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  In this Article
 »  Abstract
 »  Introduction
 »  Material and methods
 »  Results
 »  Discussion
 »  Conclusion
 »  References

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Year : 2001  |  Volume : 49  |  Issue : 1  |  Page : 95-7

Albendazole therapy for solitary persistent cysticercus granuloma.


Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India.

Correspondence Address:
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India.

  »  Abstract

Use of Albendazole therapy for the treatment of patients having persisting intracranial solitary cysticercus granuloma is controversial. Most of the times these patients are treated empirically with variety of drugs for variable period. Some authors advocate biopsy before definitive treatment. 25 patients having radiologicaly persistent solitary cysticercus granuloma (>6 months) were given 15 days course of oral albendazole (15 mg/kg body wt). Cranial CT scan was repeated one month after the completion of albendazole therapy. It was evaluated for complete resolution, partial response (> 50% decrease in size of lesion) or no change as compared to previous scan. 12 patients (48%) showed complete resolution, 4 patients (16%) showed a partial response, while 9 patients (36%) did not show any change on follow up. Albendazole therapy may be useful for patients having persistent cysticercus granuloma.

How to cite this article:
Thussu A, Arora A, Lal V, Prabhakar S, Sawhney I M. Albendazole therapy for solitary persistent cysticercus granuloma. Neurol India 2001;49:95


How to cite this URL:
Thussu A, Arora A, Lal V, Prabhakar S, Sawhney I M. Albendazole therapy for solitary persistent cysticercus granuloma. Neurol India [serial online] 2001 [cited 2023 Feb 5];49:95. Available from: https://www.neurologyindia.com/text.asp?2001/49/1/95/1289




   »   Introduction Top

Solitary cysticercus granuloma is a common cause of
epilepsy in india [Figure 1a].[1],[2],[3] Use of albendazole in
these lesions is controversial.[4],[5] We studied effect of
albendazole on 25 patients having solitary cysticercus
granuloma for more than 6 months.

   »   Material and methods Top

25 patients having solitary cysticercus granuloma
were enlisted for the study. All patients satisfied the
criteria for diagnosis of solitary cysticercus granuloma
laid down recently.[6] At entry, all patients had
radiological proof of persistence of lesion for a
minimum period of 6 months. After clinical evaluation
all patients were subjected to a battery of tests
including mantoux test, cysticercus serology and chest
x-ray. All patients were subjected to a cranial CT scan
at entry into study and one month after completing the
course of albendazole. After initial CT scan, all
patients were given oral albendazole (15 mg/kg body
weight) for a period of 15 days. Post albendazole CT
scan was evaluated for total resolution or significant
reduction in the size of lesion. A decrease in size of
more then 50% was taken as significant [Figure 1b]. Any
decrease in size of lesion of less then 50% or a
decrease in oedema without any change in the size of
the lesion was taken as non significant; and such cases
were included in the category of no change in size of
lesion. During the trial, patients continued to be on
antiepileptics and none of the patients required steroid
administration. Results were compared using chisquare
test wherever applicable. A 'p' value of <0.05
was considered significant. Study was approved by
institutional ethics committee.

   »   Results Top

The study group comprised of 25 patients, 11 male
and 14 females. Mean age of the patients was
22.42+1.29 years with a range of 8-51 years.
Granuloma was persisting for a mean of 8.8+6.31
months with a range of 6-36 months. While 4 (16%)
patients presented with partial seizures, 5(20%) had
generalised seizures. However, majority 16(64%)
presented with partial seizures with secondary
generalisation. Cysticercus serology done by indirect
haemagglutination method was positive in 6 (24%)
and negative in 19 (76%) patients. Chest X-rays were
normal in all the patients. Mantoux test was positive in
4(16%) and negative in 21(84%) of the patients.
Evaluation of post albendazole scans revealed a total
resolution in 12(84%) cases, while 4 patients (16%)
showed a significant reduction on follow up
neuroimaging [Figure 1a]. 9 patients (36%) did not show
any change is compared to the previous scan.

   »   Discussion Top

Management of solitary cysticercus granuloma has
remained controversial since the time of recognition
of this entity. Majority of the lesions are known to
disappear spontaneously.[4],[7] However, there is a
subgroup of patients where the lesion may persist for
months to years. Modalities available for management
of these patients are few with no precise guidelines.
Some authors recommend stereotactic/open biopsy to
pin point the pathological nature of the lesion. This
approach heralds a significant morbidity as compared
to albendazole therapy, which is safe and of short
duration.
Use of albendazole in patients with single small
enhancing CT lesion (SSECTL) has remained
controversial. Now a days this lesion is thought to be
the presentation of solitary cysticercus granuloma.[6]
Rawlings et al were first to use this therapy and
showed good result in two patients.8 Rajshekhar used
it in 11 patients and reported a resolution in 4
patients.[5] Our study is comparable to the study done
by Rajshekhar except for the inclusion criteria of
minimum persistence of lesion, which was 3 months
in his study and 6 months in our study. Study done by
Padma et al[4] is not comparable because in that study
albendazole was given to all the patients at the time of
presentation, while in the present study the drug was
given to patients having a radiological evidence of
persistence of lesion for at least 6 months. In the
present study, 64% patients showed a response to
albendazole, 48% showed a complete resolution while
16% showed a partial response. The results of therapy
are better in the present study in comparison to
Rajshekhar's report where 36% (4 out of 11) showed
a response. The average duration of lesion was 7.7
months responders, in comparison to non - responders
who had a mean period of persistence of lesion of 11.1
months in the present study. But this difference was
not statistically significant (p= 0.3). The therapy was
uneventful in most of the cases.

   »   Conclusion Top

Albendazole therapy is likely to be useful for solitary
cysticercus granuloma persisting for more then 6
months. As the therapy is safe and of short duration, it
is worth trying before undertaking longer treatments
like antituberculous therapy or subjecting patients to
hazardous procedures like open or stereotactic brain
biopsy.
This study however, is a small uncontrolled study A
larger study with a good control group, may be able to
provide the final answer.
 

  »   References Top

1.Wadia RS, Makhale CM, Kelkar AM et al : Focal epilepsy in India with special reference to lesion showing ring or disc like enhancement as contrast computed tomography. J Neurol Neurosurg Psychiatry 1987; 50 : 1298 - 1301.  Back to cited text no. 1    
2.Rajshekhar V : Etiology and management of single small lesions in patients with seizure : understanding a controversy. Acta Neurol Scand 1991; 84 : 465-470.  Back to cited text no. 2    
3.Chandy MJ, Rajshekhar V, Ghosh S et al : Single small enhancing CT lesion in Indian patients with epilepsy : some considerations. J Neurol Neurosurg Psychiatry 1991; 54 :702-705.  Back to cited text no. 3    
4.Padma MV, Behari M, Misra MK et al : Albendazole in single CT ring lesions in epilepsy. Neurology 1994; 44 : 1344-1346.  Back to cited text no. 4    
5.Rajshekhar V : Albendazole therapy for persistent, solitary, cysticercus granulomas in patients with seizures. Neurology 1993; 43 : 1238-1240.  Back to cited text no. 5    
6.Rajshekhar V, Chandy MJ : Validation of diagnostic criteria for solitary cysticercus granuloma in patients presenting with seizures. Acta Neurol Scand 1997; 96 : 76 -81.  Back to cited text no. 6    
7.Kramer LD, Loche GE, Byrd SE Daryabagi J : Cerebral cysticercosis documentation of natural history with CT. Radiology 1989; 171 : 459-462.  Back to cited text no. 7    
8.Rawlings D, Ferriero DM, Messing RO : Early CT reevaluation after empiric praziquantel therapy in neurocysticercosis. Neurology 1989; 39 : 739-741.  Back to cited text no. 8    

 

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