The effectiveness of anti-inflammatory and anti-seizure medication for individuals with single enhancing lesion neurocysticercosis: A meta-analysis and expert group-based consensus recommendations

Autor: Robert de Meijere, A. Clinton White, Bernard Ngowi, Annette Abraham, Hector H. Garcia, Xiao-Nong Zhou, Sarah Gabriël, Gagandeep Singh, Mamoun M. A. Homeida, Hélène Carabin, Theodore E. Nash, Javier A. Bustos, Vedantam Rajshekhar, Christina M. Coyle, Andrea Sylvia Winkler, Priyadarshi Soumyaranjan Sahu, Peter L. Chiodini
Rok vydání: 2021
Předmět:
Male
Epidemiology
Physiology
RC955-962
Neurocysticercosis
Anti-Inflammatory Agents
Steroid Therapy
Database and Informatics Methods
Mathematical and Statistical Techniques
0302 clinical medicine
Adrenal Cortex Hormones
Antiparasitic Therapy
Arctic medicine. Tropical medicine
Medicine and Health Sciences
Enhancing Lesion
Medicine
Public and Occupational Health
Cumulative incidence
Cyst
Database Searching
Brain Diseases
Pharmaceutics
Statistics
Calcinosis
Metaanalysis
Vaccination and Immunization
Treatment Outcome
Infectious Diseases
Meta-analysis
Physical Sciences
Anticonvulsants
Female
Public aspects of medicine
RA1-1270
Research Article
medicine.medical_specialty
Consensus
Corticosteroid Therapy
Immunology
030231 tropical medicine
MEDLINE
Research and Analysis Methods
Calcification
03 medical and health sciences
Signs and Symptoms
Text mining
Pharmacotherapy
Drug Therapy
Seizures
Internal medicine
Animals
Humans
Statistical Methods
Epilepsy
Taenia
business.industry
Public Health
Environmental and Occupational Health
Biology and Life Sciences
medicine.disease
Medical Risk Factors
Lesions
Preventive Medicine
Clinical Medicine
Physiological Processes
business
Mathematics
030217 neurology & neurosurgery
Zdroj: PLoS Neglected Tropical Diseases, Vol 15, Iss 3, p e0009193 (2021)
PLoS Neglected Tropical Diseases
ISSN: 1935-2735
4201-9087
Popis: Single brain enhancing lesions (SEL) are the most common presentation of neurocysticercosis (NCC) observed on neuroimaging in people presenting with epileptic seizures not only on the Indian sub-continent and in travelers returning from cysticercosis-endemic regions, but are also present in other parts of the world. The aim of this study, which consisted of a systematic review (CRD42019087665), a meta-analysis and an expert group consultation, was to reach consensus on the best anti-seizure medication and anti-inflammatory treatment for individuals with SEL NCC. Standard literature review methods were used. The Cochrane risk of bias tool was used and random effects model meta-analyses were performed. The quality of the body of evidence was rated using GRADE tables. The expert committee included 12 gender and geographically balanced members and recommendations were reached by applying the GRADE framework for guideline development. The 1–1.5-year cumulative incidence of seizure recurrence, cyst resolution or calcification following anti-seizure medication (ASM) withdrawal was not statistically different between ASM of 6, 12 or 24 months. In contrast, in persons whose cyst calcified post treatment, longer ASM decreased seizure recurrence. The cumulative incidence ratio (CIR) 1–1.5 years after stopping ASM was 1.79 95% CI: (1.00, 3.20) for patients given 6 versus 24 months treatment. Anti-inflammatory treatment with corticosteroids in patients treated with ASM compared to patients treated with ASM only showed a statistically significant beneficial effect on seizure reduction (CIR 0.44, 95% CI 0.23, 0.85) and cyst resolution (CIR 1.37, 95%CI: 1.07, 1.75). Our results indicate that ASM in patients with SEL NCC whose cysts resolved can be withdrawn, while patients whose cysts calcified seem to benefit from prolonged anti-seizure medication. Additional corticosteroid treatment was found to have a beneficial effect both on seizure reduction and cyst resolution.
Author summary Neurocysticercosis is an infection of the brain with the tapeworm Taenia solium. On the Indian sub-continent, the majority of people suffering from neurocysticercosis only show one cyst (larval form of the parasite) in their brain and often present at clinics with epileptic seizures. There is still some debate on the best way to treat these cases to reduce the risk for seizure recurrence. The goal of this study was to review the literature on how well different durations of treatment with anti-seizure medication (ASM), combined or not with corticosteroids, work in order to reduce the seizure recurrence and eliminate the cyst from the brain. The results show that ASM for 24 months compared to 6 months favors reduced seizure recurrence in patients whose cysts calcified post treatment. Concerning anti-inflammatory treatment, corticosteroids were also found to have beneficial effects on seizure reduction. However, further high-quality randomized controlled trials with adequately long follow-up time are required for better evidence on best drug(s), dose and duration of ASM and corticosteroids for individuals with SEL NCC.
Databáze: OpenAIRE
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