Correspondence

The Use of Albendazole in Patients with Single Lesions Enhanced on Contrast CT

N Engl J Med 1993; 328:356-357February 4, 1993

Article

To the Editor:

Single lesions that are enhanced during computed tomography (CT) with a contrast agent are frequently found in patients with partial seizures. Reports from the Indian subcontinent suggested that these lesions were tuberculomas1; however, recent studies have shown that cysticercosis is the most common cause of such lesions2. On the basis of these results, patients with partial seizures and single lesions enhanced on contrast CT usually receive symptomatic treatment and are reevaluated with CT after 8 to 12 weeks3. Further investigation is indicated only if the lesion has not disappeared by that time. Nevertheless, since the lesions of some patients are caused by factors other than cysticercosis, such delay may allow the progression of disease that requires immediate treatment. Routine early administration of albendazole to patients with single lesions enhanced on contrast CT may permit early detection of lesions requiring intensive investigation, by hastening the resolution of those caused by cysticercosis. We describe here the use of albendazole in such patients.

Twenty consecutive patients with partial seizures and single lesions enhanced on contrast CT received albendazole in a dose of 15 mg per kilogram of body weight per day for eight days, and were reevaluated with CT two weeks after the end of the trial. Those whose lesions disappeared were not evaluated further, those with partial resolution were followed with CT until the lesions disappeared, and those whose lesions did not change underwent intensive diagnostic investigation.

Two weeks after the end of the trial, CT showed complete resolution of lesions in 11 patients, partial resolution in 5 patients, and no change in 4 patients. The partially resolved lesions disappeared after four to six weeks in every case. Cysticercosis was the most likely cause of the single enhancing lesions in these 16 patients. In contrast, two of the four patients whose lesions did not change had astrocytomas, another had a tuberculoma, and the fourth refused further investigation.

Routine administration of albendazole is a safe and useful procedure for evaluating patients with partial seizures and single lesions enhanced on contrast CT. Our results confirm the preliminary findings of Rawlings et al.,4 who gave empirical anticysticercal therapy to patients with similar lesions. Albendazole causes cysticerci-related enhancing lesions to disappear long before the often mentioned delay of 8 to 12 weeks before reevaluation. Our approach permits early detection of lesions that require aggressive diagnosis, and avoids the hazards of prolonged delay.

Oscar H. Del Brutto, M.D.
Hospital Luis Vernaza, Guayaquil, Ecuador

4 References

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Citing Articles (15)

Citing Articles

1. 1

   Pratibha Singhi, Sunit Singhi. (2009) Neurocysticercosis in children. The Indian Journal of Pediatrics 76:5, 537-545
   CrossRef

2. 2

   Siddhartha Gogia, Bibek Talukdar, Veena Choudhury, Balvinder Singh Arora. (2003) Neurocysticercosis in children: clinical findings and response to albendazole therapy in a randomized, double-blind, placebo-controlled trial in newly diagnosed cases. Transactions of the Royal Society of Tropical Medicine and Hygiene 97:4, 416-421
   CrossRef

3. 3

   Ravindra Kumar Garg. (2002) Single enhancing computerized tomography–detected lesion in immunocompetent patients. Neurosurgical FOCUS 12:6, 1-9
   CrossRef

4. 4

   Praphan Yodnopaklow, Arunee Mahuntussanapong. (2000) Single small enhancing CT lesion in Thai patients with acute symptomatic seizures: a clinico-radiological study. Tropical Medicine and International Health 5:4, 250-255
   CrossRef

5. 5

   Hector H. Garcia, Oscar H. Del Brutto. (2000) TAENIA SOLIUM CYSTICERCOSIS. Infectious Disease Clinics of North America 14:1, 97-119
   CrossRef

6. 6

   Ravindra Kumar Garg, Manish Kumar Singh, Surendra Misra. (2000) Single-enhancing CT lesions in Indian patients with seizures: a review. Epilepsy Research 38:2-3, 91-104
   CrossRef

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   J Sotelo. (2000) Brain Cysticercosis. Archives of Medical Research 31:1, 3-14
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   H. S. Duggal, S. Haque Nizamie. (1999) Publication concerning an article single CT (ring) lesion in epilepsy patients : A new observation by Garget al Indian Journal of Pediatrics, January-February, 1999, vol.66, No.1, pages 155-157. The Indian Journal of Pediatrics 66:6, 952-953
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   Arturo Carpio, Alfonso Escobar, W. Allen Hauser. (1998) Cysticercosis and Epilepsy: A Critical Review. Epilepsia 39:10, 1025-1040
   CrossRef

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    V. Rajshekhar. (1998) Incidence and significance of adverse effects of albendazole therapy in patients with a persistent solitary cysticercus granuloma. Acta Neurologica Scandinavica 98:2, 121-123
    CrossRef

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    ARUN K. BARANWAL, PRATIBHA D. SINGHI, N. KHANDELWAL, SUNIT C. SINGHI. (1998) Albendazole therapy in children with focal seizures and single small enhancing computerized tomographic lesions: a randomized, placebo-controlled, double blind trial. The Pediatric Infectious Disease Journal 17:8, 696-700
    CrossRef

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    J.M.K Murthy, Y.V Subba Reddy. (1998) Prognosis of epilepsy associated with single CT enhancing lesion: A long term follow up study. Journal of the Neurological Sciences 159:2, 151-155
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    O Del Brutto. (1995) Cysticercosis mimicking brain tumor: the role of albendazole as a diagnostic tool. Clinical Neurology and Neurosurgery 97:3, 256-258
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    (1995) Solitary Cysticercus Granulomas. Journal of Neurosurgery 82:5,
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    G. Webbe. (1994) Human cysticercosis: Parasitology, pathology, clinical manifestations and available treatment. Pharmacology & Therapeutics 64:1, 175-200
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