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Am Fam Physician. 2004;70(3):592-594

The most common cause of adult-onset seizures in the developing world is cysticercosis. In areas of the United States with large immigrant populations, neurocysticercosis is an important consideration in the differential diagnosis of an adult with new-onset seizures. Concerns have been raised that drug treatment might lead to increased inflammation or scarring of cysts and perhaps increase the risk of seizures. Garcia and colleagues conducted a randomized trial of antiparasitic treatment in patients with cysticercosis and seizures.

The authors consecutively enrolled 120 adult patients diagnosed with active brain cysts and recent seizures. The study excluded six patients who had more than 20 active cysts. Active brain cysts were identified by noncalcified hypodense lesions on computed tomographic scans or by evidence of liquid cyst contents on magnetic resonance images. Patients were randomized to treatment with a 10-day course of 400 mg of albendazole twice daily and 2 mg of dexamethasone three times daily, or matching placebos.

All patients received standardized anti-seizure treatment and were followed for 30 months. Seizure medication was tapered off if a patient was seizure-free for more than a year. Repeat brain imaging was performed at six, 12, and 24 months after treatment. A total of 18 patients (20 percent of enrolled patients) were not available for final analysis because of incomplete adherence to study medications or lost follow-up.

In the first month after albendazole treatment, there was an increased seizure frequency in treated patients because of the rapid killing of parasites. From months 2 to 30, generalized seizures occurred in 23 percent of patients (13 of 57) treated with albendazole and 37 percent of patients (22 of 59) who received placebo, which was a statistically significant reduction. There was no significant difference in the number of patients with partial seizures (33 percent of treatment patients [19 of 57] and 27 percent of controls [16 of 59]). Brain imaging two years after treatment showed calcification of resolved cysts in 62 percent of subjects treated with albendazole compared with 38 percent of control patients. Abdominal pain and nausea were more commonly reported by patients who took albendazole.

The authors conclude that antiparasitic treatment with albendazole for neurocysticercosis is safe and effective in reducing the number of generalized seizures. Theoretic concerns about a possible increased seizure risk with treatment were not confirmed.

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