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Submission- albendazole in neurocysticercosis (choon ean)

Use of Albendazole in
Neurocysticercosis
Choon Ean Ooi
Pharmacy Department, The Royal Melbourne Hospital, Parkville Introduction
Clinical Features (cont.)
Discussion (cont.)
Prior to transfer the patient was managed with: Table 1: Advantages of albendazole Cysticercosis is a parasitic infection caused by the • BD dosing (cf. TDS with praziquantel)7 larval stage of the pork tapeworm Taenia solium.1 Approximately 50 to 100 million people worldwide are (corticosteroids, phenytoin or carbamazepine may infected with cysticercosis and its endemic areas reduce efficacy of praziquantel through induction of include Central and South America, India, China, The patient experienced no further seizures; however, Southeast Asia, and sub-Saharan Africa.2 The clinical • Better penetration into cerebrospinal fluid 9 syndromes related to cysticercosis are divided into • Plasma level is increased by about 50% when co- neurocysticercosis and extraneural cysticercosis.1,2 Case Progress
Neurocysticercosis is the most common parasitic Most studies used 15mg/kg per day (usually 800mg infection involving the central nervous system unremarkable and laboratory investigations were per day in two divided doses) of albendazole, but the worldwide and is also one of the leading causes for duration of treatment varied from 8 to 30 days.7,8 Oral bioavailability appears to be enhanced by 6.5-fold Neurocysticercosis, in turn, is divided into • Neut 14.3x109/L (Ref: 2.0-8.0 x 109/L) when albendazole is co-administered with a fatty parenchymal and extraparenchymal disease.1,2 • Lymph 0.9x109/L (Ref: 1.2-4.0 x 109/L) Humans acquire cysticercosis through faecal-oral Blood culture and serological testing for hydatid Table 2: Role of pharmacists in this scenario transmission, often by ingestion of food or water disease, strongyloidiasis, schistosomiasis, • Ensure appropriate antiepileptic drugs and contaminated with T. solium eggs excreted in the toxoplasmosis, hepatitis B, hepatitis C and HIV were faeces of the human tapeworm carriers.2-4 Following all negative. Brain MRI revealed a solitary subcortical ingestion, the eggs hatch in the small intestine and 12mm ring enhancing mass in the left superior frontal release larvae that spread via bloodstream to various • Advise patient on dose and administration time for gyrus, associated with vasogenic oedema. There was tissues where they mature into cysticerci, which albendazole (with food to increase bioavailability) also a tiny focus of T2 hypodensity. These findings remain viable over years and end with the death of the • Advise patient on possible neurologic effects such as parasite and resorption or calcification of the cyst.2-4 recurrent seizures, headache and vomiting associated with albendazole treatment Neurocysticercosis seems to produce symptoms years The patient was commenced on antiparasitic drugs • Recommend symptomatic treatment such as simple after the initial invasion of the nervous system by the and albendazole was chosen over praziquantel given parasite, by either inflammation around the parasite, its favourable pharmacokinetic profile. Repeated full • Discuss the impact of alcohol consumption on treatment mass effect or residual scarring.3 The clinical blood count was normalised at this time. effect and the increased risk of recurrent seizures with manifestations are dependent on the location, number and stage of the cysticerci at presentation but seizures After 48 hours of monitoring, the patient was (in 70% to 90% of symptomatic cases) and headache Conclusion
are the most common for neurocysticercosis.5 Neurocysticercosis has become an increasingly important emerging infection outside the endemic • albendazole PO 400mg BD (for total of 11 days) areas. Current evidence show that the use of antiparasitic drugs in selected patients does lead to A week post discharge, the patient was reviewed in To report a case of new-onset seizure related to resolution of the infection and improvement of the risk clinic, reporting no seizure activity and demonstrating neurocysticercosis and its treatment with albendazole.
of recurrent seizures. Albendazole is preferred over no neurological deficits on examination. A reducing praziquantel given its favourable pharmacokinetic dose of dexamethasone was prescribed and phenytoin was to be continued for at least six months.
Clinical Features
References
A 24-year-old man was transferred from another Discussion
White AC, Weller PF, Baron EL. Clinical manifestations and diagnosis of cysticercosis. UpToDate®. Jul 2012.
hospital for investigation following his first episode of Mansur MM, Montes M, Yancey LS. Cysticercosis. eMedicine. 22nd Oct 2012. Available at <http://emedicine.medscape.com/article/215589-overview#a0199>. Accessed on 19th May 2013.
generalised tonic-clonic seizure. The patient was Baird RA, Wiebe S, Zunt JR, et al. Evidence-based guideline: Treatment of parenchymalneurocysticercosis: Report of the Guideline Development Subcommittee of the American Academy of originally from Hyderabad, India and had been Treatment for neurocysticercosis includes antiparasitic Neurology. Neurology 2013; 80: 1424-1429.
Garcia HH, Evans CAW, Nash TE, et al. Current consensus guidelines for treatment of studying and residing in Melbourne for the past years. or cysticidal drugs, corticosteroids, antiepileptic drugs neurocysticercosis. Clinical Microbiology Reviews 2002 October; 15(4): 747-756.
and surgery, depending on the number, location and Ferri FF. Ferri’s clinical advisor 2010: Instant diagnosis and treatment. 1st ed. Mosby, an Imprint of Elsevier; 2009. Available from MD Consult. Coyle CM, Tanowitz HB. Diagnosis and treatment of neurocysticercosis. Interdisciplinary Perspectives viability of cysticerci, the host inflammatory responses on Infectious Diseases 2009; Article ID 180742. Available at <http://www.hindawi.com/journals/ipid/2009/180742.html>. Accessed on 19th May 2013. White AC, Weller PF, Baron EL. Treatment of cysticercosis. UpToDate®. Apr 2013.
Matthaiou DK, Panos G, Adamidi ES, Falagas ME. Albendazole versus praziquantel in the treatment of neurocysticercosis: A meta-analysis of comparative trials. PLOS Neglected Tropical Diseases 2008; Most of the treatment guidelines are based on empiric Jung H, Hurtado M, Sanchez M, Medina MT, Sotelo J. Plasma and cerebrospinal fluid levels of albendazole and praziquantel in patients with neurocysticercosis. Clinical Neuropharmacology 1990; observations or uncontrolled studies, hence the Jung H, Hurtado M, Medina MT, Sanchez M, Sotelo J. Dexamethasone increases plasma levels of therapeutic value of antiparasitic drugs remains albendazole. Journal of Neurology 1990; 237: pp.279-280.
Jung H, Hurtado M, Sanchez M, Medina MT, Sotelo J. Clinical pharmacokinetics of albendazole in controversial.4,6 Albendazole and praziquantel are the patients with brain cysticercosis. Journal of Clinical Pharmacology 1992; 32; pp. 28-31.
Nagy J. Schipper HG, Koopmans RP, Butter JJ, Van Boxtel CJ, Kager PA. Effect of grapefruit juice or denied previous intravenous or recreational drug use most commonly used antiparasitic drugs. Both are cimetidine coadministration on albendazole bioavailability. American Journal of Tropical Medicine and Hygeine 2002; 66(3): pp. 260-263.
effective in killing 60% to 85% of parenchymal brain cysticerci.4 A recent meta-analysis suggested that Acknowledgements
albendazole is superior to praziquantel in seizure An initial brain CT showed a solitary heterogenous control, cyst resolution and subsequent cure of I would like to thank Michael Frank and Lisa Ciabotti for their 9x11x7mm nodule centred at the corticomedullary infection among those with viable cysts.8 No assistance in the preparation of this case report.
junction of the anterior medial left frontal lobe with significant differences in reduction of total number of cysts, mortality, total adverse events and development Contact Details
of intracranial hypertension between albendazole and praziquantel.8 For further information, please contact choonean.ooi@mh.org.au

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