TY - JOUR
T1 - The effectiveness of anti-inflammatory and anti-seizure medication for individuals with single enhancing lesion neurocysticercosis
T2 - A meta-analysis and expert group-based consensus recommendations
AU - Abraham, Annette
AU - Bustos, Javier A.
AU - Carabin, Hélène
AU - de Meijere, Robert
AU - Sahu, Priyadarshi S.
AU - Rajshekhar, Vedantam
AU - Singh, Gagandeep
AU - Clinton White, A.
AU - Chiodini, Peter L.
AU - Gabriël, Sarah
AU - Homeida, Mamoun
AU - Nash, Theodore
AU - Ngowi, Bernard
AU - Zhou, Xiao Nong
AU - Coyle, Christina
AU - Garcia, Hector H.
AU - Winkler, Andrea S.
N1 - Funding Information:
AA and JB received temporary consultancy fees from WHO and AA was partially funded by the German Federal Ministry of Education and Research (BMBF) [The Lancet One Health Commission 01KA1912]. We also acknowledge funding by BMBF [CYSTINET-Africa 01KA1618] supporting AA, ASW (Germany) and BN (Tanzania) and generating knowledge of neurocysticercosis management that contributed to the current systematic review and metanalysis as well as to the development of the WHO neurocysticercosis management guidelines. JB and HGG further acknowledge partial support by the Fogarty International Center (NIH Training grant D43 TW001140), Tropical Medicine Research Center Program (NIAID-NIH grant U19AI129909) and (NIAID-NIH grant 1R01AI116456-01). TN was supported by Intramural research program of the NIH. HC is funded by the Canada Research Chair in Epidemiology and One Health (CIHR/IRSC CRC 950-231857) and PSS was supported by the Indian council of Medical Research under Ad-hoc Research Grant (Neuroscience) (IRIS ID:2010- 10530). This work was supported by WHO. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© 2021 Abraham et al.
PY - 2021/3
Y1 - 2021/3
N2 - 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 antiseizure 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.
AB - 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 antiseizure 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.
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U2 - 10.1371/journal.pntd.0009193
DO - 10.1371/journal.pntd.0009193
M3 - Article
C2 - 33788843
AN - SCOPUS:85104424726
SN - 1935-2727
VL - 15
JO - PLoS neglected tropical diseases
JF - PLoS neglected tropical diseases
IS - 3
M1 - e0009193
ER -
