Singhi Pratibha, Jain Vivek, Khandelwal Narendra
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Child Neurol. 2004 May;19(5):323-7. doi: 10.1177/088307380401900503.
Single small enhancing computed tomographic (CT) lesions representing cysticercus granuloma are a common cause of focal seizures in children. Controversy exists regarding the efficacy of various modalities of treatment. We conducted a randomized prospective trial to evaluate the efficacy of corticosteroids, albendazole, and corticosteroids with albendazole in children with focal seizures and single small enhancing CT lesions. The study population consisted of 133 children with focal seizures of recent onset (< 3 months) and single small enhancing CT lesions who presented to the Neurocysticercosis Clinic of Pediatric Neurology Services at the Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, an urban teaching and tertiary care hospital in Chandigarh, North India. All children were randomly assigned to receive corticosteroids (group S), albendazole (group A), or both corticosteroids and albendazole (group SA) for 28 days. CT was done at 3 and 6 months after enrollment in the study. Of the 133 patients enrolled, 23 were lost to follow-up. Of the remaining 110 patients, 38 patients were in group S, 37 in group A, and 35 in group SA. All children were followed up for at least 18 months. Disappearance of the lesion on CT scan was noted in 52.6% of patients in group S, 59.5% in group A, and 62.9% in Group SA (P > .1) at the 3-month follow-up. After the 6-month follow-up, disappearance of the lesion was noted in 76.3% in group S, 75.7% in group A, and 74.2% in group SA (P > .1). Twenty-three patients had seizure recurrence while on antiepilepsy drugs: 36.8% of patients in group S, 13.5% in group A, and 11.4% in group SA (P < .05). Seizure recurrence after antiepilepsy drug withdrawal was seen in seven children (three in group S and two each in groups A and SA). In conclusion, there was no significant difference in resolution of CT lesions in the three therapy groups at 3 and 6 months of follow-up. Children in the corticosteroid group had significantly more seizure recurrences while on antiepilepsy drugs.
计算机断层扫描（CT）显示的单个小强化病灶代表囊尾蚴肉芽肿，是儿童局灶性癫痫发作的常见原因。关于各种治疗方式的疗效存在争议。我们进行了一项随机前瞻性试验，以评估皮质类固醇、阿苯达唑以及皮质类固醇联合阿苯达唑对患有局灶性癫痫发作且CT显示单个小强化病灶的儿童的疗效。研究对象包括133名近期发作（<3个月）且CT显示单个小强化病灶的局灶性癫痫儿童，他们前往位于印度北部昌迪加尔的一家城市教学及三级护理医院——医学教育与研究研究生院高级儿科中心儿科神经科服务的神经囊尾蚴病诊所就诊。所有儿童被随机分配接受皮质类固醇治疗（S组）、阿苯达唑治疗（A组）或皮质类固醇与阿苯达唑联合治疗（SA组），为期28天。在研究入组后的3个月和6个月进行CT检查。在133名入组患者中，23名失访。在其余110名患者中，S组有38名患者，A组有37名患者，SA组有35名患者。所有儿童至少随访18个月。在3个月随访时，S组52.6%的患者、A组59.5%的患者以及SA组中62.9%的患者CT扫描显示病灶消失（P>.1）。在6个月随访后，S组76.3%的患者、A组75.7%的患者以及SA组74.2%的患者病灶消失（P>.1）。23名患者在服用抗癫痫药物期间癫痫复发：S组36.8%的患者、A组13.5%的患者以及SA组11.4%的患者（P<.05）。7名儿童在停用抗癫痫药物后癫痫复发（S组3名，A组和SA组各2名）。总之，在随访3个月和6个月时，三个治疗组CT病灶的消退情况无显著差异。皮质类固醇组的儿童在服用抗癫痫药物期间癫痫复发明显更多。
