Department of Pediatric Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands.
Neurology. 2013 Jan 8;80(2):152-62. doi: 10.1212/WNL.0b013e31827b90a8. Epub 2012 Dec 26.
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.
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.
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.
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.
抗蠕虫药和皮质类固醇药物治疗实质型脑囊尾蚴病的疗效已得到充分证实。然而，实质型单个囊尾蚴肉芽肿（SCG）的治疗仍存在争议。我们试图获得一致的估计，即抗蠕虫药和皮质类固醇药物治疗 SCG 的疗效。
系统回顾和量化比较 SCG 个体用抗蠕虫药或皮质类固醇药物与单独用抗癫痫药物（AEDs）治疗的无癫痫发作率、肉芽肿消退率和残留钙化率的随机对照试验（RCTs），并使用固定或随机效应荟萃分析进行定量分析。
确定了 15 项 RCT 纳入研究。10 项 RCT 将 765 名 SCG 患者分配到 AED 治疗加或不加抗蠕虫药（阿苯达唑）治疗。另外 5 项 RCT 将 457 名 SCG 患者分配到 AED 治疗加或不加皮质类固醇药物治疗。抗蠕虫治疗与更高的无癫痫发作率显著相关（无事件优势比：2.45；95%置信区间：1.49-4.03；p = 0.0004），并且更高的肉芽肿消退率显著相关（优势比：2.09；95%置信区间：1.41-3.00；p = 0.0003），但不会改变残留钙化的风险。皮质类固醇治疗与任何结局均无显著相关性。
阿苯达唑的抗蠕虫治疗可提高无癫痫发作率并加速肉芽肿消退。皮质类固醇治疗的作用仍不确定。在治疗后不同时间点测量时，其益处（在皮质类固醇的情况下则没有益处）是一致的。
