Severe forms of neurocysticercosis: treatment with albendazole

Agapejev, Svetlana; Silva, Maria Dorvalina da; Ueda, Anete K.

doi:10.1590/S0004-282X1996000100014

Abstracts

Study of 22 patients with the severe form of neurocysticercosis treated with albendazole (ABZ) administered in 6 different schedules ranging from 15 to 30 mg/kg/day for 21 to 60 days. Dextrochloropheniramine and ketoprofen were the adjuvant drugs. Multiple symptoms were observed in 90.9% of patients. Intracranial hypertension was manifested in 90.9%. Hydrocephaly occurred in 86.4%. Evolution was satisfactory in 10 patients, 8 died and 4 had sequelae. Tomographic studies showed the appearance of an isolated IVth ventricle in 9 patients, after ventriculoperitoneal shunt, before ABZ treatment in 3 of them, during in 5 and after treatment in one. Median clinical follow-up duration was 10 months for the patients who died and 3-4 years for survivors. In 3 patients there was an increase in cyst size during the administration of the 15 mg/kg/day ABZ dose, which was not observed in any patient when the 30 mg/kg/day dose was used.

cysticercosis; neurocysticercosis; severe forms; treatment; albendazole; dextrochloropheniramine; ketoprofen

Estudo de 22 doentes, com a forma grave de neurocisticercose, tratados com albendazol (ABZ), administrado em 6 diferentes esquemas, que variaram de 15 a 30 mg/kg/dia, durante 21 a 60 dias. A dextroclorofeniramina e o cetoprofeno foram as drogas coadjuvantes. Múltiplos sintomas ocorreram em 20 doentes. Hipertensão intracraniana foi manifestação mais comum em 20. Hidrocefalia foi detectada em 19. A evolução foi satisfatória em 45,4%, faleceram 36,4% e 18,2% ficaram com sequelas. Na evolução tomográfica apareceu IVº ventrículo isolado em 40,9%, após derivação ventriculoperitoneal, em 3 deles antes do tratamento com ABZ, em 5 durante e, em um, após o tratamento. A mediana estatística do período de seguimento clínico foi 10 meses para aqueles que faleceram e 3-4 anos para os sobreviventes. Em 3 doentes houve aumento no tamanho dos cistos durante a dose de 15 mg/kg/dia de ABZ, não observado na vigência de 30 mg/kg/dia.

cisticercose; neurocisticercose; formas graves; tratamento; albendazol; dextroclorofeniramina; cetoprofeno

Svetlana Agapejev^I; Maria Dorvalina da Silva^II; Anete K. Ueda^III

^IDivision of Neurology, Department of Neurology and Psychiatry and Department of Pathology, Botucatu School of Medicine, State University of São Paulo (UNESP): M.D., Ph.D., Assistent Professor(Neurology)

^IIDivision of Neurology, Department of Neurology and Psychiatry and Department of Pathology, Botucatu School of Medicine, State University of São Paulo (UNESP): M.D., Assistent Physician (Neurology)

^IIIDivision of Neurology, Department of Neurology and Psychiatry and Department of Pathology, Botucatu School of Medicine, State University of São Paulo (UNESP): M.D., Ph.D., Assistent Professor (Pathology)

ABSTRACT

Study of 22 patients with the severe form of neurocysticercosis treated with albendazole (ABZ) administered in 6 different schedules ranging from 15 to 30 mg/kg/day for 21 to 60 days. Dextrochloropheniramine and ketoprofen were the adjuvant drugs. Multiple symptoms were observed in 90.9% of patients. Intracranial hypertension was manifested in 90.9%. Hydrocephaly occurred in 86.4%. Evolution was satisfactory in 10 patients, 8 died and 4 had sequelae. Tomographic studies showed the appearance of an isolated IV^th ventricle in 9 patients, after ventriculoperitoneal shunt, before ABZ treatment in 3 of them, during in 5 and after treatment in one. Median clinical follow-up duration was 10 months for the patients who died and 3-4 years for survivors. In 3 patients there was an increase in cyst size during the administration of the 15 mg/kg/day ABZ dose, which was not observed in any patient when the 30 mg/kg/day dose was used.

Key words: cysticercosis, neurocysticercosis, severe forms, treatment, albendazole, dextrochloropheniramine, ketoprofen.

RESUMO

Estudo de 22 doentes, com a forma grave de neurocisticercose, tratados com albendazol (ABZ), administrado em 6 diferentes esquemas, que variaram de 15 a 30 mg/kg/dia, durante 21 a 60 dias. A dextroclorofeniramina e o cetoprofeno foram as drogas coadjuvantes. Múltiplos sintomas ocorreram em 20 doentes. Hipertensão intracraniana foi manifestação mais comum em 20. Hidrocefalia foi detectada em 19. A evolução foi satisfatória em 45,4%, faleceram 36,4% e 18,2% ficaram com sequelas. Na evolução tomográfica apareceu IVº ventrículo isolado em 40,9%, após derivação ventriculoperitoneal, em 3 deles antes do tratamento com ABZ, em 5 durante e, em um, após o tratamento. A mediana estatística do período de seguimento clínico foi 10 meses para aqueles que faleceram e 3-4 anos para os sobreviventes. Em 3 doentes houve aumento no tamanho dos cistos durante a dose de 15 mg/kg/dia de ABZ, não observado na vigência de 30 mg/kg/dia.

Palavras-chave: cisticercose, neurocisticercose, formas graves, tratamento, albendazol, dextroclorofeniramina, cetoprofeno.

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Acknowledgments - The authors are grateful to the Discipline of Tropical Diseases, specially in the person of Professor Domingos Alves Meira, M.D., for their collaboration and encouragement that permitted the start and the maintenance of the study on treatment of neurocysticercosis. They are also grateful to Mrs. Elettra Greene for revising the English text.

Aceite: 17-setembro-1995.

Svetlana Agapejev, M.D., Ph. D. - Department of Neurology and Psychiatry - School of Medicine. UNESP -P.O. Box 540 - 18618-000 Botucatu SP - Brasil.

1. Agapejev S, Meira DA, Barraviera B, Machado JM, Pereira PCM, Kamegasawa A, Ueda AK. Neurocysticercosis: treatment with albendazole and dextrochloropheniramine. Trans R Soc Trop Med Hyg 1989; 83:377-383.
2. Agapejev S. Incidence of neurocysticercosis at the University Hospital, Faculty of Medicine of Botucatu, State University of São Paulo (Abstract). Thesis, Ribeirão Preto, 1994. Arq Neuropsiquiatr 1995; 53: 170-171.
3. Andrade AS F°, Galdino GS, Mattos GR, Moreno OA, Ancilon M, Rollemberg JC Fş. Albendazol em neurocisticercose: relato de 5 casos. Rev Bras Neurol 1991; 27:115-120.
4. Araújo LP, Silva MN. Formas císticas da neurocisticercose: considerações sobre o tratamento cirúrgico. Arq Bras Neurocirurg 1994, 13:173-180.
5. Camargo-Lima JG. Cisticercose encefálica: aspectos clínicos. Thesis, Escola Paulista de Medicina São Paulo, 1966.
6. Colli BO, Martelli N, Assirati JA Jr, Machado HR, Salvarini CP, Sassoli VP, Forjaz SV. Cysticercosis of the central nervous system: I.Surgical treatment of cerebral cysticercosis - a 23 years experience in the Hospital das Clínicas of Ribeirão Preto Medical School. Arq Neuropsiquiatr 1994; 52:166-186.
7. Correa D, Dalma D, Espinoza B, Plancarte A, Rabiela MT, Madrazo I, Gorodezky C, Flisser A. Heterogeneity of humoral immune components in human cysticercosis. J Parasitol 1985; 71: 535-541.
8. Cruz M, Cruz I, Horton J. Albendazole versus praziquantel in the treatment of cerebral cysticercosis : clinical evaluation. Trans R Soc Trop Med Hyg 1991; 85:244-247.
9. Davis LE, Kornfeld M. Neurocysticercosis: neurologic, pathogenic, diagnosis and therapeutic aspects. Eur Neurol 1991; 31:229-240.
10. Del Brutto OH, Sotelo J. Neurocysticercosis:an update. Rev Infect Dis 1988; 10:1075-1087.
11. Del Brutto OH, Sotelo J. Albendazole therapy for subarachnoid and ventricular cysticercosis. J Neurosurg 1990; 72:816-817.
12. Del Brutto OH, Sotelo J, Aguirre R, Díaz-Calderón E, Alarcón JA . Albendazole therapy for giant subarachnoid cysticerci. Arch Neurol 1992; 49:535-538.
13. Escobedo F, Penagos P, Rodriguez J, Sotelo J. Eficácia de albendazol en el tratamiento médico de la cisticercosis cerebral: estúdio controlado tomográficamente. Invest Méd Internat 1988, 15(Supl): 23-26.
14. Estanol B, Corona T, Abad P. A prognostic classification of cerebral cysticercosis : therapeutic implications. J Neurol Neurosurg Psychiatry 1986; 49:1131-1134.
15. Flisser A, Perez-Monfort R, Larralde C. The immunology of human and animal cysticercosis : a review. Bull WHO 1979; 57:839-856.
16. Gilman AG, Goodman LS, Rail RW, Murad F. The pharmacological basis of therapeutics.Ed 7. New York: Macmillan 1980: 627-629.
17. Jung H, Hurtado M, Sanchez M, Medina MT, Sotelo J. Plasma and CSF levels of albendazole and praziquantel in patients with neurocysticercosis. Cl Neuropharmacol 1990; 13:559-564.
18. Livramento JA, Machado LR, Spina-França A. Immunology of neurocysticercosis. In Fejerman N, Chamoles NA (eds). New trends in pediatrics neurology. Amsterdam: Elsevier, 1993; 307-312.
19. Lobato R, Lamas E, Portillo JM, Roger R, Esparza J, Rivas JJ, Muñoz MJ. Hydrocephalus in cerebral cysticercosis: pathogenic and therapeutic considerations. J Neurosurg 1981; 55:786-793.
20. Malagón F. Elementos del binomio taeniasis/cisticercosis: una sintesis. In Flisser A, Malagón F (eds). Cisticercosis humana y porcina: su conocimiento e investigación en México. Ciudad de México: Li musa, 1989: 3-6.
21. Moreira EL. Neurocisticercose. Clínica, patologia e tratamento da forma ventricular bloqueante. Thesis,. Faculdade de Medicina de Ribeirão Preto. Ribeirão Preto, 1984.
22. Miller O. Curso de corticoterapia. J Bras Med 1978. (ed esp): 7-11.
23. Netter P, Lapique F, Bannwarth B, Tamisier JN, Thomas P, Royer RJ. Diffusion of intramuscular ketoprofen into the cerebrospinal fluid. Eur J Clin Pharmacol 1985; 29:319-321.
24. Salazar A, Sotelo J, Martinez H, Escobedo F. Differential diagnosis between ventriculitis and fourth ventricle cyst in neurocysticercosis. J Neurosurg 1983; 59:660-663.
25. Sotelo J, Marin C. Hydrocephalus secondary to cysticercotic arachnoiditis, a long-term follow-up review. J Neurosurg 1987; 66:686-689.
26. Sotelo J, Escobedo F, Penagos P. Albendazole vs praziquantel for therapy for neurocysticercosis: a controlled trial. Arch Neurol 1988: 45:532-534.
27. Sotelo J, Del Brutto OH, Penagos P, Torres B, Rodriguez-Carbajal J, Rubio-Donnadieu F. Comparison of therapeutic regimen of anti-cysternal drugs for parenchymal brain cysticercosis. J Neurol 1990; 237:69-72.
28. Spina-França A. Síndrome liquórica da neurocisticercose. Arq Neuropsiquiatr 1961; 19:307-314.
29. Spina França A. Cysticercosis of the central nervous system. In Chopra JS et al (eds). Advances in neurology. Amsterdam Elsevier, 1990: 283-291.
30. Stepien L, Choróbski J. Cysticercosis cerebri and its operative treatment. Arch Neurol Psychiat 1949; 61:499-527.
31. Takayanagui OM, Jardim E. Therapy for neurocysticercosis. Comparison between albendazole and praziquantel. Arch Neurol 1992; 49:290-294.
32. Torrealba G, Del Villar S, Tagle P, Arriagada P, Kase CS. Cysticercosis of the central nervous system: clinical and therapeutic considerations. J Neurol Neurosurg Psychiatry 1984; 47:784-790.
33. Vasconcelos D, Cruz-Segura H, Mateos-Gomez H, Zenteno-Alanis G. Selective indications for the use of praziquantel in the treatment of brain cysticercosis. J Neurol Neurosurg Psychiatry 1987; 50:383-388.
34. Vazquez V, Sotelo J. The course of seizures after treatment for cerebral cysticercosis. N Engl J Med 1992; 327: 696-701.

Severe forms of neurocysticercosis: treatment with albendazole

Formas graves da neurocisticercose: tratamento com albendazol

Publication Dates

Publication in this collection
07 Dec 2010
Date of issue
Mar 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Agapejev S, Meira DA, Barraviera B, Machado JM, Pereira PCM, Kamegasawa A, Ueda AK. Neurocysticercosis: treatment with albendazole and dextrochloropheniramine. Trans R Soc Trop Med Hyg 1989; 83:377-383.

[2] 2. Agapejev S. Incidence of neurocysticercosis at the University Hospital, Faculty of Medicine of Botucatu, State University of São Paulo (Abstract). Thesis, Ribeirão Preto, 1994. Arq Neuropsiquiatr 1995; 53: 170-171.

[3] 3. Andrade AS F°, Galdino GS, Mattos GR, Moreno OA, Ancilon M, Rollemberg JC Fş. Albendazol em neurocisticercose: relato de 5 casos. Rev Bras Neurol 1991; 27:115-120.

[4] 4. Araújo LP, Silva MN. Formas císticas da neurocisticercose: considerações sobre o tratamento cirúrgico. Arq Bras Neurocirurg 1994, 13:173-180.

[5] 5. Camargo-Lima JG. Cisticercose encefálica: aspectos clínicos. Thesis, Escola Paulista de Medicina São Paulo, 1966.

[6] 6. Colli BO, Martelli N, Assirati JA Jr, Machado HR, Salvarini CP, Sassoli VP, Forjaz SV. Cysticercosis of the central nervous system: I.Surgical treatment of cerebral cysticercosis - a 23 years experience in the Hospital das Clínicas of Ribeirão Preto Medical School. Arq Neuropsiquiatr 1994; 52:166-186.

[7] 7. Correa D, Dalma D, Espinoza B, Plancarte A, Rabiela MT, Madrazo I, Gorodezky C, Flisser A. Heterogeneity of humoral immune components in human cysticercosis. J Parasitol 1985; 71: 535-541.

[8] 8. Cruz M, Cruz I, Horton J. Albendazole versus praziquantel in the treatment of cerebral cysticercosis : clinical evaluation. Trans R Soc Trop Med Hyg 1991; 85:244-247.

[9] 9. Davis LE, Kornfeld M. Neurocysticercosis: neurologic, pathogenic, diagnosis and therapeutic aspects. Eur Neurol 1991; 31:229-240.

[10] 10. Del Brutto OH, Sotelo J. Neurocysticercosis:an update. Rev Infect Dis 1988; 10:1075-1087.

[11] 11. Del Brutto OH, Sotelo J. Albendazole therapy for subarachnoid and ventricular cysticercosis. J Neurosurg 1990; 72:816-817.

[12] 12. Del Brutto OH, Sotelo J, Aguirre R, Díaz-Calderón E, Alarcón JA . Albendazole therapy for giant subarachnoid cysticerci. Arch Neurol 1992; 49:535-538.

[13] 13. Escobedo F, Penagos P, Rodriguez J, Sotelo J. Eficácia de albendazol en el tratamiento médico de la cisticercosis cerebral: estúdio controlado tomográficamente. Invest Méd Internat 1988, 15(Supl): 23-26.

[14] 14. Estanol B, Corona T, Abad P. A prognostic classification of cerebral cysticercosis : therapeutic implications. J Neurol Neurosurg Psychiatry 1986; 49:1131-1134.

[15] 15. Flisser A, Perez-Monfort R, Larralde C. The immunology of human and animal cysticercosis : a review. Bull WHO 1979; 57:839-856.

[16] 16. Gilman AG, Goodman LS, Rail RW, Murad F. The pharmacological basis of therapeutics.Ed 7. New York: Macmillan 1980: 627-629.

[17] 17. Jung H, Hurtado M, Sanchez M, Medina MT, Sotelo J. Plasma and CSF levels of albendazole and praziquantel in patients with neurocysticercosis. Cl Neuropharmacol 1990; 13:559-564.

[18] 18. Livramento JA, Machado LR, Spina-França A. Immunology of neurocysticercosis. In Fejerman N, Chamoles NA (eds). New trends in pediatrics neurology. Amsterdam: Elsevier, 1993; 307-312.

[19] 19. Lobato R, Lamas E, Portillo JM, Roger R, Esparza J, Rivas JJ, Muñoz MJ. Hydrocephalus in cerebral cysticercosis: pathogenic and therapeutic considerations. J Neurosurg 1981; 55:786-793.

[20] 20. Malagón F. Elementos del binomio taeniasis/cisticercosis: una sintesis. In Flisser A, Malagón F (eds). Cisticercosis humana y porcina: su conocimiento e investigación en México. Ciudad de México: Li musa, 1989: 3-6.

[21] 21. Moreira EL. Neurocisticercose. Clínica, patologia e tratamento da forma ventricular bloqueante. Thesis,. Faculdade de Medicina de Ribeirão Preto. Ribeirão Preto, 1984.

[22] 22. Miller O. Curso de corticoterapia. J Bras Med 1978. (ed esp): 7-11.

[23] 23. Netter P, Lapique F, Bannwarth B, Tamisier JN, Thomas P, Royer RJ. Diffusion of intramuscular ketoprofen into the cerebrospinal fluid. Eur J Clin Pharmacol 1985; 29:319-321.

[24] 24. Salazar A, Sotelo J, Martinez H, Escobedo F. Differential diagnosis between ventriculitis and fourth ventricle cyst in neurocysticercosis. J Neurosurg 1983; 59:660-663.

[25] 25. Sotelo J, Marin C. Hydrocephalus secondary to cysticercotic arachnoiditis, a long-term follow-up review. J Neurosurg 1987; 66:686-689.

[26] 26. Sotelo J, Escobedo F, Penagos P. Albendazole vs praziquantel for therapy for neurocysticercosis: a controlled trial. Arch Neurol 1988: 45:532-534.

[27] 27. Sotelo J, Del Brutto OH, Penagos P, Torres B, Rodriguez-Carbajal J, Rubio-Donnadieu F. Comparison of therapeutic regimen of anti-cysternal drugs for parenchymal brain cysticercosis. J Neurol 1990; 237:69-72.

[28] 28. Spina-França A. Síndrome liquórica da neurocisticercose. Arq Neuropsiquiatr 1961; 19:307-314.

[29] 29. Spina França A. Cysticercosis of the central nervous system. In Chopra JS et al (eds). Advances in neurology. Amsterdam Elsevier, 1990: 283-291.

[30] 30. Stepien L, Choróbski J. Cysticercosis cerebri and its operative treatment. Arch Neurol Psychiat 1949; 61:499-527.

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

[32] 32. Torrealba G, Del Villar S, Tagle P, Arriagada P, Kase CS. Cysticercosis of the central nervous system: clinical and therapeutic considerations. J Neurol Neurosurg Psychiatry 1984; 47:784-790.

[33] 33. Vasconcelos D, Cruz-Segura H, Mateos-Gomez H, Zenteno-Alanis G. Selective indications for the use of praziquantel in the treatment of brain cysticercosis. J Neurol Neurosurg Psychiatry 1987; 50:383-388.

[34] 34. Vazquez V, Sotelo J. The course of seizures after treatment for cerebral cysticercosis. N Engl J Med 1992; 327: 696-701.