Garg R K
Department of Neurology, King George's Medical College, Lucknow-226003, India.
Neurol India. 2001 Dec;49(4):329-37.
Neurocysticercosis is the most common parasitic disease of the central nervous system. Praziquantel and albendazole, the two antiparasitic drugs, have been reported to be effective against cysticercosis. Both the drugs effectively destroy the cerebral parenchymal cystic lesions. However, albendazole is possibly more effective in subarachnoidal, ventricular and spinal forms of cysticercosis, and frequently obviates the need for surgery. Initially, longer courses of albendazole and praziquantel had been advocated. Now even shorter treatment regimens are found equally effective. Complete course of praziquantel therapy can be administered in a single day with comparable efficacy instead of conventional treatment of 15 days. Similarly, one week therapy of albendazole is as effective as 30 days' treatment regimen. Recently, there is an intense debate whether anticysticercal treatment is useful and safe. Opponents of anticysticercal therapy argue that effectiveness of therapy is possibly a reflection of natural course of the disease. It has been observed that even if cysticercal lesions are left untreated, they either disappear spontaneously or calcify. Anticysticercal therapy is potentially risky, it may aggravate cerebral oedema, and may produce vasculitis and stroke, and several deaths have also been reported. To minimise these risks, concomitant corticosteroids should be administered especially, if there is a massive parasitic load. It is better to avoid anticysticercal treatment in patients with cysticercotic encephalitis. Doubts have been expressed that anticysticercal therapy really affects ultimate long-term clinical outcomes (e.g. control of seizure and possibility of seizure free state after discontinuation of antiepileptic drugs). So far, definite evidences in this regard, based on finding of well planned placebo-controlled studies, are lacking and an opinion that, there is an urgent need for such a study, has been expressed. Measures for effective prevention like provision for safe drinking water and safe excreta disposal should be emphasisfxed.
神经囊尾蚴病是中枢神经系统最常见的寄生虫病。据报道，两种抗寄生虫药物吡喹酮和阿苯达唑对囊尾蚴病有效。这两种药物都能有效破坏脑实质囊性病变。然而，阿苯达唑可能对蛛网膜下腔、脑室和脊髓型囊尾蚴病更有效，并且常常无需进行手术。最初，人们主张使用更长疗程的阿苯达唑和吡喹酮。现在发现甚至更短的治疗方案同样有效。吡喹酮治疗的完整疗程可以在一天内完成，疗效相当，而不是采用传统的15天治疗。同样，阿苯达唑一周的治疗与30天的治疗方案效果相同。最近，关于抗囊尾蚴治疗是否有用和安全存在激烈争论。抗囊尾蚴治疗的反对者认为，治疗效果可能是疾病自然病程的反映。据观察，即使囊尾蚴病变不进行治疗，它们也会自行消失或钙化。抗囊尾蚴治疗有潜在风险，可能会加重脑水肿，可能引发血管炎和中风，也有几例死亡报告。为了将这些风险降至最低，应特别给予皮质类固醇，尤其是在寄生虫负荷量大的情况下。对于患有囊尾蚴性脑炎的患者，最好避免进行抗囊尾蚴治疗。有人怀疑抗囊尾蚴治疗是否真的会影响最终的长期临床结果（例如癫痫的控制以及停用抗癫痫药物后无癫痫状态的可能性）。到目前为止，基于精心设计的安慰剂对照研究结果，这方面还缺乏确凿证据，并且有人表示迫切需要这样一项研究。应强调采取有效的预防措施，如提供安全饮用水和安全处理排泄物。
