Centre for Evidence-Based Practice and Knowledge Translation, Tecnológico de Monterrey School of Medicine and Health Sciences, Instituto de Pediatría Zambrano Hellion, Avda Morones Prieto 3000, Col. Doctores, Monterrey, Mexico.
Int J Infect Dis. 2013 Aug;17(8):e583-92. doi: 10.1016/j.ijid.2012.12.010. Epub 2013 Jan 20.
Neurocysticercosis is an infection of the central nervous system by the larval stage of Taenia solium. It is a major cause of epileptic seizures in low- and middle-income countries. Corticosteroids are frequently used to reduce inflammation and perilesional edema. We aimed to evaluate their efficacy for reducing the rate of seizures and lesion persistence in imaging studies.
We searched randomized controlled trials in Medline, Central, EMBASE, LILACS, and the gray literature without language restrictions. We assessed eligibility, extracted data, and assessed the risk of bias in the included studies. The main outcomes included seizure recurrence and lesion persistence on imaging studies at 6-12 months of follow-up. Risk ratios (RR) were used for evaluating the main outcomes.
Thirteen studies involving 1373 participants were included. The quality of the evidence was deemed low to very low. Corticosteroids alone versus placebo/no drug (five trials) reduced the rate of seizure recurrence at 6-12 months (RR 0.46, 95% confidence interval (CI) 0.27-0.77; 426 participants) and the persistence of lesions in imaging studies (RR 0.63, 95% CI 0.43-0.92; 417 participants). No differences were noted in other comparisons, including the use of corticosteroids and albendazole combined. Corticosteroids plus albendazole increased the risk of abdominal pain, rash, and headaches (odds ratio 8.73, 95% CI 2.09-36.5; 116 participants, one trial).
Although the evidence suggest corticosteroids can reduce the rate of seizure recurrence and speed up resolution of lesions at 6-12 months of follow-up, there remains uncertainty on the effect estimate due to a high risk of methodological and publication bias. More adequately performed randomized trials that evaluate the use of anthelmintics, corticosteroids, and both combined against placebo are needed.
神经囊尾蚴病是由猪带绦虫幼虫引起的中枢神经系统感染。它是中低收入国家癫痫发作的主要原因。皮质类固醇常被用于减轻炎症和病灶周围水肿。我们旨在评估其降低癫痫发作率和影像学研究中病灶持续存在的疗效。
我们在 Medline、Central、EMBASE、LILACS 和灰色文献中进行了无语言限制的随机对照试验搜索。我们评估了纳入研究的资格、提取了数据，并评估了偏倚风险。主要结局包括 6-12 个月随访时的癫痫发作复发和影像学研究中的病灶持续存在。风险比（RR）用于评估主要结局。
共纳入 13 项研究，涉及 1373 名参与者。证据质量被认为是低到非常低。皮质类固醇单独与安慰剂/无药物（五项试验）相比，降低了 6-12 个月时的癫痫发作复发率（RR 0.46，95%置信区间（CI）0.27-0.77；426 名参与者）和影像学研究中病灶的持续存在（RR 0.63，95%CI 0.43-0.92；417 名参与者）。在其他比较中，包括皮质类固醇和阿苯达唑联合使用，没有发现差异。皮质类固醇加阿苯达唑增加了腹痛、皮疹和头痛的风险（比值比 8.73，95%CI 2.09-36.5；116 名参与者，一项试验）。
尽管证据表明皮质类固醇可以降低癫痫发作复发率，并在 6-12 个月的随访中加速病灶的消退，但由于方法学和发表偏倚的风险较高，对效应估计仍存在不确定性。需要进行更多设计合理的随机试验，评估驱虫药、皮质类固醇和两者联合与安慰剂相比的效果。
