Universidad Peruana Cayetano Heredia

The effectiveness of anti-inflammatory and anti-seizure medication for individuals with single enhancing lesion neurocysticercosis: A meta-analysis and expert group-based consensus recommendations

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dc.contributor.author Abraham, Annette
dc.contributor.author Bustos Palomino, Javier Arturo
dc.contributor.author Carabin, Hélène
dc.contributor.author de Meijere, Robert
dc.contributor.author Sahu, Priyadarshi S.
dc.contributor.author Rajshekhar, Vedantam
dc.contributor.author Singh, Gagandeep
dc.contributor.author White, A. Clinton Jr
dc.contributor.author Chiodini, Peter L.
dc.contributor.author Gabriël, Sarah
dc.contributor.author Homeida, Mamoun
dc.contributor.author Nash, Theodore
dc.contributor.author Ngowi, Bernard
dc.contributor.author Zhou, Xiao Nong
dc.contributor.author Coyle, Christina
dc.contributor.author García Lescano, Héctor Hugo
dc.contributor.author Winkler, Andrea S.
dc.date.accessioned 2021-04-13T20:51:04Z
dc.date.available 2021-04-13T20:51:04Z
dc.date.issued 2021
dc.identifier.uri https://hdl.handle.net/20.500.12866/9234
dc.description.abstract Single brain enhancing lesions (SEL) are the most common presentation of neurocysticercosis (NCC) observed on neuroimaging in people presenting with epileptic seizures not only on the Indian sub-continent and in travelers returning from cysticercosis-endemic regions, but also globally. The aim of this study, which consisted of a systematic review (CRD42019087665), a meta-analysis and an expert group consultation, was to reach consensus on the best anti-seizure medication and anti-inflammatory treatment for individuals with SEL NCC. Standard literature review methods were used, including the Cochrane risk of bias random effects model, meta-analyses were performed and the quality of the body of evidence was rated using GRADE tables. The expert committee included 12 gender and geographically balanced members and recommendations were reached by applying the GRADE framework for guideline development. The 1-1.5-year cumulative incidence of seizure recurrence, cyst resolution or calcification following anti-seizure medication (ASM) withdrawal was not statistically different between ASM of 6, 12 or 24 months. In contrast, in persons whose cyst calcified post treatment, longer ASM decreased seizure recurrence. The cumulative incidence ratio (CIR) 1-1.5 years after stopping ASM was 1.79 95% CI: (1.00, 3.20) for patients given 6 versus 24 months treatment. Duration of treatment had no effect on seizure recurrence in patients whose cyst did not calcify. Anti-inflammatory treatment with corticosteroids in patients treated with ASM compared to patients treated with ASM only showed a statistically significant beneficial effect on seizure reduction (CIR 0.44, 95% CI 0.23, 0.85) and cyst resolution (CIR 1.37, 95%CI: 1.07, 1.75). Our results indicate that ASM in patients with SEL NCC whose cysts resolved can be withdrawn, while patients whose cysts calcified seem to benefit from prolonged anti-seizure medication. Additional corticosteroid treatment was found to have a beneficial effect both on seizure reduction and cyst resolution. en_US
dc.language.iso eng
dc.publisher Public Library of Science
dc.relation.ispartofseries PLoS Neglected Tropical Diseases
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Corticosteroid therapy en_US
dc.subject Lesions en_US
dc.subject Antiparasitic therapy en_US
dc.subject Medical risk factors en_US
dc.subject Calcification en_US
dc.subject Metaanalysis en_US
dc.subject Drug therapy en_US
dc.subject Granulomas en_US
dc.title The effectiveness of anti-inflammatory and anti-seizure medication for individuals with single enhancing lesion neurocysticercosis: A meta-analysis and expert group-based consensus recommendations en_US
dc.type info:eu-repo/semantics/review
dc.identifier.doi https://doi.org/10.1371/journal.pntd.0009193
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.06
dc.relation.issn 1935-2735


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