Short course of prednisolone in patients with solitary cysticercus granuloma: A double blind placebo controlled study
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a solitary cysticercus granuloma often have a good seizure-related prognosis and anti-epileptic drugs can safely be withdrawn following resolution of the granuloma.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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