Correspondence

Single-Day Praziquantel Therapy for Neurocysticercosis

N Engl J Med 1996; 334:125January 11, 1996

Article

To the Editor:

Administration of praziquantel for 15 days is effective therapy for patients with parenchymal brain cysticercosis.1 Because the plasma and cerebrospinal fluid concentrations of praziquantel are highest two hours after its administration, after which they decline rapidly,2,3 we hypothesized that a high concentration that was maintained for about six hours by giving three doses at two-hour intervals might increase the length of time the parasite was exposed to high concentrations of drug and be sufficient cysticidal therapy for these patients. We therefore treated 10 patients (6 women and 4 men; mean [±SD] age, 33±11 years) with parenchymal brain cysticerci with three oral doses of 25 mg of praziquantel per kilogram of body weight, given at two-hour intervals, followed for the next three days by a daily dose of 10 mg of dexamethasone intramuscularly. All the patients had seizures as their principal symptom. The effectiveness of treatment was evaluated by magnetic resonance imaging three months later.

The cysts had disappeared in six patients, who were considered cured. In three patients, the number of cysts was reduced by 33 to 60 percent. In one patient, who had only one cyst, there was no change. The total number of cysts in all patients decreased from 35 to 7, for a rate of disappearance of 80 percent. Two patients had a seizure — one at 12 hours and one at 24 hours after therapy, and four patients had headache that abated a few minutes after the administration of dexamethasone. No patient had seizures while taking anticonvulsive therapy during a mean follow-up period of 11±2 months.

Many patients with neurocysticercosis cannot afford the cost of praziquantel or do not comply with the standard 15-day treatment regimen. In other cases, the fear of secondary reactions leads to the administration of a glucocorticoid simultaneously with praziquantel, which may decrease the efficacy of praziquantel.4 Our regimen has several advantages. The dose and cost of praziquantel and the length of therapy are greatly reduced. The features of cysticercosis — the parasitic infection and the inflammation that follows the killing of the cysts — are treated sequentially, so that one drug does not interfere with the other.4,5 We think that this regimen has cysticidal effects similar to those produced by longer courses of praziquantel and therefore warrants further evaluation.

Teresa Corona, M.D.
Roberto Lugo, M.D.
Roberto Medina, M.D.
Julio Sotelo, M.D.
National Institute of Neurology and Neurosurgery, 14269 Mexico City, Mexico

5 References

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   Vazquez V, Sotelo J. The course of seizures after treatment for cerebral cysticercosis. N Engl J Med 1992;327:696-701
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   Bittencourt PR, Gracia CM, Gorz AM, Oliveira TV. High-dose praziquantel for neurocysticercosis: serum and CSF concentrations. Acta Neurol Scand 1990;82:28-33
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   Jung H, Vazquez ML, Sanchez M, Penagos P, Sotelo J. Clinical pharmacokinetics of praziquantel. Proc West Pharmacol Soc 1991;34:335-340
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   Vazquez ML, Jung H, Sotelo J. Plasma levels of praziquantel decrease when dexamethasone is given simultaneously. Neurology 1987;37:1561-1562
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   Gonzalez-Esquivel DF, Sanchez-Rodriguez M, Sotelo J, Jung H. In vitro metabolic interaction between praziquantel and dexamethasone. Pharmacol Comm 1994;4:301-305
   

Citing Articles (13)

Citing Articles

1. 1

   Hector H. Garcia, Armando E. Gonzalez, Robert H. Gilman. (2011) Cysticercosis of the central nervous system. Current Opinion in Infectious Diseases 24:5, 423-427
   CrossRef

2. 2

   Theodore E. Nash, Hector H. Garcia. (2011) Diagnosis and treatment of neurocysticercosis. Nature Reviews Neurology 7:10, 584-594
   CrossRef

3. 3

   Ana Flisser, Philip S. Craig. 2010. Larval Cestodes. .
   CrossRef

4. 4

   Julio Sotelo, Claudia Diaz-Olavarrieta. (2010) Neurocysticercosis: Changes after 25 Years of Medical Therapy. Archives of Medical Research 41:1, 62-63
   CrossRef

5. 5

   Sumit Sinha, B.S. Sharma. (2009) Neurocysticercosis: A review of current status and management. Journal of Clinical Neuroscience 16:7, 867-876
   CrossRef

6. 6

   Hector H Garcia. (2008) Antiparasitic drugs in neurocysticercosis: albendazole or praziquantel?. Expert Review of Anti-infective Therapy 6:3, 295-298
   CrossRef

7. 7

   Hector H Garcia, Oscar H Del Brutto. (2005) Neurocysticercosis: updated concepts about an old disease. The Lancet Neurology 4:10, 653-661
   CrossRef

8. 8

   Héctor H García, Armando E Gonzalez, Carlton AW Evans, Robert H Gilman. (2003) Taenia solium cysticercosis. The Lancet 362:9383, 547-556
   CrossRef

9. 9

   Terrence Riley, A C White. (2003) Management of Neurocysticercosis. CNS Drugs 17:8, 577-591
   CrossRef

10. 10

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

11. 11

    J Sotelo. (2000) Brain Cysticercosis. Archives of Medical Research 31:1, 3-14
    CrossRef

12. 12

    Luis A. Herrera, Tzutzuy Ramirez, Ulises Rodríguez, Tere Corona, Julio Sotelo, Marcelino Lorenzo, Francisco Ramos, Irmgard Verdorfer, Erich Gebhart, Patricia Ostrosky-Wegman. (2000) Possible association between Taenia solium cysticercosis and cancer: increased frequency of DNA damage in peripheral lymphocytes from neurocysticercosis patients. Transactions of the Royal Society of Tropical Medicine and Hygiene 94:1, 61-65
    CrossRef

13. 13

    A. Clinton White, Hector H. Garcia. (1999) Recent developments in the epidemiology, diagnosis, treatment, and prevention of neurocysticercosis. Current Infectious Disease Reports 1:5, 434-440
    CrossRef