Tags

Type your tag names separated by a space and hit enter

Enhanced steroid dosing reduces seizures during antiparasitic treatment for cysticercosis and early after.
Epilepsia. 2014 Sep; 55(9):1452-9.E

Abstract

OBJECTIVE

Neurocysticercosis (NCC) is a major cause of seizures and epilepsy in endemic countries. Antiparasitic treatment of brain cysts leads to seizures due to the host's inflammatory reaction, requiring concomitant steroids. We hypothesized that increased steroid dosing will reduce treatment-associated seizures.

METHODS

Open-label randomized trial comparing 6 mg/day dexamethasone for 10 days (conventional) with 8 mg/day for 28 days followed by a 2-week taper (enhanced) in patients with NCC receiving albendazole. Follow-up included active seizure surveillance and brain imaging. Study outcomes were seizure days and patients with seizures, both measured in days 11-42. Additional analyses compared days 1-10, 11-21, 22-32, 33-42, 43-60, and 61-180.

RESULTS

Thirty-two individuals were randomized into each study arm; two did not complete follow-up. From days 11 to 42, 59 partial and 6 generalized seizure days occurred in 20 individuals, nonsignificantly fewer in the enhanced arm (12 vs. 49, p = 0.114). The numbers of patients with seizures in this period showed similar nonsignificant differences. In the enhanced steroid arm there were significantly fewer days and individuals with seizures during antiparasitic treatment (days 1-10: 4 vs. 17, p = 0.004, and 1 vs. 10, p = 0.003, number needed to treat [NNT] 4.6, relative risk [RR] 0.1013, 95% confidence interval [CI] 0.01-0.74) and early after dexamethasone cessation (days 11-21: 6 vs. 27, p = 0.014, and 4 vs. 12, p = 0.021, NNT 4.0, RR 0.33, 95% CI 0.12-0.92) but not after day 21. There were no significant differences in antiparasitic efficacy or relevant adverse events.

SIGNIFICANCE

Increased dexamethasone dosing results in fewer seizures for the first 21 days during and early after antiparasitic treatment for viable parenchymal NCC but not during the first 11-42 days, which was the primary predetermined time of analysis.

Authors+Show Affiliations

Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru; Department of Microbiology, School of Sciences, Cayetano Heredia Peruvian University, Lima, Peru; Center for Global Health - Tumbes, Cayetano Heredia Peruvian University, Lima, Peru; School of Public Health, Cayetano Heredia Peruvian University, Lima, Peru.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25092547

Citation

Garcia, Hector H., et al. "Enhanced Steroid Dosing Reduces Seizures During Antiparasitic Treatment for Cysticercosis and Early After." Epilepsia, vol. 55, no. 9, 2014, pp. 1452-9.
Garcia HH, Gonzales I, Lescano AG, et al. Enhanced steroid dosing reduces seizures during antiparasitic treatment for cysticercosis and early after. Epilepsia. 2014;55(9):1452-9.
Garcia, H. H., Gonzales, I., Lescano, A. G., Bustos, J. A., Pretell, E. J., Saavedra, H., & Nash, T. E. (2014). Enhanced steroid dosing reduces seizures during antiparasitic treatment for cysticercosis and early after. Epilepsia, 55(9), 1452-9. https://doi.org/10.1111/epi.12739
Garcia HH, et al. Enhanced Steroid Dosing Reduces Seizures During Antiparasitic Treatment for Cysticercosis and Early After. Epilepsia. 2014;55(9):1452-9. PubMed PMID: 25092547.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enhanced steroid dosing reduces seizures during antiparasitic treatment for cysticercosis and early after. AU - Garcia,Hector H, AU - Gonzales,Isidro, AU - Lescano,Andres G, AU - Bustos,Javier A, AU - Pretell,E Javier, AU - Saavedra,Herbert, AU - Nash,Theodore E, AU - ,, Y1 - 2014/08/04/ PY - 2014/06/23/accepted PY - 2014/8/6/entrez PY - 2014/8/6/pubmed PY - 2014/11/5/medline KW - Cestodes KW - Cysticercosis KW - Epilepsy KW - Neurocysticercosis KW - Peru KW - Seizures KW - Taenia solium SP - 1452 EP - 9 JF - Epilepsia JO - Epilepsia VL - 55 IS - 9 N2 - OBJECTIVE: Neurocysticercosis (NCC) is a major cause of seizures and epilepsy in endemic countries. Antiparasitic treatment of brain cysts leads to seizures due to the host's inflammatory reaction, requiring concomitant steroids. We hypothesized that increased steroid dosing will reduce treatment-associated seizures. METHODS: Open-label randomized trial comparing 6 mg/day dexamethasone for 10 days (conventional) with 8 mg/day for 28 days followed by a 2-week taper (enhanced) in patients with NCC receiving albendazole. Follow-up included active seizure surveillance and brain imaging. Study outcomes were seizure days and patients with seizures, both measured in days 11-42. Additional analyses compared days 1-10, 11-21, 22-32, 33-42, 43-60, and 61-180. RESULTS: Thirty-two individuals were randomized into each study arm; two did not complete follow-up. From days 11 to 42, 59 partial and 6 generalized seizure days occurred in 20 individuals, nonsignificantly fewer in the enhanced arm (12 vs. 49, p = 0.114). The numbers of patients with seizures in this period showed similar nonsignificant differences. In the enhanced steroid arm there were significantly fewer days and individuals with seizures during antiparasitic treatment (days 1-10: 4 vs. 17, p = 0.004, and 1 vs. 10, p = 0.003, number needed to treat [NNT] 4.6, relative risk [RR] 0.1013, 95% confidence interval [CI] 0.01-0.74) and early after dexamethasone cessation (days 11-21: 6 vs. 27, p = 0.014, and 4 vs. 12, p = 0.021, NNT 4.0, RR 0.33, 95% CI 0.12-0.92) but not after day 21. There were no significant differences in antiparasitic efficacy or relevant adverse events. SIGNIFICANCE: Increased dexamethasone dosing results in fewer seizures for the first 21 days during and early after antiparasitic treatment for viable parenchymal NCC but not during the first 11-42 days, which was the primary predetermined time of analysis. SN - 1528-1167 UR - https://www.unboundmedicine.com/medline/citation/25092547/full_citation L2 - https://doi.org/10.1111/epi.12739 DB - PRIME DP - Unbound Medicine ER -