Treatment of neurocysticercosis with praziquantel in Colombia

Abstract

 

38 cases of neurocysticercosis were studied and treated with praziquantel, of which 3 had subcutaneous cysticerci.

The diagnosis was made with specialized techniques including scanography (CT) and hemagglutination test (HG).

4 main syndromes are described: epilepsy (E) in 17 cases, intracranial hypertension (ICH) in 8 cases, combination of the 2 syndromes in 8 and headache in 3 cases; Epilepsy, headache and vertigo occurred in 2 cases.

16 cases were operated on and a cysticercus was removed in 11; In 4, referrals were made for hydrocephalus and in 1 the surgery was aimed at a calcification that was found.

Only 22 patients were treated with praziquantel. Of 36 who had subsequent control, the following evolution was observed: in 8 with ICH, 7 cured (87%) and 1 improved; in 16 with epilepsy, 11 asymptomatic (69%), 4 improved and 1 without changes; in 8 with ICH and E, 5 asymptomatic (62.5%), 2 deaths and 1 improved; in 2 with headache, one asymptomatic and the other improved; In 2 with epilepsy, headache and vertigo, there were no changes in their clinical picture.

Scanography showed more than one phase of involution of the cysticercus in 17 cases. In 15 cases in which there is CT control after treatment of phases I-II-III, the images disappeared in 9 (60%); in 4 (27%), they basically remained unchanged; In 2 (13%), new lesions apparently appeared.


In the case in phase III, uptake disappeared. There was no modification in the pre-existing calcifications. HG was positive in 66% of cases. Side effects were observed in 12 patients, in 5 of which they were of some importance, which were controlled by increasing the dose of steroids and with mannitol.


It is concluded that praziquantel is effective in neurocysticercosis, a disease that previously had no specific medical treatment. In this group, mortality was reduced from 50% to 5.3%, in cases treated at the same institution.