = 0.187), although this difference did not reach statistical significance. Conclusion Cerebral hemodynamic changes suggestive of vasculitis are frequent in patients with NCC and can be evaluated using TCD.

Resumen Antecedentes La arteritis es una complicación de la neurocisticercosis (NCC), que no siempre se conoce y podría desencadenar enfermedad cerebrovascular. La ultrasonografía Doppler transcraneal (DTC) es un método no invasivo que sirve para detectar y monitorizar enfermedades cerebrovasculares. No obstante, la utilidad de la DTC para evaluar los cambios hemodinámicos cerebrales que sugieren vasculitis asociada a NCC sigue siendo incierta. Objetivo Evaluar los cambios hemodinámicos cerebrales utilizando DTC en pacientes con NCC subaracnoidea y parenquimal. Métodos Se incluyeron 53 pacientes con NCC (29 con subaracnoidea y 24 con parenquimal) evaluados en un hospital de referencia para enfermedades neurológicas. Los participantes se sometieron a una entrevista clínica y serología para cisticercosis y a una DTC realizada dentro de las 2 semanas posteriores a la inscripción. Se registraron la velocidad media del flujo, la velocidad sistólica máxima, la velocidad diastólica final y el índice de pulsatilidad. Resultados Los participantes incluyeron 23 (43,4%) mujeres con una mediana de edad de 37 años (rango intercuartílico [RIC]: 29-48). Se detectaron cambios hemodinámicos cerebrales sugestivos de vasculitis en 12 pacientes (22,64%); el vaso más comprometido fue la arteria cerebral media, en 11 (91,67%) pacientes. Hubo más mujeres en el grupo con signos ecográficos de vasculitis (10/12, 83,33% versus 13/41, 31,71%; p = 0,002), y esto fue más frecuente en el grupo de NCC subaracnoidea (9/29, 31,03% versus 3/24, 12,5%; p = 0,187), aunque esta diferencia no alcanzó significancia estadística. Conclusión Los cambios hemodinámicos cerebrales sugestivos de vasculitis son frecuentes en pacientes con NCC y pueden evaluarse mediante DTC.

Older Age in Subarachnoid Neurocysticercosis Reflects a Long Prepatent Period.

Patients with subarachnoid neurocysticercosis (NCC) are usually older than those with parenchymal disease. Whether this difference reflects a prolonged presymptomatic period or a delay in diagnosis is not clear. From 408 eligible patients, we retrospectively compared the age at symptom onset in 140 patients diagnosed with parenchymal (pure viable or pure calcified) and subarachnoid NCC who had a confirmatory image available not more than 2 years after the beginning of symptoms. Patients with mixed (parenchymal and subarachnoid) NCC or those with parenchymal cysts at different stages (viable and/or degenerating and/or calcified) were not included. After controlling by sex and residence in rural endemic regions, the mean age at symptom onset in patients with subarachnoid disease was 13.69 years older than those with viable parenchymal disease. A long incubation period is a major contributing factor to older age at presentation in subarachnoid NCC, independent of delayed diagnosis or access to care.

Consistent Measurement of Parasite-Specific Antigen Levels in Sera of Patients with Neurocysticercosis Using Two Different Monoclonal Antibody (mAb)-Based Enzyme-Linked Immunosorbent Assays.

Monoclonal antibody (mAb)-based enzyme-linked immunosorbent assay (ELISA) is a complementary diagnosis technique for neurocysticercosis (NCC), which detects circulating parasite antigen (Ag) indicative of viable infection and Ag levels that correlate well with the parasite burden. In this study, we compared the performance of two Ag-ELISA techniques for the detection of NCC. We assessed the agreement between our in-house TsW8/TsW5 Ag-ELISA and the widely used B158/B60 Ag-ELISA for measuring T. solium antigen levels in the sera from 113 patients with calcified, parenchymal, and subarachnoid NCC. Concordance was demonstrated evaluating the limits of agreement (LoAs) stratified by the type of NCC. Both ELISA's detected 47/48 (97.8%) subarachnoid NCC cases. In parenchymal and calcified NCC, the B158/B60 Ag-ELISA detected 19/24 (79.2%) and 18/41 (43.9%) cases, while the TsW8/TsW5 Ag-ELISA detected 21/24 (87.5%) and 13/41 (31.7%), respectively. Parenchymal and calcified NCC obtained a perfect agreement (100%), indicating that all sample results were within the predicted LoA, while for subarachnoid NCC, the agreement was 89.6%. The high concordance between the assays was confirmed by Lin's concordance coefficient (LCC = 0.97). Patients with viable parenchymal NCC (LCC = 0.95) obtained the highest concordance between assays, followed by subarachnoid NCC (LCC = 0.93) and calcified NCC (LCC = 0.92). The TsW8/TsW5 Ag-ELISA and B158/B60 Ag-ELISA showed high Ag measurement correlations across diverse types of NCC.

Calcified Neurocysticercosis: Demographic, Clinical, and Radiological Characteristics of a Large Hospital-Based Patient Cohort.

Neurocysticercosis (NCC), the infection of the central nervous system caused by Taenia solium larvae (cysticerci), is a major cause of acquired epilepsy worldwide. Calcification in NCC is the most common neuroimaging finding among individuals with epilepsy in T. solium-endemic areas. We describe the demographic, clinical, and radiological profiles of a large hospital cohort of patients with calcified NCC in Peru (during the period 2012-2022) and compared profiles between patients with and without a previous known diagnosis of viable infection. A total of 524 patients were enrolled (mean age at enrollment: 40.2 ± 15.2 years, mean age at symptom onset: 29.1 ± 16.1 years, 56.3% women). Of those, 415 patients (79.2%) had previous seizures (median time with seizures: 5 years, interquartile range (IQR): 2-13 years; median number of seizures: 7 (IQR: 3-32)), of which 333 (80.2%) had predominantly focal to bilateral tonic-clonic seizures; and 358 (68.3%) used antiseizure medication). Patients had a median number of three calcifications (IQR: 1-7), mostly located in the frontal lobes (79%). In 282 patients (53.8%) there was a previous diagnosis of viable infection, while 242 only had evidence of calcified NCC since their initial neuroimaging. Most patients previously diagnosed with viable infection were male, had previous seizures, had seizures for a longer time, had more calcifications, and had a history of taeniasis more frequently than patients without previously diagnosed viable infection (all p < 0.05). Patients with calcified NCC were heterogeneous regarding burden of infection and clinical manifestations, and individuals who were diagnosed after parasites calcified presented with milder disease manifestations.

Improved Diagnosis of Viable Parenchymal Neurocysticercosis by Combining Antibody Banding Patterns on Enzyme-Linked Immunoelectrotransfer Blot (EITB) with Antigen Enzyme-Linked Immunosorbent Assay (ELISA).

The diagnosis of neurocysticercosis (NCC) depends on neuroimaging and serological confirmation. While antibody detection by enzyme-linked immunoelectrotransfer blot (EITB) fails to predict viable NCC, EITB banding patterns provide information about the host's infection course. Adding antigen enzyme-linked immunosorbent assay (Ag-ELISA) results to EITB banding patterns may improve their ability to predict or rule out of viable NCC. We assessed whether combining EITB banding patterns with Ag-ELISA improves discrimination of viable infection in imaging-confirmed parenchymal NCC. EITB banding patterns were grouped into classes using latent class analysis. True-positive and false-negative Ag-ELISA results in each class were compared using Fisher's exact test. Four classes were identified: 1, EITB negative or positive to GP50 alone (GP50 antigen family); 2, positive to GP42-39 and GP24 (T24/42 family), with or without GP50; and 3 and 4, positive to GP50, GP42-39, and GP24 and reacting to bands in the 8-kDa family. Most cases in classes 3 and 4 had viable NCC (82% and 88%, respectively) compared to classes 2 and 1 (53% and 5%, respectively). Adding positive Ag-ELISA results to class 2 predicted all viable NCC cases (22/22 [100%]), whereas 11/40 patients (27.5%) Ag-ELISA negative had viable NCC (P < 0.001). Only 1/4 patients (25%) Ag-ELISA positive in class 1 had viable NCC, whereas 1/36 patients (2.8%) Ag-ELISA negative had viable NCC (P = 0.192). In classes 3 and 4, adding Ag-ELISA was not contributory. Combining Ag-ELISA with EITB banding patterns improves discrimination of viable from nonviable NCC, particularly for class 2 responses. Together, these complement neuroimaging more appropriately for the diagnosis of viable NCC.

Hippocampal Atrophy/Sclerosis Is Associated with Old, Calcified Parenchymal Brain Neurocysticercosis, But Not with More Recent, Viable Infections.

Magnetic resonance images from 197 patients with calcified neurocysticercosis (NCC), 38 with viable NCC and 197 NCC-free healthy rural villagers were evaluated to compare the frequency of hippocampal atrophy/sclerosis (HAS) across these populations. Scheltens' medial temporal atrophy scale was used for hippocampal rating. The median age of the 432 study participants was 46 years (interquartile range, 29-62 years), and 58% were women. Hippocampal atrophy/sclerosis was disclosed in 26.9% patients with calcified NCC, compared with 7.9% in patients with viable NCC and 8.1% in healthy rural villagers. After adjusting for age, gender, and history of epilepsy, hippocampal atrophy/sclerosis was more frequent in patients with calcified NCC than in those with viable cysts (RR, 3.60; 95% CI, 1.18- 0.99; P = 0.025) and healthy rural villagers (RR, 3.43; 95% CI, 1.94-6.06; P < 0.001), suggesting that hippocampal damage develops late in the course of this parasitic disease.

Mortality in Parenchymal and Subarachnoid Neurocysticercosis.

Neurocysticercosis (NCC) is endemic in many parts of the world, carrying significant neurological morbidity that varies according to whether lesions are located inside the cerebral parenchyma or in extraparenchymal spaces. The latter, in particular subarachnoid NCC, is assumed to be more severe, but no controlled studies comparing mortality between types of NCC exist. The aim of this study was to compare all-cause mortality between patients with intraparenchymal NCC and those with subarachnoid NCC. Vital status and sociodemographic characteristics were evaluated in patients with intraparenchymal viable, intraparenchymal calcified, and subarachnoid NCC attending a neurological referral hospital in Lima, Perú. Survival analyses using Kaplan-Meier curves and Cox proportional regression models were carried out to compare mortality rates between groups. From 840 NCC patients followed by a median time of 82.3 months, 42 (5.0%) died, six (1.8%) in the intraparenchymal viable group, four (1.3%) in the calcified group, and 32 (16.6%) in the subarachnoid group (P < 0.001). Older age and lower education were significantly associated with mortality. The age-adjusted hazard ratio for death in the subarachnoid group was 13.6 (95% CI: 5.6-33.0, P < 0.001) compared with the intraparenchymal viable group and 10.7 (95% CI: 3.7-30.8, P < 0.001) when compared with the calcified group. We concluded that subarachnoid disease is associated with a much higher mortality in NCC.

Detection of Taenia solium DNA in the Urine of Neurocysticercosis Patients.

Neurocysticercosis (NCC), caused by Taenia solium larvae that reside in the central nervous system, results in serious public health and medical issues in many regions of the world. Current diagnosis of NCC is complex requiring both serology and costly neuroimaging of parasitic cysts in the brain. This diagnostic pipeline can be problematic in resource-constrained settings. There is an unmet need for a highly sensitive and clinically informative diagnostic test to complement the present diagnostic approaches. Here, we report that T. solium-derived cell-free DNA is readily detectable in the urine of patients with the subarachnoid and parenchymal forms of NCC, and discuss the potential utility of this approach in enhancing and refining T. solium diagnostics.

Low sensitivity and frequent cross-reactions in commercially available antibody detection ELISA assays for Taenia solium cysticercosis.

OBJECTIVE: To evaluate the diagnostic performance of two commercially available ELISA kits, Novalisa® and Ridascreen® , for the detection of antibodies to Taenia solium, compared to serological diagnosis of neurocysticercosis (NCC) by LLGP-EITB (electro-immunotransfer blot assay using lentil-lectin purified glycoprotein antigens). METHODS: Archive serum samples from patients with viable NCC (n = 45) or resolved, calcified NCC (n = 45), as well as sera from patients with other cestode parasites (hymenolepiasis, n = 45 and cystic hydatid disease, n = 45), were evaluated for cysticercosis antibody detection using two ELISA kits, Novalisa® and Ridascreen® . All NCC samples had previously tested positive, and all samples from heterologous infections were negative on LLGP-EITB for cysticercosis. Positive rates were calculated by kit and sample group and compared between the two kits. RESULTS: Compared to LLGP-EITB, the sensitivity of both ELISA assays to detect specific antibodies in patients with viable NCC was low (44.4% and 22.2%), and for calcified NCC, it was only 6.7% and 4.5%. Sera from patients with cystic hydatid disease were highly cross-reactive in both ELISA assays (38/45, 84.4%; and 25/45, 55.6%). Sera from patients with hymenolepiasis cross-reacted in five cases in one of the assays (11.1%) and in only one sample with the second assay (2.2%). CONCLUSIONS: The performance of Novalisa® and Ridascreen® was poor. Antibody ELISA detection cannot be recommended for the diagnosis of neurocysticercosis.

Antibody Banding Patterns of the Enzyme-Linked Immunoelectrotransfer Blot and Brain Imaging Findings in Patients With Neurocysticercosis.

Background: The enzyme-linked immunoelectrotransfer blot (EITB) assay is the reference serological test for neurocysticercosis (NCC). A positive result on EITB does not always correlate with the presence of active infections in the central nervous system (CNS), and patients with a single viable brain cyst may be EITB negative. Nonetheless, EITB antibody banding patterns appears to be related with the expression of 3 protein families of Taenia solium, and in turn with the characteristics of NCC in the CNS (type, stage, and burden of viable cysts). Methods: We evaluated EITB antibody banding patterns and brain imaging findings of 548 NCC cases. Similar banding patterns were grouped into homogeneous classes using latent class analysis. The association between classes and brain imaging findings was assessed. Results: Four classes were identified. Class 1 (patients negative or only positive to the GP50 band, related to the protein family of the same name) was associated with nonviable or single viable parenchymal cysticerci; class 2 (patients positive to bands GP42-39 and GP24, related to the T24-42 protein family, with or without anti-GP50 antibodies) was associated with intraparenchymal viable and nonviable infections; classes 3 and 4 (positive to GP50, GP42-39, and GP24 but also responding to low molecular weight bands GP21, GP18, GP14, and GP13, related to the 8 kDa protein family) were associated with extraparenchymal and intraparenchymal multiple viable cysticerci. Conclusions: EITB antibody banding patterns correlate with brain imaging findings and complement imaging information for the diagnosis of NCC and for staging NCC patients.

Goma sifilítica intracraneal en un paciente adolescente VIH seronegativo: reporte de un caso / Intracranial syphilitic gummain an HIV negative adolescent patient: a case report

La sífilis es una enfermedad sistémica causada por la espiroqueta Treponema pallidum que compromete al sistema nervioso central en cualquier etapa y cuyas presentaciones clínicas se modificaron en las últimas décadas. Se presenta el caso de un varón de 16 años con antecedentes de conducta sexual de riesgo y sífilis hace 3 años, sin recibir tratamiento. Acude por cefalea y disminución de visión hace 4 meses. Evaluación inicial objetiva hemianopsia homónima derecha, edema papilar bilateral y retinopatía exudativa izquierda. Pruebas serológicas de sífilis reactivas, VIH: no reactivo. Resonancia magnética de encéfalo: proceso expansivo en lóbulo occipital izquierdo captador de contraste. Recibió tratamiento para sífilis por 3 días y por sospecha inicial de proceso neoproliferativo se realizó biopsia que evidenció proceso granulomatosocrónico sifilítico. En su reingreso, mostró mayor compromiso de agudeza y defecto del campo visual. Potenciales evocados visuales: ausente en ambos ojos. Se inició Penicilina G sódica por 4 semanas (por evidencia de mejoría imagenológica) asociado a corticoides, encontrando disminución serológica y discreta mejoría clínica al término del tratamiento. La neurosífilis gomatosa esuna presentación infrecuente de la sífilis terciaria debiéndose considerar como diagnóstico diferencial en lesiones expansivas intracraneales en individuos VIHseronegativos con serología de sífilis reactiva.

Syphilis is a systemic disease caused by the spirochete Treponema pallidum which can compromise the central nervous system at any stage and whose clinical presentations have been modified in recent decades. Were port the case of a 16 years old male with a 3-years history of sexual risk behavior and syphilis with no treatment who experienced headache and decreased vision for four months. Initial assessment showed right homonymous hemianopia, bilateral papilledema and left exudative retinopathy. Serological tests for syphilis: reactive HIV: non-reactive. Brain MRI revealed a single irregularly enhancing lesion in the left occipital lobe. He received treatment for syphilis for three days, and stereotactic biopsies were performed by the initial suspicion of brain tumour. Histological examination showed a chronic granulomatous consistent with neurosyphilis. In his read mission, greater affectation of acuity and visual field defect was evident. Visual evoked potentials: absent in both eyes. Penicillin G sodium was initiated for 4weeks (for evidence of improvement imagenological)associated with corticosteroids, showing serological and discrete clinical improvement at the end of treatment decreased. The gummatous neurosyphilisis a rare form of tertiary syphilis which ever considered as differential expansive intracranial lesions in HIV-seronegative individuals with reactive syphilis serology.

Enhanced steroid dosing reduces seizures during antiparasitic treatment for cysticercosis and early after.

OBJECTIVE: Neurocysticercosis (NCC) is a major cause of seizures and epilepsy in endemic countries. Antiparasitic treatment of brain cysts leads to seizures due to the host's inflammatory reaction, requiring concomitant steroids. We hypothesized that increased steroid dosing will reduce treatment-associated seizures. METHODS: Open-label randomized trial comparing 6 mg/day dexamethasone for 10 days (conventional) with 8 mg/day for 28 days followed by a 2-week taper (enhanced) in patients with NCC receiving albendazole. Follow-up included active seizure surveillance and brain imaging. Study outcomes were seizure days and patients with seizures, both measured in days 11-42. Additional analyses compared days 1-10, 11-21, 22-32, 33-42, 43-60, and 61-180. RESULTS: Thirty-two individuals were randomized into each study arm; two did not complete follow-up. From days 11 to 42, 59 partial and 6 generalized seizure days occurred in 20 individuals, nonsignificantly fewer in the enhanced arm (12 vs. 49, p = 0.114). The numbers of patients with seizures in this period showed similar nonsignificant differences. In the enhanced steroid arm there were significantly fewer days and individuals with seizures during antiparasitic treatment (days 1-10: 4 vs. 17, p = 0.004, and 1 vs. 10, p = 0.003, number needed to treat [NNT] 4.6, relative risk [RR] 0.1013, 95% confidence interval [CI] 0.01-0.74) and early after dexamethasone cessation (days 11-21: 6 vs. 27, p = 0.014, and 4 vs. 12, p = 0.021, NNT 4.0, RR 0.33, 95% CI 0.12-0.92) but not after day 21. There were no significant differences in antiparasitic efficacy or relevant adverse events. SIGNIFICANCE: Increased dexamethasone dosing results in fewer seizures for the first 21 days during and early after antiparasitic treatment for viable parenchymal NCC but not during the first 11-42 days, which was the primary predetermined time of analysis.

Pharmacokinetics of combined treatment with praziquantel and albendazole in neurocysticercosis.

AIMS: Neurocysticercosis is the most common cause of acquired epilepsy in the world. Antiparasitic treatment of viable brain cysts is of clinical benefit, but current antiparasitic regimes provide incomplete parasiticidal efficacy. Combined use of two antiparasitic drugs may improve clearance of brain parasites. Albendazole (ABZ) has been used together with praziquantel (PZQ) before for geohelminths, echinococcosis and cysticercosis, but their combined use is not yet formally recommended and only scarce, discrepant data exist on their pharmacokinetics when given together. We assessed the pharmacokinetics of their combined use for the treatment of neurocysticercosis. METHODS: A randomized, double-blind, placebo-controlled phase II evaluation of the pharmacokinetics of ABZ and PZQ in 32 patients with neurocysticercosis was carried out. Patients received their usual concomitant medications including an antiepileptic drug, dexamethasone, and ranitidine. Randomization was stratified by antiepileptic drug (phenytoin or carbamazepine). Subjects had sequential blood samples taken after the first dose of antiparasitic drugs and again after 9 days of treatment, and were followed for 3 months after dosing. RESULTS: Twenty-one men and 11 women, aged 16 to 55 (mean age 28) years were included. Albendazole sulfoxide concentrations were increased in the combination group compared with the ABZ alone group, both in patients taking phenytoin and patients taking carbamazepine. PZQ concentrations were also increased by the end of therapy. There were no significant side effects in this study group. CONCLUSIONS: Combined ABZ + PZQ is associated with increased albendazole sulfoxide plasma concentrations. These increased concentrations could independently contribute to increased cysticidal efficacy by themselves or in addition to a possible synergistic effect.

Diagnóstico y manejo de la neurocisticercosis en el Perú / Neurocysticercosis diagnosis and management in Peru

La neurocisticercosis (NCC) es la parasitosis humana mßs frecuente del sistema nervioso central y es causada por las larvas del céstodo Taenia solium. La NCC es endémica en prßcticamente todos los paises en vías de desarrollo. En general se presenta como formas intraparenquimales asociadas con convulsiones o formas extraparenquimales asociadas con hipertensión endocraneana. La sospecha clínica y epidemiológica es importante pero el diagnóstico se realiza primariamente por imßgenes y se confirma con serología. La tomografía axial computarizada y la resonancia magnética son las pruebas imagenológicas usadas. Como prueba confirmatoria se usa el diagnóstico inmunológico a través de western blot, que actualmente se pude realizar en el Instituto Nacional de Ciencias Neurológicas tanto en suero como en líquido cefalorraquídeo. El tratamiento involucra medidas sintomßticas (control de convulsiones o hipertensión endocraneana según sea el caso) y tratamiento antiparasitario (albendazol o praziquantel). El tratamiento antiparasitario debe hacerse bajo condiciones de hospitalización y en hospitales de tercer nivel.(AU)

Neurocysticercosis (NCC) is the most common parasitic disease of the central nervous system and is caused by larvae of the tapeworn Taenia solium. NCC is endemic in almost all developing countries. It presents as intraparenchymal forms associated with seizures or as extraparenchymal forms associated with intracranial hypertension. The clinical and epidemiological suspicion are important but the diagnosis is made primarily by images and confirmed by serology. Computed tomography (CT) and magnetic resonance imaging tests are used. Inmunodiagnosis by Western Blot, which is currently perform in the Instituto Nacional de Ciencias Neurológicas in serum and cerebrospinal fluid serves as confirmatory test. Treatment involves symptomatic measures (control of seizures or intracranial hypertension) and anticysticercal medications (albendazole and praziquantel). Anticysticercal treatment should be used under hospital conditions because of secondary effects.(AU)

Diagnóstico y manejo de la neurocisticercosis en el Perú / Neurocysticercosis diagnosis and management in Peru

La neurocisticercosis (NCC) es la parasitosis humana más frecuente del sistema nervioso central y es causada por las larvas del céstodo Taenia solium. La NCC es endémica en prácticamente todos los paises en vías de desarrollo. En general se presenta como formas intraparenquimales asociadas con convulsiones o formas extraparenquimales asociadas con hipertensión endocraneana. La sospecha clínica y epidemiológica es importante pero el diagnóstico se realiza primariamente por imágenes y se confirma con serología. La tomografía axial computarizada y la resonancia magnética son las pruebas imagenológicas usadas. Como prueba confirmatoria se usa el diagnóstico inmunológico a través de western blot, que actualmente se pude realizar en el Instituto Nacional de Ciencias Neurológicas tanto en suero como en líquido cefalorraquídeo. El tratamiento involucra medidas sintomáticas (control de convulsiones o hipertensión endocraneana según sea el caso) y tratamiento antiparasitario (albendazol o praziquantel). El tratamiento antiparasitario debe hacerse bajo condiciones de hospitalización y en hospitales de tercer nivel.

Neurocysticercosis (NCC) is the most common parasitic disease of the central nervous system and is caused by larvae of the tapeworn Taenia solium. NCC is endemic in almost all developing countries. It presents as intraparenchymal forms associated with seizures or as extraparenchymal forms associated with intracranial hypertension. The clinical and epidemiological suspicion are important but the diagnosis is made primarily by images and confirmed by serology. Computed tomography (CT) and magnetic resonance imaging tests are used. Inmunodiagnosis by Western Blot, which is currently perform in the Instituto Nacional de Ciencias Neurológicas in serum and cerebrospinal fluid serves as confirmatory test. Treatment involves symptomatic measures (control of seizures or intracranial hypertension) and anticysticercal medications (albendazole and praziquantel). Anticysticercal treatment should be used under hospital conditions because of secondary effects.

[Neurocysticercosis diagnosis and management in Peru]. / Diagnóstico y manejo de la neurocisticercosis en el Perú.

Neurocysticercosis (NCC) is the most common parasitic disease of the central nervous system and is caused by larvae of the tapeworm Taenia solium. NCC is endemic in almost all developing countries. It presents as intraparenchymal forms associated with seizures or as extraparenchymal forms associated with intracranial hypertension. The clinical and epidemiological suspicion are important but the diagnosis is made primarily by images and confirmed by serology. Computed tomography (CT) and magnetic resonance imaging tests are used. Immunodiagnosis by Western Blot, which is currently perform in the Instituto Nacional de Ciencias Neurológicas in serum and cerebrospinal fluid serves as confirmatory test. Treatment involves symptomatic measures (control of seizures or intracranial hypertension) and anticysticercal medications (albendazole and praziquantel). Anticysticercal treatment should be used under hospital conditions because of secondary effects.