Quantitative assessment of lesion load and efficacy of 3 cycles of albendazole in disseminated cysticercosis: a prospective evaluation

• Main Authors: Sudhakar Pandey, Hardeep Singh Malhotra, Ravindra Kumar Garg, Kiran Preet Malhotra, Neeraj Kumar, Imran Rizvi, Amita Jain, Neera Kohli, Rajesh Verma, Praveen Sharma, Ravi Uniyal, Shweta Pandey
• Format: Article
• Language: English
• Published: BMC 2020-03-01
• Series: BMC Infectious Diseases
• Subjects: Disseminated cysticercosis; Neurocysticercosis; Albendazole; Corticosteroids; Lesion load
• Online Access: http://link.springer.com/article/10.1186/s12879-020-4891-5

Abstract Background The management of disseminated cysticercosis is unclear and largely considered hazardous. The role of albendazole remains controversial in such patients. Methods A tertiary care, University hospital-based prospective intervention study was conducted from December 2015 to December 2017. Patients with disseminated cysticercosis, defined as the presence of multiple viable neurocysticerci (≥ 3) in the brain along with involvement of an additional extra site, were included in the study. Patients with cysticercal encephalitis were excluded. A detailed evaluation, including ophthalmoscopy, ocular B scans, ultrasound abdomen, and X-rays were done. Albendazole was administered at a dose of 15 mg/kg/day in 3 cycles of 28 days each. All patients were also given adjuvant corticosteroids and anti-epileptic drugs. Clinical and radiological follow up was carried out at a difference of 3 months between each treatment cycle. For radiological quantification, lesions were counted at 10 pre-specified levels. Statistical analysis was done to estimate the difference in seizure frequency and lesion load. Results Twenty-nine patients (21 with > 20 lesions; 8 with ≤ 20 lesions) were given albendazole as per the protocol. There was a significant reduction in the occurrence of seizures (P < 0.001) and headache (P < 0.001). A significant reduction in lesion load from baseline to third follow-up was seen in the estimations done at different levels (P < 0.001). No patient developed serious side-effect warranting cessation of therapy. Conclusion Cyclical use of albendazole appears efficacious in treating disseminated cysticercosis. The method of quantification described may be used in future studies for objective assessment. Trial registration ISRCTN11630542 ; 28th September 2019; Retrospectively registered.