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Enhanced steroid dosing reduces seizures during antiparasitic treatment for cysticercosis and early after

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dc.contributor.author García Lescano, Héctor Hugo
dc.contributor.author Gonzales, Isidro
dc.contributor.author Lescano Guevara, Andres Guillermo
dc.contributor.author Bustos Palomino, Javier Arturo
dc.contributor.author Pretell, E.Javier
dc.contributor.author Saavedra Pastor, Herbert
dc.contributor.author Nash, Theodore E.
dc.contributor.author The Cysticercosis Working Group in Peru
dc.date.accessioned 2022-01-04T20:29:57Z
dc.date.available 2022-01-04T20:29:57Z
dc.date.issued 2014
dc.identifier.uri https://hdl.handle.net/20.500.12866/10450
dc.description.abstract Objective: Neurocysticercosis (NCC) is a major cause of seizures and epilepsy in endemic countries. Antiparasitic treatment of brain cysts leads to seizures due to the host's inflammatory reaction, requiring concomitant steroids. We hypothesized that increased steroid dosing will reduce treatment-associated seizures. Methods: Open-label randomized trial comparing 6 mg/day dexamethasone for 10 days (conventional) with 8 mg/day for 28 days followed by a 2-week taper (enhanced) in patients with NCC receiving albendazole. Follow-up included active seizure surveillance and brain imaging. Study outcomes were seizure days and patients with seizures, both measured in days 11–42. Additional analyses compared days 1–10, 11–21, 22–32, 33–42, 43–60, and 61–180. Results: Thirty-two individuals were randomized into each study arm; two did not complete follow-up. From days 11 to 42, 59 partial and 6 generalized seizure days occurred in 20 individuals, nonsignificantly fewer in the enhanced arm (12 vs. 49, p = 0.114). The numbers of patients with seizures in this period showed similar nonsignificant differences. In the enhanced steroid arm there were significantly fewer days and individuals with seizures during antiparasitic treatment (days 1–10: 4 vs. 17, p = 0.004, and 1 vs. 10, p = 0.003, number needed to treat [NNT] 4.6, relative risk [RR] 0.1013, 95% confidence interval [CI] 0.01–0.74) and early after dexamethasone cessation (days 11–21: 6 vs. 27, p = 0.014, and 4 vs. 12, p = 0.021, NNT 4.0, RR 0.33, 95% CI 0.12–0.92) but not after day 21. There were no significant differences in antiparasitic efficacy or relevant adverse events. Significance: Increased dexamethasone dosing results in fewer seizures for the first 21 days during and early after antiparasitic treatment for viable parenchymal NCC but not during the first 11–42 days, which was the primary predetermined time of analysis. en_US
dc.language.iso eng
dc.publisher Wiley
dc.relation.ispartofseries Epilepsia
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Cysticercosis en_US
dc.subject Neurocysticercosis en_US
dc.subject Seizures en_US
dc.subject Epilepsy en_US
dc.subject Taenia solium en_US
dc.subject Cestodes en_US
dc.subject Peru en_US
dc.title Enhanced steroid dosing reduces seizures during antiparasitic treatment for cysticercosis and early after en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1111/epi.12739
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.25
dc.relation.issn 1528-1167


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