Background: Single small enhancing CT lesions (SSECTL) of brain with or without perifocal oedema are common in patients of symptomatic epilepsy in India. Solitary cysticercus granuloma, a benign form of parenchymal neurocysticercosis is considered to be the most common aetiology for SSECTL. Definite information is lacking regarding effectiveness of antiparasitic treatment on resolution of these lesions and on long term seizure recurrence.
Objective: To evaluate response to albendazole treatment in patients who had SSECTL and new onset seizures treated with antiepileptic drugs (AED) in a prospective clinical trial.
Methods: Forty-three patients who presented with new onset seizures and documented to have SSECTL were alternatively allocated to receive albendazole 15 mg/kg/day for two weeks or no cysticidal therapy. All patients were treated with AED and followed for at least 6 months for seizure recurrence and serial CT scans were obtained at 4 weeks, 3 months and at study completion.
Results: Twenty-eight (65%) patients were in the age group 5-25 years and 31 (72%) patients clinically presented with partial motor seizures with or without generalisation. Most of the SSECTL were ring lesion (75%) and located in and around the sensory-motor cortex at gray-white junction (65%). In the albendazole group, 56% patients compared to 35% in the control group showed resolution of SSECTL (P = 0.154) at 1 month. Twenty-two of 23 patients (95.6%), who received albendazole as opposed to 14 of 20 patients (70%) in the control group demonstrated radiological resolution upon study completion (P = 0.03). Punctate residual calcification and seizure recurrence were observed in 4 patients (9.3%) in the control group and 3 (7%) patients in the albendazole group (P = 0.47).
Conclusions: Patients presenting with seizures due to single viable parenchymal NCC, albendazole hastens resolution of SSECTL if treatment is given in the early phase of illness.
- Single small enhancing CT lesions (SSECTL)
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