What is the recommended treatment for neurocysticercosis in the Philippines?

From the Guidelines

The recommended treatment for neurocysticercosis in the Philippines is a combination of antiparasitic drugs, corticosteroids, and anticonvulsants, with the primary antiparasitic medication being albendazole (15 mg/kg/day divided into two doses, maximum 1200 mg daily) for 10-14 days, and corticosteroids started 1-3 days before antiparasitic treatment to reduce inflammation and edema caused by dying parasites. The treatment approach varies based on the number, location, and viability of cysts, with some cases requiring surgical intervention for large cysts causing increased intracranial pressure 1.

Key Considerations

• For patients with 1-2 viable parenchymal cysticerci, albendazole monotherapy for 10-14 days is recommended, while for patients with >2 viable parenchymal cysticerci, albendazole combined with praziquantel for 10-14 days is recommended 1.
• Corticosteroids should be used whenever antiparasitic drugs are used to reduce inflammation and edema caused by dying parasites 1.
• Antiepileptic drugs should be used in all patients with seizures, and may need to be continued for 6-24 months 1.
• Treatment should be individualized based on the number and location of lesions, as well as the viability of the parasites within the nervous system 1.

Important Treatment Details

• Albendazole should be taken with food to enhance absorption 1.
• Corticosteroids, such as dexamethasone or prednisone, should be started 1-3 days before antiparasitic treatment and continued throughout therapy 1.
• Anticonvulsants, such as phenytoin, carbamazepine, or levetiracetam, should be prescribed for patients with seizures and may need to be continued for 6-24 months 1.
• Surgical intervention may be required for large cysts causing increased intracranial pressure 1.

From the FDA Drug Label

Table 1 AlbendazoleDosage Indication Patient Weight Dose Duration Hydatid Disease 60 kg or greater 400 mg twice daily, with meals 28-day cycle followed by a 14-day albendazole free interval, for a total of 3 cycles Less than 60 kg 15 mg/kg/day given in divided doses twice daily with meals (maximum total daily dose 800 mg) Neurocysticercosis 60 kg or greater 400 mg twice daily, with meals 8 to 30 days Less than 60 kg 15 mg/kg/day given in divided doses twice daily with meals (maximum total daily dose 800 mg)

1. 2 Concomitant Medication to Avoid Adverse Reactions Patients being treated for neurocysticercosis should receive appropriate steroid and anticonvulsant therapy as required. Oral or intravenous corticosteroids should be considered to prevent cerebral hypertensive episodes during the first week of treatment [see Warnings and Precautions (5.3)].

The recommended treatment for neurocysticercosis in the Philippines is albendazole. The dosage is as follows:

• For patients weighing 60 kg or greater: 400 mg twice daily with meals for 8 to 30 days.
• For patients weighing less than 60 kg: 15 mg/kg/day given in divided doses twice daily with meals (maximum total daily dose 800 mg). Patients being treated for neurocysticercosis should also receive steroid and anticonvulsant therapy as required, and oral or intravenous corticosteroids should be considered to prevent cerebral hypertensive episodes during the first week of treatment 2.

From the Research

Treatment Options for Neurocysticercosis in the Philippines

• The recommended treatment for neurocysticercosis involves a combination of antiparasitic therapy with praziquantel and albendazole, as evidenced by a double-blind, randomised controlled trial 3.
• Albendazole has been used successfully in the treatment of cerebral cysticercosis, with a recommended dose of 800 mg/day for 8 days 4.
• The optimal management approach varies with the stage of the disease, with single enhancing or cystic lesions treated with albendazole and steroids, and patients with more than two cystic lesions treated with combination therapy with albendazole and praziquantel 5.
• The American Academy of Neurology recommends albendazole therapy, administered with or without corticosteroids, as probably effective in decreasing both long-term seizure frequency and the number of cysts demonstrable radiologically in adults and children with neurocysticercosis 6.
• Pharmacokinetic interaction of albendazole sulfoxide with dexamethasone has been investigated, suggesting that dexamethasone decreases the rate of elimination of albendazole sulfoxide 7.

Considerations for Treatment in the Philippines

• The treatment approach should be individualized based on the patient's specific condition, including the location, number of lesions, and host response.
• Symptom management, including seizure control and management of increased intracranial pressure, is crucial in the initial therapy.
• Combination therapy with albendazole and praziquantel may be considered for patients with multiple cystic lesions.
• Surgical management may be necessary for patients with hydrocephalus, especially with minimally invasive approaches.