Garg R K
Department of Neurology, King George's Medical College, Lucknow, Uttar Pradesh, India.
Natl Med J India. 1997 Jul-Aug;10(4):173-7.
Neurocysticercosis, the most common parasitic disease of the central nervous system, was treated surgically for a long time. Praziquantel (an isoquinolone) and albendazole (an imidazole) are anticysticercal drugs that are currently being used for the treatment of neurocysticercosis. Both have been reported to eliminate or markedly reduce the number and size of cysticerci. Albendazole is less expensive than praziquantel, and is as effective when given for 8 days as compared to longer periods. In a small number of comparative trials, albendazole appeared to be slightly more effective than praziquantel for the treatment of parenchymal cysticercosis. Albendazole has also been found effective in ventricular, subarachnoidal and racemose forms of the disease. However, the response to treatment is not universal. Treatment with these drugs has been associated with a high frequency of adverse reactions, probably due to the host's inflammatory reaction to the dying parasites. Headache, nausea and seizures are common but usually transient. Steroids appear to ameliorate these effects and their concomitant administration has been advocated. However, no data are available to support this view. The rationale of medical therapy in spinal cysticercosis is presently based on the reported efficacy of anticysticercal drugs in cerebral cysticercosis. A marked improvement in an associated seizure disorder following anticysticercal therapy has been observed. Though seizure control is better, the total duration of anti-epileptic drug therapy has not been determined. Some single enhancing computed tomography lesions in patients of epilepsy may be benign forms of neurocysticercosis. The spontaneous resolution of a majority of these lesions has led to doubts of them being merely infective in aetiology. Also, a controlled trial could not demonstrate any beneficial effect of albendazole on such lesions. Hence, most authors recommend that these patients should be treated with anti-epileptic drugs only. Doubts persist about the efficacy of anticysticercal drugs in altering the natural course of the disease and the reported tendency of cysticercus lesions to resolve.
神经囊尾蚴病是中枢神经系统最常见的寄生虫病，长期以来一直采用手术治疗。吡喹酮（一种异喹啉酮）和阿苯达唑（一种咪唑）是目前用于治疗神经囊尾蚴病的抗囊尾蚴药物。据报道，两者均可消除或显著减少囊尾蚴的数量和大小。阿苯达唑比吡喹酮便宜，给药8天与较长疗程的效果相同。在少数对照试验中，阿苯达唑在治疗实质性囊尾蚴病方面似乎比吡喹酮略有效。阿苯达唑在该病的脑室型、蛛网膜下腔型和葡萄状型中也被发现有效。然而，治疗反应并不普遍。使用这些药物治疗与不良反应的高发生率相关，这可能是由于宿主对垂死寄生虫的炎症反应所致。头痛、恶心和癫痫发作很常见，但通常是短暂的。类固醇似乎可改善这些效应，因此有人主张同时使用类固醇。然而，尚无数据支持这一观点。目前，脊髓囊尾蚴病药物治疗的理论依据是抗囊尾蚴药物在脑囊尾蚴病中已报道的疗效。抗囊尾蚴治疗后相关癫痫发作障碍有明显改善。虽然癫痫控制较好，但抗癫痫药物治疗的总疗程尚未确定。癫痫患者中一些增强计算机断层扫描的单个病灶可能是神经囊尾蚴病的良性形式。这些病灶大多数可自发消退，这使人怀疑它们在病因上是否仅仅是感染性的。此外，一项对照试验未能证明阿苯达唑对这类病灶有任何有益作用。因此，大多数作者建议仅用抗癫痫药物治疗这些患者。对于抗囊尾蚴药物改变疾病自然病程的疗效以及囊尾蚴病灶自行消退的报道趋势仍存在疑问。
