Drug therapy for solitary cysticercus granuloma: a systematic review and meta-analysis

Abstract

Objective: The effectiveness of anthelminthic and corticosteroid drug therapy in parenchymal neurocysticercosis is well established. The treatment of parenchymal solitary cysticercus granuloma (SCG), however, remains controversial. We attempted to obtain a consistent estimate of the efficacy of anthelminthic and corticosteroid drug treatment in SCG.

Methods: Randomized-controlled trials (RCTs) comparing rates of seizure freedom, granuloma resolution, and residual calcification in individuals with SCG treated with anthelminthic or corticosteroid drugs with those treated with antiepileptic drugs (AEDs) alone were systematically reviewed and quantified using fixed- or random-effects meta-analysis.

Results: Fifteen RCTs were identified for inclusion. Ten RCTs assigned 765 people with SCG to AED treatment with or without anthelminthic drug (albendazole) treatment. A further 5 RCTs assigned 457 people with SCG to AED treatment with or without corticosteroid drugs. Anthelminthic treatment was associated with significantly increased rates of seizure freedom (nonevent odds ratio: 2.45; 95% confidence interval: 1.49-4.03; p = 0.0004) and significantly higher rates of granuloma resolution (odds ratio: 2.09; 95% confidence interval: 1.41-3.00; p = 0.0003), but did not alter the risk of residual calcification. Corticosteroid treatment was not significantly associated with any outcome.

Conclusions: Anthelminthic treatment with albendazole provides improved rates of seizure freedom and hastens resolution of the granuloma. The role of corticosteroid treatment remains uncertain. The benefits (or lack thereof in the case of corticosteroids) are consistent when measured across different time points after treatment.

Figure 1. Flow chart of the literature search

Flow chart of the literature search and identification of randomized-controlled trials (RCTs) included in this study.

Figure 2. Forest plots of anthelminthic therapy

(Nonevent) odds ratios (ORs) of seizure freedom (A) and granuloma resolution (B) in patients with parenchymal solitary cysticercus granuloma treated with anthelminthics. The vertical bar indicates no difference between anthelminthic and no anthelminthic therapy. Point estimated ORs are given as squares and scaled proportional to the study's contribution to the (sub)total. Horizontal lines indicate the 95% OR (95% confidence interval [CI]) obtained by fixed- and random-effects analysis. Diamonds indicate the pooled OR 95% CI. df = degrees of freedom; M-H = Mantel-Haenszel.

Figure 3. Forest plots of corticosteroids

(Nonevent) odds ratios (ORs) of seizure freedom (A) and granuloma resolution (B) in patients with parenchymal solitary cysticercus granuloma treated with corticosteroids. The vertical bar indicates no difference between corticosteroids and no corticosteroids. Point estimated ORs are given as squares and scaled proportional to the study's contribution to the (sub)total. Horizontal lines indicate the 95% confidence interval (CI) obtained by random-effects analysis. Diamonds indicate the pooled OR 95% CI. df = degrees of freedom; M-H = Mantel-Haenszel.