Short course of prednisolone in patients with solitary cysticercus granuloma: A double blind placebo controlled study

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Summary

The study was conducted to confirm the role of a short course of oral corticosteroids in patients with solitary cysticercus granuloma with seizures by a double-blind placebo-controlled study. In an open-label trial we, in past, had demonstrated a beneficial role of prednisolone. A short course of prednisolone helped in early resolution of solitary cysticercus granuloma. In this double-blind placebo-controlled randomized study, 60 patients with new-onset seizures and a single enhancing computed tomography (CT)-detected lesion of cysticercosis were randomly divided in two groups to receive either anti-epileptic monotherapy with prednisolone (n=30) or anti-epileptic monotherapy along with placebo (n=30). The patients received prednisolone, 1 mg/kg/day for 10 days, followed by tapering over next 4 days. None of the patients received albendazole therapy. The patients were followed up monthly, at least for 9 months. A repeat CT scan was performed after 6 months. The data were analysed by chi-square test. The majority of patients were young. Simple partial seizure, with or without secondary generalization, was the commonest seizure type encountered. Follow-up CT scans at 6 months demonstrated non-significantly better response for prednisolone treated patients. In prednisolone group the lesion disappeared in 52% of patients and in 48% patients who received placebo. However, a significantly lesser number of prednisolone treated patients (n=12%) than controls (n=48%), had seizure recurrence. Our study suggests that short-term prednisolone therapy may not help in rapid resolution of solitary cysticercus granuloma, however, prednisolone therapy improves seizure-related prognosis.

Introduction

Cysticercosis is the most common parasitic disease of the central nervous system. Single small enhancing computed tomographic (CT) lesions representing solitary cysticercus granuloma are a common cause of seizures in India.1 Most granulomata resolve spontaneously, but the rate of resolution is highly variable and resolution may take anywhere between 2 weeks and several months. Patients with a solitary cysticercus granuloma often have a good seizure-related prognosis and anti-epileptic drugs can safely be withdrawn following resolution of the granuloma. As most lesions resolve spontaneously, the use of anti-cysticercal drugs has been controversial.1, 2 In an open-label trial we, in the past, have demonstrated a beneficial role of prednisolone. Short-term prednisolone therapy helps in rapid resolution of solitary cysticercus granuloma in Indian patients with new-onset seizures.3 The present study was planned to confirm the role of a short course of oral corticosteroids in patients with solitary cysticercus granuloma by a double-blind placebo-controlled study.

Section snippets

Materials and methods

This prospective, double-blind placebo-controlled study was conducted between February 2004 and February 2005 in department of Neurology of King George's Medical University, Lucknow, India. Our medical centre is situated in North Indian province of Uttar Pradesh, which is a highly endemic for Taenia solium cysticercosis. The study was approved by the institutional ethics committee. Sixty consecutive patients with new-onset seizure who also had single enhancing cerebral CT lesions were included

Results

No significant differences were seen in any of the epidemiological parameters between the prednisolone group (30 patients) and the group that received only anti-epileptic drug (30 patients). Approx. 80% of the included patients were younger than 20 years. Simple partial seizure with or without secondary generalization was the most common type of seizure. In all four patients, who had lesions in the occipital lobe, convulsions were preceded by visual aura. The majority of patients in each group

Discussion

In developing countries, corticosteroids along with albendazole are often used in patients with solitary cysticercus granuloma. Corticosteroids are presumed to help in reducing the parenchymal inflammatory reaction provoked by a degenerative or dying cyst and reducing its consequences. In a few open-label studies in the past, including one conducted by us, a beneficial effect of prednisolone was suggested.3, 6, 7 In these studies short-term administration of oral corticosteroids had been shown

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