Clinical spectrum of 500 children with neurocysticercosis and response to albendazole therapy

Neurocysticercosis is a major cause of neurologic illness worldwide. Its ma nifestations are variable, and somewhat different when it occurs in childre n. Controversy exists regarding anticysticercal therapy. The clinical, labo ratory, and radiographic features of 500 consecutive children with neurocys ticercosis were studied; the children were then followed prospectively and their response to albendazole therapy was analyzed. Diagnosis of neurocysti cercosis was based primarily on neuroimaging. Computed tomographic (CT) sca ns, neurocysticercosis serology chest radiographs, and Mantoux tests were d one in all children, and magnetic resonance imaging scans in 10%. Ail child ren with multiple lesions, and some randomly allocated children with single , small, enhancing CT lesions received albendazole. CT scans were repeated after 3 to 6 months. There were 272 boys and 228 girls, age range 16/12 to 126/12 years. Seizures were present in 94.8% of cases; 83.7% had focal seiz ures, Features of raised intracranial pressure were seen in 30% of patients and focal neurodeficit in 4%. Single lesions were seen in 76% of the child ren, with perilesional edema in 57.4%. Thirty-four children who had multipl e cysts and received albendazole underwent serial CT evaluation. Four showe d disappearance of lesions and 22 had reductions in the size or number, to give an overall improvement rate of 76%. Serial CT studies were available o n 176 children with single lesions, 90 of whom received albendazole. Improv ement (disappearance or reduction in the size of lesions) was observed in 9 1% (82 of 90) of albendazole-treated children versus 85% (73 of 86) of untr eated children. This difference was not significant. No significant side-ef fects of albendazole were reported. These data indicate that partial seizur es and single parenchymal cysts are the most frequent clinical and neurorad iographic manifestations of neurocysticercosis in children. Although albend azole therapy should be considered, especially in children with multiple le sions, many children with isolated neurocysticercosis will improve without antiparasitic therapy.