Is antiparasitic treatment beneficial in chronic subarachnoid neurocysticercosis? A comparative case series

Is antiparasitic treatment beneficial in chronic subarachnoid neurocysticercosis? A comparative case series | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Is antiparasitic treatment beneficial in chronic subarachnoid neurocysticercosis? A comparative case series Mireia Angerri-Nadal, Pablo Arroyo-Pereiro, Georgina Sauque, Ivan Pelegrin, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4577448/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Neurocysticercosis is particularly severe when affecting the subarachnoid space (SUBNCC). While antiparasitic therapy effectively controls the infection, it can lead to significant complications. This study aims to characterize a cohort of patients with SUBNCC, with a focus on their clinical course depending on therapeutic interventions. We conducted an observational, retrospective study involving patients diagnosed with SUBNCC at a tertiary hospital between 1985 and 2022. The primary endpoint was to delineate the clinical progression and demographic features of the cohort. A secondary objective was to compare relapse rates between patients receiving antiparasitic treatment and those who did not. Fifteen patients were included, with a median age of 31 years, mainly from South America. Approximately 46.7% of patients experienced at least one relapse, with rates of 46% in patients initially treated with antiparasitic medication and 50% in those treated with steroids alone. Complication rates were similar between both groups. Comparison of time to relapse revealed no statistically significant difference (17/27 treated with antiparasitic medication versus 10/27 with corticosteroids only; p=0.39). In patients with SUBNCC, clinical relapses managed with corticosteroids alone do not appear to result in worse outcomes in terms of complications and relapse rates compared to those managed with antiparasitic medication. Biological sciences/Microbiology/Antimicrobials/Antiparasitic agents Health sciences/Neurology/Neurological disorders Neurocysticercosis Subarachnoid Space Complications Antiparasitic Agents Recurrence. Figures Figure 1 Figure 2 Figure 3 Introduction Neurocysticercosis (NCC) stands as the predominant parasitic affliction of the Central Nervous System (CNS), attributable to the larval stage of the pork tapeworm Taenia solium . Its endemicity is notably concentrated in low-income countries characterized by inadequate excreta disposal and free-ranging pig husbandry, posing a substantial public health challenge across Latin America, Asia, and sub-Saharan Africa 1 . The escalating immigration from these regions has notably increased in the incidence of NCC cases within countries with low local transmission rates 2 . Clinical presentations of NCC vary depending on number, inflammation and anatomical location of the cystic lesions. Cysts within the brain parenchyma predominantly precipitate seizures, whereas extraparenchymal manifestations, such as ventricular or subarachnoid cysts (SUBNCC), may impede cerebrospinal fluid circulation, culminating in hydrocephalus and intracranial hypertension 1,3 . SUBNCC confers a heightened risk of morbidity and mortality 4 . Differing from parenchymal NCC, extraparenchymal NCC comprises structurally aberrant, slowly proliferating T. solium cysts devoid of scolex, typically organizing into conglomerates with a racemose appearance 5 . The prolonged incubation period is characteristic owing to the slow growth. Eventually, cystic expansion may elicit mass effects; however, characteristic symptoms predominantly arise from an inflammatory arachnoiditis provoked by the host's response to deteriorating cysts. Subsequent stages may involve inactive disease, which may occur spontaneously or as a result of effective treatment 6,7 . Paradoxically, treatment may incite host inflammatory reactions directed towards injured parasites, causing clinical manifestations similar to the infection itself 8,9 . Instances of cerebral infarction ensuing from antiparasitic therapy-induced angiitis have been documented 10 . High-dose corticosteroids are widely advocated to forestall treatment-induced inflammation, especially in cases of vasculitis or giant subarachnoid cysts, which pose heightened risks of stroke 11–13 . Notably, the 2017 clinical practice guidelines for NCC management accentuates the imperative of initially tempering inflammation with high-dose corticosteroids before commencing antiparasitic therapy 14 . In routine clinical practice, patients with SUBNCC often present with clinical manifestations linked to persistent inflammation caused by cyst locations susceptible to dreadful consequences upon degeneration. In such scenarios, antiparasitic therapy can precipitate adverse outcomes, leading clinicians to opt for corticosteroid treatment exclusively. In light of these considerations, this study endeavors to delineate the clinical trajectory and therapeutic management of a cohort of SUBNCC patients, discerning whether those subjected to antiparasitic therapy manifest disparate clinical outcomes relative to those administered corticosteroid monotherapy. Methods In this single-center, observational, retrospective study, we enrolled consecutive patients diagnosed with SUBNCC at a tertiary hospital between November 1985 and July 2022. Inclusion criteria encompassed patients meeting published NCC diagnostic criteria 15 and seeking medical attention related to the infection. Cases lacking subarachnoid involvement or pertinent information were excluded. All data were extracted by two different physicians through individual review of each patient’s medical records. Variables gathered for each patient included: age, gender, birthplace, immigration date, date of clinical onset and diagnosis, signs and symptoms, cysts location, serology results, treatment, complications, and relapses. Relapses were defined as any new neurological clinical expression attributable to SUBNCC or acute changes in neuroimaging that motivated a treatment choice. All neuroimaging was obtained by magnetic resonance imaging (MRI), most of them in a 1’5T or 3T scanner, with a variable frequency depending on the medical needs of each case. All the scans included at least T1, T2, fluid-attenuated inversion recovery (FLAIR), diffusion-weighted, and enhanced T1-weighted sequences. Cestode antigen analyses were predominantly conducted utilizing an enzyme-linked immunosorbent assay (ELISA) assay, facilitated by the laboratory facilities within our institution. The sensitivity of these assays was established to be ≥2. Lumbar punctures were performed selectively guided by clinical necessity, primarily for differential diagnostic purposes, rather than as routine procedures before and after treatment initiation. Treatment strategies were individualized, with decisions made collaboratively by neurologists and infectologists, taking into consideration various factors such as the clinical status of the patient, cyst location, and the potential risk of vascular involvement during relapse. Antiparasitic therapy typically consisted of albendazole administered at a dosage of 15mg/kg/day either as monotherapy or in combination with praziquantel (albendazole 15 mg/kg/day plus praziquantel 50 mg/kg/day) 14 . Concurrent administration of high-dose corticosteroids was employed, with subsequent tapering regimens aligned with established treatment guidelines. Patients were closely followed up during and post-treatment, and patients with the highest risks due to cyst locations were admitted at the hospital for strict treatment follow-up. The primary endpoint was to describe the clinical evolution and demographic characteristics of patients with SUBNCC. A secondary endpoint compared relapses based on whether patients received antiparasitic treatment or not. Statistical methods Primary endpoint was assessed using a descriptive analysis. Categorical variables were presented as absolute frequencies. Demographic and clinical variables were presented as median and ranges or mean and standard deviation according to the distribution. For the secondary comparative analysis, Kaplan-Meier survival analysis and Cox regression test were performed to assess the time to relapse in each group. All tests were studied with confidence intervals of 95% and a significance level of 5%. Statistical analyses were performed in SPSS v.22 (SPSS Inc, Chicago, USA). Ethical standards This study was approved by the local Research Ethics Committee, with reference PR080/24. Exemption of informed consent was approved. Data were collected anonymously. Patient information confidentiality was handled in accordance with Spanish regulations. Results An initial registry of 38 patients with NCC was obtained after individual case review. Twenty-one were excluded for lacking subarachnoid involvement, and one patient was excluded for lacking relevant information. A total of 15 patients with SUBNCC were finally included (see Figure 1). The median age of patients at diagnosis was 30.1 years (range 24-54 years), with eight of them being women (53%). The most frequent birthplaces were Bolivia, Ecuador, and Honduras, with a median time since immigration of 8.1 years (range 3-16 years). Demographic and clinical variables are summarized in Table 1. Headache and seizures were the most common initial clinical presentations. MRI revealed concomitant parenchymal involvement in most cases (13/15, 87%). Antiparasitic treatment at the initial episode was mainly albendazole (13/15, 87%), except for two patients where antiparasitic treatment was ruled out due to elevated cerebrovascular risk. The mean follow-up time was 11.3 years (range 1-30 years). A total of seven patients (46.7%) experienced at least one relapse. The recurrence rate was 46% (6/13) for patients receiving antiparasitic treatment at onset, versus 50% (1/2) for patients treated with steroids alone. Complications and management details, including relapses, are described in Table 2. A swimmer plot of patients’ follow-up and events is depicted in Figure 2. Regarding complications, two patients required ventriculoperitoneal shunts (VPS) at disease onset, and one patient suffered a stroke after receiving antiparasitic treatment. During follow-up, two other cases required a VPS, and one case was diagnosed with vasculitis secondary to SUBNCC. A secondary analysis compared time to relapse between episodes treated with antiparasitic treatment versus corticosteroids only. A total of 27 episodes were registered, with 17 treated with antiparasitic treatment and 10 with corticosteroids only. The median time to relapse in the antiparasitic treated group was 6.7 years versus 2.9 years for the corticosteroid treated group, with no statistical difference between groups (LL=-30.77, Chi2(df=1)=0.73, p=0.39) (Figure 3). Regarding complications, in the antiparasitic treated group, three patients needed a VPS and one experienced a stroke due to treatment; whereas two patients needed a VPS in the corticosteroid treated group. One patient in the corticosteroid group suffered bilateral osteonecrosis of the knee. Discussion We present a retrospective series of 15 patients with SUBNCC treated at a Spanish hospital over a period of more than 30 years. Given the chronic nature and high recurrence rate of the disease, long-term follow-up of patients is crucial. Our results regarding patients’ demographics and clinical presentation are consistent with published data 4,7 , reinforcing the importance of considering this diagnosis in young immigrant patients from endemic areas who present with headache, seizures, or other neurological manifestations of unknown origin. The proportion of relapses in our cohort was similar to previously reported case series 4,16 . Nearly half of the patients experienced at least one relapse, typically manifesting as lymphocytic meningitis, with some cases necessitating VPS to control secondary hydrocephalus. Most clinical episodes were managed with antiparasitic treatment both at the onset and during relapse. No difference was observed in relapse rates between patients initially treated with antiparasitic medication and those who were not, although the distribution of cases in each group was notably heterogeneous (14 cases vs. 2, respectively). Moreover, the follow-up times until recurrence or loss to follow-up were uneven and notably shorter in the 2 patients initially treated with corticosteroid therapy. Consequently, a survival analysis method was used considering each clinical episode independently, comparing the time to new relapses between episodes treated with antiparasitic agents (17 cases) and those treated with steroids alone (10 cases). Similarly, no statistically significant differences were observed between the two therapeutic approaches. In a randomized controlled trial conducted in 2008 to evaluate the efficacy of albendazole treatment in patients with NCC 17 , a group of 57 patients receiving albendazole was compared with a placebo group of 90 patients, both of which received corticosteroids. While a clear advantage was noted in the disappearance of active cysts by 12 months in the albendazole group when analyzing the entire sample, this difference was not significant when considering only cases of SUBNCC. Subsequently, another study was conducted with the same sample 18 , assessing the effects of albendazole treatment on non-seizure outcomes in symptomatic NCC patients. Although patients treated with albendazole exhibited significantly lower odds of memory loss and confusion, and increased odds of affective disorders, no differences were observed in the incidence of new headaches or neurological deficits between the two groups, suggesting that the clinical benefits of anthelmintic treatment remain uncertain. Complications observed in our cohort were consistent with those reported in prior studies 7 , indicating no significant differences in the incidence of complications between patients treated with antiparasitic agents and those who were not. In our cohort, four patients required VPS placement during follow-up, and one patient experienced central nervous system vasculitis. However, the most significant complication observed was stroke associated with antiparasitic treatment. Such complications are particularly concerning given their potential severity in young, productive patients; therefore, it is crucial to prioritize the prevention of iatrogenic harm, to minimize the risk of these adverse outcomes. Several limitations must be acknowledged that may affect the generalizability of the study results. Firstly, the retrospective design of the study may result in missing important clinical details or unrecorded episodes. Additionally, there was no documentation of corticosteroid dosages, timing of treatment initiation, or tapering schedules. Furthermore, the small sample size, heterogeneity of cyst locations and clinical characteristics, and unequal distribution of treated and untreated patients may also influence the study outcomes. This study does not provide definitive conclusions regarding the prioritization of inflammation control over infection treatment in SUBNCC. However, it initiates a debate regarding whether all cases of SUBNCC truly benefit from antiparasitic treatment, as there are no discernible differences supporting one therapeutic strategy over another, while the potential iatrogenic effects of antiparasitic therapy in this patient subgroup can be significant. We would suggest treating the patients with antiparasitic drugs at the debut, but maybe to treat relapses only with steroids. To establish more robust conclusions, further studies with larger sample sizes are warranted, ideally employing a randomized clinical trial design comparing patients receiving cysticidal treatment versus corticosteroids alone. Conclusion In patients with SUBNCC, clinical relapses treated with steroids alone do not appear to result in worse outcomes in terms of complications and relapses compared to those treated with antiparasitic medication. Declarations Data availability The datasets used and/or analysed during this study are available from the corresponding author on reasonable request from any qualified investigator. Acknowledgements We would like to express our deep gratitude to all the team in the Neurology and Infectious Disease department for their continuous, excellent work. We would also like to thank all the patients who participated in this study. We thank CERCA Programme / Generalitat de Catalunya for institutional support. Author contributions statement AMV and MSY conceptualized and designed the study. MAN, GS and IP collected the data. MAN drafted the initial manuscript. PAP performed data analysis, interpreted the results and critically revised the manuscript. AMY and CC critically revised the manuscript. AMV and SMY interpreted the results, critically revised the manuscript and supervised the process. All authors read and approved the final manuscript. Additional information Competing interests Pablo Arroyo-Pereiro, Antonio Martínez-Yélamos, Sergio Martínez-Yélamos and Albert Muñoz-Vendrell have received honoraria from Teva, Lilly, Lundbeck, Roche, UCB, Bial, Chiesi, Allergan, Esai, Zambon, Kern Pharma, Pfizer, Biogen Idec, Bristol Myers Squibb, Novartis, TEVA, Merck, Janssen, Neuraxpharm, Genzyme, Sanofi, Bayer, Almirall and/or Celgene. Mireia Angerri-Nadal, Georgina Sauque, Ivan Pelegrin and Carmen Cabellos have no conflicts of interest to declare. Funding This study did not receive any specific grants from funding agencies in the public, commercial, or non-proft sectors. References Garcia, H. H., Nash, T. E. & Del Brutto, O. H. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol 13, 1202–1215 (2014). Zammarchi, L. et al. Epidemiology and Management of Cysticercosis and Taenia solium Taeniasis in Europe, Systematic Review 1990–2011. PLoS One 8, (2013). Garcia, H. H., Gonzalez, A. E. & Gilman, R. H. Cysticercosis of the central nervous system: How should it be managed? Curr Opin Infect Dis 24, 423–427 (2011). Fleury, A., Carrillo-Mezo, R., Flisser, A., Sciutto, E. & Corona, T. Subarachnoid basal neurocysticercosis: A focus on the most severe form of the disease. Expert Rev Anti Infect Ther 9, 123–133 (2011). J Valkounová, Z Zdárská, J. S. Histochemistry of the racemose form of Cysticercus cellulosae. Folia Parasitol (Praha) 39, 207–226 (1992). Nash, T. E. & O’Connell, E. M. Subarachnoid neurocysticercosis: emerging concepts and treatment. Curr Opin Infect Dis 33, 339–346 (2020). Nash, T. E. et al. Natural history of treated subarachnoid neurocysticercosis. American Journal of Tropical Medicine and Hygiene 102, 78–89 (2020). Nash, T. E., Ware, J. A. M., Coyle, C. M. & Mahanty, S. Etanercept to control inflammation in the treatment of complicated neurocysticercosis. American Journal of Tropical Medicine and Hygiene 100, 609–616 (2019). Cangalaya, C. et al. Inflammation Caused by Praziquantel Treatment Depends on the Location of the Taenia solium Cysticercus in Porcine Neurocysticercosis. PLoS Negl Trop Dis 9, 1–13 (2015). Bang OY, Heo JH, Choi SA, K. DI. Large cerebral infarction during praziquantel therapy in neurocysticercosis. Stroke 28, 211–213 (1997). Hamamoto Filho, P. T., Rodríguez-Rivas, R. & Fleury, A. Neurocysticercosis: A Review into Treatment Options, Indications, and Their Efficacy. Res Rep Trop Med Volume 13, 67–79 (2022). Garcia, H. H. & Del Brutto, O. H. Neurocysticercosis: Updated concepts about an old disease. Lancet Neurology 4, 653–661 (2005). Nash, T. E., Mahanty, S. & Garcia, H. H. Corticosteroid use in neurocysticercosis. Expert Rev Neurother 11, 1175–1183 (2011). White, A. C. et al. Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clinical Infectious Diseases 66, e49–e75 (2018). Del Brutto, O. H. et al. Revised diagnostic criteria for neurocysticercosis. J Neurol Sci 372, 202–210 (2017). Osorio, R. et al. Factors Associated With Cysticidal Treatment Response in Extraparenchymal Neurocysticercosis. J Clin Pharmacol 59, 548–556 (2019). Carpio, A. et al. Effects of albendazole treatment on neurocysticercosis: A randomised controlled trial. J Neurol Neurosurg Psychiatry 79, 1050–1055 (2008). Thapa, K. et al. The effect of albendazole treatment on non-seizure outcomes in patients with symptomatic neurocysticercosis. Trans R Soc Trop Med Hyg 112, 73–80 (2018). Tables Table 1. Demographic and clinical variables. MRI: magnetic resonance imaging n = 15 Age at diagnosis in years [median (range)] 30.1 (24-54) Gender [n (%)] Male 7 (47) Female 8 (53) Birthplace [n (%)] Bolivia 5 (33) Ecuador 4 (27) Honduras 3 (20) Perú 2 (13) Spain 1 (7) Years from immigration [median (range)] 8.1 (16-3) Symptoms [n (%)] Headache 11 (73) Seizures 7 (47) Neurological deficit 4 (26) Other 3 (20) Cyst location in MRI [n (%)] Subarachnoid + parenchymal 13 (87) Subarachnoid 2 (13) Serum serologies [n (%)] 11 (73) Positive 7/11 (64) Negative 4/11 (36) Cerebrospinal fluid serologies [n (%)] 4 (27) Positive 3/4 (75) Negative 1/4 (15) Antiparasitic treatment, debut episode [n (%)] Albendazole 12 (80) Albendazole + Praziquantel 1 (7) None 2 (13) Table 2. Description of all the episodes and its treatment. Sex Age at diagnosis Cyst location Date Debut / relapse Clinical presentation Treatment Complications of treatment Patient 1 F 39 Subarachnoid + parenchymal 15/01/2001 Debut Seizure Albendazole Vasculitis and stroke. HC 17/03/2021 Relapse Headache, cyst progression in MRI Corticosteroids Patient 2 M 31 Subarachnoid 19/10/2012 Debut Lymphocytic meningitis Albendazole 20/06/2019 Relapse Lymphocytic meningitis and HC Corticosteroids 23/11/2021 Relapse Lymphocytic meningitis and seizures Corticosteroids 02/01/2023 Relapse Seizures, HC Corticosteroids + VPS Osteonecrosis of the knee Patient 3 F 25 Subarachnoid + parenchymal 10/09/2010 Debut Vasculitis and lymphocytic meningitis Albendazole 24/01/2017 Relapse Seizures Corticosteroids Patient 4 M 32 Subarachnoid + parenchymal 15/09/2009 Debut Aphasia Albendazole Patient 5 M 45 Subarachnoid + parenchymal 15/12/2003 Debut Seizure Albendazole Patient 6 F 41 Subarachnoid + parenchymal 15/03/2004 Debut Probable meningitis Albendazole 10/09/2004 Relapse Lymphocytic meningitis Praziquantel 17/06/2005 Relapse Vasculitis and stroke Corticosteroids Patient 7 F 37 Subarachnoid + parenchymal 04/06/2021 Debut Probable meningitis Corticosteroids Patient 8 F 34 Subarachnoid 13/03/2018 Debut HC Corticosteroids 18/02/2021 Relapse Lymphocytic meningitis and HC Corticosteroids + VPS 13/03/2021 Relapse Headache and cyst progression in MRI Corticosteroids Patient 9 M 40 Subarachnoid + parenchymal 23/03/2022 Debut Seizure Albendazole + Praziquantel Patient 10 F 30 Subarachnoid + parenchymal 30/01/2017 Debut Asymptomatic (cyst found in an MRI) Albendazole Patient 11 M 29 Subarachnoid + parenchymal 15/07/2010 Debut Lymphocytic meningitis and HC Albendazole + VPS 01/06/2016 Relapse Lymphocytic meningitis Albendazole 09/07/2016 Relapse Lymphocytic meningitis Albendazole + Praziquantel Patient 12 M 24 Subarachnoid + parenchymal 15/03/2023 Debut Seizure Albendazole Patient 13 F 36 Subarachnoid + parenchymal 30/08/2012 Debut Seizure Albendazole Patient 14 M 54 Subarachnoid + parenchymal 15/02/2007 Debut Aphasia Albendazole Patient 15 F 44 Subarachnoid + parenchymal 15/11/1993 Debut Seizure and HC Albendazole + VPS 02/08/1997 Relapse Arachnoiditis and HC Praziquantel M: Male, F: Female. IRM: magnetic resonance imaging. HC: hydrocephalus. VPS: Ventriculoperitoneal shunt Additional Declarations Competing interest reported. Pablo Arroyo-Pereiro, Antonio Martínez-Yélamos, Sergio Martínez-Yélamos and Albert Muñoz-Vendrell have received honoraria from Teva, Lilly, Lundbeck, Roche, UCB, Bial, Chiesi, Allergan, Esai, Zambon, Kern Pharma, Pfizer, Biogen Idec, Bristol Myers Squibb, Novartis, TEVA, Merck, Janssen, Neuraxpharm, Genzyme, Sanofi, Bayer, Almirall and/or Celgene. Mireia Angerri-Nadal, Georgina Sauque, Ivan Pelegrin and Carmen Cabellos have no conflicts of interest to declare. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4577448","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":320760972,"identity":"7e8940f8-e8c0-4d5e-94b2-b4b6cbd0778c","order_by":0,"name":"Mireia Angerri-Nadal","email":"","orcid":"","institution":"Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat","correspondingAuthor":false,"prefix":"","firstName":"Mireia","middleName":"","lastName":"Angerri-Nadal","suffix":""},{"id":320760973,"identity":"151c02c4-9d85-4277-af20-fa079ba66130","order_by":1,"name":"Pablo Arroyo-Pereiro","email":"data:image/png;base64,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","orcid":"","institution":"Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat","correspondingAuthor":true,"prefix":"","firstName":"Pablo","middleName":"","lastName":"Arroyo-Pereiro","suffix":""},{"id":320760974,"identity":"f2b2701f-486b-4b84-a96f-732185c72885","order_by":2,"name":"Georgina Sauque","email":"","orcid":"","institution":"Hospital Universitari Bellvitge-IDIBELL","correspondingAuthor":false,"prefix":"","firstName":"Georgina","middleName":"","lastName":"Sauque","suffix":""},{"id":320760975,"identity":"ed48e38b-a743-491c-8cfe-88b1b1b6ab20","order_by":3,"name":"Ivan Pelegrin","email":"","orcid":"","institution":"Hospital Universitari Bellvitge-IDIBELL","correspondingAuthor":false,"prefix":"","firstName":"Ivan","middleName":"","lastName":"Pelegrin","suffix":""},{"id":320760977,"identity":"8f42b75b-ca94-47f7-8e2d-de6d466a1488","order_by":4,"name":"Antonio Martínez-Yélamos","email":"","orcid":"","institution":"Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat","correspondingAuthor":false,"prefix":"","firstName":"Antonio","middleName":"","lastName":"Martínez-Yélamos","suffix":""},{"id":320760979,"identity":"812f4c26-12cc-4f09-9c6c-9d7e739f95d8","order_by":5,"name":"Sergio Martínez-Yélamos","email":"","orcid":"","institution":"Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat","correspondingAuthor":false,"prefix":"","firstName":"Sergio","middleName":"","lastName":"Martínez-Yélamos","suffix":""},{"id":320760980,"identity":"04313d98-ccb2-462d-8d8b-3d45a59a4a89","order_by":6,"name":"Carmen Cabellos","email":"","orcid":"","institution":"Hospital Universitari Bellvitge-IDIBELL","correspondingAuthor":false,"prefix":"","firstName":"Carmen","middleName":"","lastName":"Cabellos","suffix":""},{"id":320760982,"identity":"3bc87287-3e89-4b79-9fae-217f9ed02638","order_by":7,"name":"Albert Muñoz-Vendrell","email":"","orcid":"","institution":"Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat","correspondingAuthor":false,"prefix":"","firstName":"Albert","middleName":"","lastName":"Muñoz-Vendrell","suffix":""}],"badges":[],"createdAt":"2024-06-13 16:14:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4577448/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4577448/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60200277,"identity":"a9a4a06d-2488-4167-abbd-997d6a546cd4","added_by":"auto","created_at":"2024-07-13 02:32:30","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36167,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart for patient inclusion. NCC: Neurocysticercosis; SUBNCC: subarachnoid neurocysticercosis\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4577448/v1/d58e4e155461263c8a748212.jpg"},{"id":60200279,"identity":"699e4ecc-f0dd-400d-ad2a-c8540703d7f5","added_by":"auto","created_at":"2024-07-13 02:32:30","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36771,"visible":true,"origin":"","legend":"\u003cp\u003eSwimmer plot showing each patient’s follow-up, representing a timeline with a figure for each clinical episode and an x for the end of follow-up.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4577448/v1/65891086d9a370b2fce374bc.jpg"},{"id":60200278,"identity":"07d725ae-d3ae-4c1e-acd6-647457f7d23c","added_by":"auto","created_at":"2024-07-13 02:32:30","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":30143,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier surveillance showing time to next relapse after each clinical episode for both arms of treatment.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4577448/v1/44ceb41299af03e2f7af9794.jpg"},{"id":63386809,"identity":"a91b08a7-c0c7-45e3-912b-fe5f11c9220c","added_by":"auto","created_at":"2024-08-27 14:46:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":567449,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4577448/v1/1066380e-4deb-4c21-a083-2c5c54021c9b.pdf"}],"financialInterests":"Competing interest reported. Pablo Arroyo-Pereiro, Antonio Martínez-Yélamos, Sergio Martínez-Yélamos and Albert Muñoz-Vendrell have received honoraria from Teva, Lilly, Lundbeck, Roche, UCB, Bial, Chiesi, Allergan, Esai, Zambon, Kern Pharma, Pfizer, Biogen Idec, Bristol Myers Squibb, Novartis, TEVA, Merck, Janssen, Neuraxpharm, Genzyme, Sanofi, Bayer, Almirall and/or Celgene.\n\nMireia Angerri-Nadal, Georgina Sauque, Ivan Pelegrin and Carmen Cabellos have no conflicts of interest to declare.","formattedTitle":"Is antiparasitic treatment beneficial in chronic subarachnoid neurocysticercosis? A comparative case series","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNeurocysticercosis (NCC) stands as the predominant parasitic affliction of the Central Nervous System (CNS), attributable to the larval stage of the pork tapeworm \u003cem\u003eTaenia solium\u003c/em\u003e. Its endemicity is notably concentrated in low-income countries characterized by inadequate excreta disposal and free-ranging pig husbandry, posing a substantial public health challenge across Latin America, Asia, and sub-Saharan Africa \u003csup\u003e1\u003c/sup\u003e. The escalating immigration from these regions has notably increased in the incidence of NCC cases within countries with low local transmission rates \u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eClinical presentations of NCC vary depending on number, inflammation and anatomical location of the cystic lesions. Cysts within the brain parenchyma predominantly precipitate seizures, whereas extraparenchymal manifestations, such as ventricular or subarachnoid cysts (SUBNCC), may impede cerebrospinal fluid circulation, culminating in hydrocephalus and intracranial hypertension \u003csup\u003e1,3\u003c/sup\u003e. SUBNCC confers a heightened risk of morbidity and mortality \u003csup\u003e4\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDiffering from parenchymal NCC, extraparenchymal NCC comprises structurally aberrant, slowly proliferating \u003cem\u003eT. solium\u003c/em\u003e cysts devoid of scolex, typically organizing into conglomerates with a racemose appearance \u003csup\u003e5\u003c/sup\u003e. The prolonged incubation period is characteristic owing to the slow growth. Eventually, cystic expansion may elicit mass effects; however, characteristic symptoms predominantly arise from an inflammatory arachnoiditis provoked by the host's response to deteriorating cysts. Subsequent stages may involve inactive disease, which may occur spontaneously or as a result of effective treatment \u003csup\u003e6,7\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eParadoxically, treatment may incite host inflammatory reactions directed towards injured parasites, causing clinical manifestations similar to the infection itself \u003csup\u003e8,9\u003c/sup\u003e. Instances of cerebral infarction ensuing from antiparasitic therapy-induced angiitis have been documented \u003csup\u003e10\u003c/sup\u003e. High-dose corticosteroids are widely advocated to forestall treatment-induced inflammation, especially in cases of vasculitis or giant subarachnoid cysts, which pose heightened risks of stroke \u003csup\u003e11\u0026ndash;13\u003c/sup\u003e. Notably, the 2017 clinical practice guidelines for NCC management accentuates the imperative of initially tempering inflammation with high-dose corticosteroids before commencing antiparasitic therapy \u003csup\u003e14\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn routine clinical practice, patients with SUBNCC often present with clinical manifestations linked to persistent inflammation caused by cyst locations susceptible to dreadful consequences upon degeneration. In such scenarios, antiparasitic therapy can precipitate adverse outcomes, leading clinicians to opt for corticosteroid treatment exclusively.\u003c/p\u003e \u003cp\u003eIn light of these considerations, this study endeavors to delineate the clinical trajectory and therapeutic management of a cohort of SUBNCC patients, discerning whether those subjected to antiparasitic therapy manifest disparate clinical outcomes relative to those administered corticosteroid monotherapy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn this single-center, observational, retrospective study, we enrolled consecutive patients diagnosed with SUBNCC at a tertiary hospital between November 1985 and July 2022. Inclusion criteria encompassed patients meeting published NCC diagnostic criteria \u003csup\u003e15\u003c/sup\u003e and seeking medical attention related to the infection. Cases lacking subarachnoid involvement or pertinent information were excluded.\u003c/p\u003e\n\u003cp\u003eAll data were extracted by two different physicians through individual review of each patient\u0026rsquo;s medical records. Variables gathered for each patient included: age, gender, birthplace, immigration date, date of clinical onset and diagnosis, signs and symptoms, cysts location, serology results, treatment, complications, and relapses. Relapses were defined as any new neurological clinical expression attributable to SUBNCC or acute changes in neuroimaging that motivated a treatment choice.\u003c/p\u003e\n\u003cp\u003eAll neuroimaging was obtained by magnetic resonance imaging (MRI), most of them in a 1\u0026rsquo;5T or 3T scanner, with a variable frequency depending on the medical needs of each case. All the scans included at least T1, T2, fluid-attenuated inversion recovery (FLAIR), diffusion-weighted, and enhanced T1-weighted sequences. Cestode antigen analyses were predominantly conducted utilizing an enzyme-linked immunosorbent assay (ELISA) assay, facilitated by the laboratory facilities within our institution. The sensitivity of these assays was established to be \u0026ge;2. Lumbar punctures were performed selectively guided by clinical necessity, primarily for differential diagnostic purposes, rather than as routine procedures before and after treatment initiation. Treatment strategies were individualized, with decisions made collaboratively by neurologists and infectologists, taking into consideration various factors such as the clinical status of the patient, cyst location, and the potential risk of vascular involvement during relapse. Antiparasitic therapy typically consisted of albendazole administered at a dosage of 15mg/kg/day either as monotherapy or in combination with praziquantel (albendazole 15 mg/kg/day plus praziquantel 50 mg/kg/day) \u003csup\u003e14\u003c/sup\u003e. Concurrent administration of high-dose corticosteroids was employed, with subsequent tapering regimens aligned with established treatment guidelines. Patients were closely followed up during and post-treatment, and patients with the highest risks due to cyst locations were admitted at the hospital for strict treatment follow-up.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe primary endpoint was to describe the clinical evolution and demographic characteristics of patients with SUBNCC. A secondary endpoint compared relapses based on whether patients received antiparasitic treatment or not.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary endpoint was assessed using a descriptive analysis. Categorical variables were presented as absolute frequencies. Demographic and clinical variables were presented as median and ranges or mean and standard deviation according to the distribution. For the secondary comparative analysis, Kaplan-Meier survival analysis and Cox regression test were performed to assess the time to relapse in each group. All tests were studied with confidence intervals of 95% and a significance level of 5%. Statistical analyses were performed in SPSS v.22 (SPSS Inc, Chicago, USA).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the local Research Ethics Committee, with reference PR080/24. Exemption of informed consent was approved. Data were collected anonymously. Patient information confidentiality was handled in accordance with Spanish regulations.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAn initial registry of 38 patients with NCC was obtained after individual case review. Twenty-one were excluded for lacking subarachnoid involvement, and one patient was excluded for lacking relevant information. A total of 15 patients with SUBNCC were finally included (see Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe median age of patients at diagnosis was 30.1 years (range 24-54 years), with eight of them being women (53%). The most frequent birthplaces were Bolivia, Ecuador, and Honduras, with a median time since immigration of 8.1 years (range 3-16 years).\u003c/p\u003e\n\u003cp\u003eDemographic and clinical variables are summarized in Table 1. Headache and seizures were the most common initial clinical presentations. MRI revealed concomitant parenchymal involvement in most cases (13/15, 87%). Antiparasitic treatment at the initial episode was mainly albendazole (13/15, 87%), except for two patients where antiparasitic treatment was ruled out due to elevated cerebrovascular risk. The mean follow-up time was 11.3 years (range 1-30 years).\u003c/p\u003e\n\u003cp\u003eA total of seven patients (46.7%) experienced at least one relapse. The recurrence rate was 46% (6/13) for patients receiving antiparasitic treatment at onset, versus 50% (1/2) for patients treated with steroids alone. Complications and management details, including relapses, are described in Table 2. A swimmer plot of patients\u0026rsquo; follow-up and events is depicted in Figure 2.\u003c/p\u003e\n\u003cp\u003eRegarding complications, two patients required ventriculoperitoneal shunts (VPS) at disease onset, and one patient suffered a stroke after receiving antiparasitic treatment. During follow-up, two other cases required a VPS, and one case was diagnosed with vasculitis secondary to SUBNCC. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA secondary analysis compared time to relapse between episodes treated with antiparasitic treatment versus corticosteroids only. A total of 27 episodes were registered, with 17 treated with antiparasitic treatment and 10 with corticosteroids only. The median time to relapse in the antiparasitic treated group was 6.7 years versus 2.9 years for the corticosteroid treated group, with no statistical difference between groups (LL=-30.77, Chi2(df=1)=0.73, p=0.39) (Figure 3). Regarding complications, in the antiparasitic treated group, three patients needed a VPS and one experienced a stroke due to treatment; whereas two patients needed a VPS in the corticosteroid treated group. One patient in the corticosteroid group suffered bilateral osteonecrosis of the knee. \u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe present a retrospective series of 15 patients with SUBNCC treated at a Spanish hospital over a period of more than 30 years. Given the chronic nature and high recurrence rate of the disease, long-term follow-up of patients is crucial. Our results regarding patients’ demographics and clinical presentation are consistent with published data \u003csup\u003e4,7\u003c/sup\u003e, reinforcing the importance of considering this diagnosis in young immigrant patients from endemic areas who present with headache, seizures, or other neurological manifestations of unknown origin.\u003c/p\u003e\n\u003cp\u003eThe proportion of relapses in our cohort was similar to previously reported case series \u003csup\u003e4,16\u003c/sup\u003e. Nearly half of the patients experienced at least one relapse, typically manifesting as lymphocytic meningitis, with some cases necessitating VPS to control secondary hydrocephalus. Most clinical episodes were managed with antiparasitic treatment both at the onset and during relapse.\u003c/p\u003e\n\u003cp\u003eNo difference was observed in relapse rates between patients initially treated with antiparasitic medication and those who were not, although the distribution of cases in each group was notably heterogeneous (14 cases vs. 2, respectively). Moreover, the follow-up times until recurrence or loss to follow-up were uneven and notably shorter in the 2 patients initially treated with corticosteroid therapy. Consequently, a survival analysis method was used considering each clinical episode independently, comparing the time to new relapses between episodes treated with antiparasitic agents (17 cases) and those treated with steroids alone (10 cases). Similarly, no statistically significant differences were observed between the two therapeutic approaches.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn a randomized controlled trial conducted in 2008 to evaluate the efficacy of albendazole treatment in patients with NCC \u003csup\u003e17\u003c/sup\u003e, a group of 57 patients receiving albendazole was compared with a placebo group of 90 patients, both of which received corticosteroids. While a clear advantage was noted in the disappearance of active cysts by 12 months in the albendazole group when analyzing the entire sample, this difference was not significant when considering only cases of SUBNCC. Subsequently, another study was conducted with the same sample \u003csup\u003e18\u003c/sup\u003e, assessing the effects of albendazole treatment on non-seizure outcomes in symptomatic NCC patients. Although patients treated with albendazole exhibited significantly lower odds of memory loss and confusion, and increased odds of affective disorders, no differences were observed in the incidence of new headaches or neurological deficits between the two groups, suggesting that the clinical benefits of anthelmintic treatment remain uncertain. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eComplications observed in our cohort were consistent with those reported in prior studies \u003csup\u003e7\u003c/sup\u003e, indicating no significant differences in the incidence of complications between patients treated with antiparasitic agents and those who were not. In our cohort, four patients required VPS placement during follow-up, and one patient experienced central nervous system vasculitis. However, the most significant complication observed was stroke associated with antiparasitic treatment. Such complications are particularly concerning given their potential severity in young, productive patients; therefore, it is crucial to prioritize the prevention of iatrogenic harm, to minimize the risk of these adverse outcomes.\u003c/p\u003e\n\u003cp\u003eSeveral limitations must be acknowledged that may affect the generalizability of the study results. Firstly, the retrospective design of the study may result in missing important clinical details or unrecorded episodes. Additionally, there was no documentation of corticosteroid dosages, timing of treatment initiation, or tapering schedules. Furthermore, the small sample size, heterogeneity of cyst locations and clinical characteristics, and unequal distribution of treated and untreated patients may also influence the study outcomes.\u003c/p\u003e\n\u003cp\u003eThis study does not provide definitive conclusions regarding the prioritization of inflammation control over infection treatment in SUBNCC. However, it initiates a debate regarding whether all cases of SUBNCC truly benefit from antiparasitic treatment, as there are no discernible differences supporting one therapeutic strategy over another, while the potential iatrogenic effects of antiparasitic therapy in this patient subgroup can be significant. We would suggest treating the patients with antiparasitic drugs at the debut, but maybe to treat relapses only with steroids. To establish more robust conclusions, further studies with larger sample sizes are warranted, ideally employing a randomized clinical trial design comparing patients receiving cysticidal treatment versus corticosteroids alone.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn patients with SUBNCC, clinical relapses treated with steroids alone do not appear to result in worse outcomes in terms of complications and relapses compared to those treated with antiparasitic medication.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eavailability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during this study are available from the corresponding author on reasonable request from any qualified investigator.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our deep gratitude to all the team in the Neurology and Infectious Disease department for their continuous, excellent work. We would also like to thank all the patients who participated in this study. We thank CERCA Programme / Generalitat de Catalunya for institutional support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAMV and MSY conceptualized and designed the study. MAN, GS and IP collected the data. MAN drafted the initial manuscript. PAP performed data analysis, interpreted the results and critically revised the manuscript. AMY and CC critically revised the manuscript. AMV and SMY interpreted the results, critically revised the manuscript and supervised the process. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePablo Arroyo-Pereiro, Antonio Mart\u0026iacute;nez-Y\u0026eacute;lamos, Sergio Mart\u0026iacute;nez-Y\u0026eacute;lamos and Albert Mu\u0026ntilde;oz-Vendrell have received honoraria from Teva, Lilly, Lundbeck, Roche, UCB, Bial, Chiesi, Allergan, Esai, Zambon, Kern Pharma, Pfizer, Biogen Idec, Bristol Myers Squibb, Novartis, TEVA, Merck, Janssen, Neuraxpharm, Genzyme, Sanofi, Bayer, Almirall and/or Celgene.\u003c/p\u003e\n\u003cp\u003eMireia Angerri-Nadal, Georgina Sauque, Ivan Pelegrin and Carmen Cabellos have no conflicts of interest to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study did not receive any specific grants from funding agencies in the public, commercial, or non-proft sectors.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGarcia, H. H., Nash, T. E. \u0026amp; Del Brutto, O. H. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol 13, 1202\u0026ndash;1215 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZammarchi, L. \u003cem\u003eet al.\u003c/em\u003e Epidemiology and Management of Cysticercosis and Taenia solium Taeniasis in Europe, Systematic Review 1990\u0026ndash;2011. PLoS One 8, (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarcia, H. H., Gonzalez, A. E. \u0026amp; Gilman, R. H. Cysticercosis of the central nervous system: How should it be managed? Curr Opin Infect Dis 24, 423\u0026ndash;427 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFleury, A., Carrillo-Mezo, R., Flisser, A., Sciutto, E. \u0026amp; Corona, T. Subarachnoid basal neurocysticercosis: A focus on the most severe form of the disease. Expert Rev Anti Infect Ther 9, 123\u0026ndash;133 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJ Valkounov\u0026aacute;, Z Zd\u0026aacute;rsk\u0026aacute;, J. S. Histochemistry of the racemose form of Cysticercus cellulosae. Folia Parasitol (Praha) 39, 207\u0026ndash;226 (1992).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNash, T. E. \u0026amp; O\u0026rsquo;Connell, E. M. Subarachnoid neurocysticercosis: emerging concepts and treatment. Curr Opin Infect Dis 33, 339\u0026ndash;346 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNash, T. E. \u003cem\u003eet al.\u003c/em\u003e Natural history of treated subarachnoid neurocysticercosis. American Journal of Tropical Medicine and Hygiene 102, 78\u0026ndash;89 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNash, T. E., Ware, J. A. M., Coyle, C. M. \u0026amp; Mahanty, S. Etanercept to control inflammation in the treatment of complicated neurocysticercosis. American Journal of Tropical Medicine and Hygiene 100, 609\u0026ndash;616 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCangalaya, C. \u003cem\u003eet al.\u003c/em\u003e Inflammation Caused by Praziquantel Treatment Depends on the Location of the Taenia solium Cysticercus in Porcine Neurocysticercosis. PLoS Negl Trop Dis 9, 1\u0026ndash;13 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBang OY, Heo JH, Choi SA, K. DI. Large cerebral infarction during praziquantel therapy in neurocysticercosis. Stroke 28, 211\u0026ndash;213 (1997).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamamoto Filho, P. T., Rodr\u0026iacute;guez-Rivas, R. \u0026amp; Fleury, A. Neurocysticercosis: A Review into Treatment Options, Indications, and Their Efficacy. Res Rep Trop Med Volume 13, 67\u0026ndash;79 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarcia, H. H. \u0026amp; Del Brutto, O. H. Neurocysticercosis: Updated concepts about an old disease. Lancet Neurology 4, 653\u0026ndash;661 (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNash, T. E., Mahanty, S. \u0026amp; Garcia, H. H. Corticosteroid use in neurocysticercosis. Expert Rev Neurother 11, 1175\u0026ndash;1183 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhite, A. C. \u003cem\u003eet al.\u003c/em\u003e Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clinical Infectious Diseases 66, e49\u0026ndash;e75 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDel Brutto, O. H. \u003cem\u003eet al.\u003c/em\u003e Revised diagnostic criteria for neurocysticercosis. J Neurol Sci 372, 202\u0026ndash;210 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOsorio, R. \u003cem\u003eet al.\u003c/em\u003e Factors Associated With Cysticidal Treatment Response in Extraparenchymal Neurocysticercosis. J Clin Pharmacol 59, 548\u0026ndash;556 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarpio, A. \u003cem\u003eet al.\u003c/em\u003e Effects of albendazole treatment on neurocysticercosis: A randomised controlled trial. J Neurol Neurosurg Psychiatry 79, 1050\u0026ndash;1055 (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThapa, K. \u003cem\u003eet al.\u003c/em\u003e The effect of albendazole treatment on non-seizure outcomes in patients with symptomatic neurocysticercosis. Trans R Soc Trop Med Hyg 112, 73\u0026ndash;80 (2018).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eDemographic and clinical variables. MRI: magnetic resonance imaging\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en = 15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge at diagnosis in years [median (range)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.1 (24-54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGender [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBirthplace [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBolivia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEcuador\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHonduras\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePer\u0026uacute;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSpain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYears from immigration [median (range)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.1 (16-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSymptoms [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHeadache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeizures\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeurological deficit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCyst location in MRI [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (87)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSerum serologies [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7/11 (64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4/11 (36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCerebrospinal fluid serologies [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3/4 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1/4 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAntiparasitic treatment, debut episode [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAlbendazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAlbendazole + Praziquantel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eDescription of all the episodes and its treatment.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCyst location\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDebut / relapse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical presentation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications of treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e15/01/2001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eSeizure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\n \u003cp\u003eVasculitis and stroke. HC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e17/03/2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eHeadache, cyst progression in MRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eCorticosteroids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e19/10/2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eLymphocytic meningitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e20/06/2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eLymphocytic meningitis and HC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eCorticosteroids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e23/11/2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eLymphocytic meningitis and seizures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eCorticosteroids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e02/01/2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eSeizures, HC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eCorticosteroids + VPS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\n \u003cp\u003eOsteonecrosis of the knee\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e10/09/2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eVasculitis and lymphocytic meningitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e24/01/2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eSeizures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eCorticosteroids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e15/09/2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eAphasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e15/12/2003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eSeizure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e15/03/2004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eProbable meningitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e10/09/2004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eLymphocytic meningitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003ePraziquantel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e17/06/2005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eVasculitis and stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eCorticosteroids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e04/06/2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eProbable meningitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eCorticosteroids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e13/03/2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eCorticosteroids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e18/02/2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eLymphocytic meningitis and HC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eCorticosteroids + VPS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e13/03/2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eHeadache and cyst progression in MRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eCorticosteroids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e23/03/2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eSeizure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole + Praziquantel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e30/01/2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eAsymptomatic (cyst found in an MRI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e15/07/2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eLymphocytic meningitis and HC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole + VPS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e01/06/2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eLymphocytic meningitis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e09/07/2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eLymphocytic meningitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole + Praziquantel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e15/03/2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eSeizure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e30/08/2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eSeizure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e15/02/2007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eAphasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\n \u003cp\u003ePatient 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\n \u003cp\u003eSubarachnoid + parenchymal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e15/11/1993\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eDebut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eSeizure and HC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003eAlbendazole + VPS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.659619450317125%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.016913319238901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.807610993657505%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.505285412262157%\" valign=\"top\"\u003e\n \u003cp\u003e02/08/1997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" valign=\"top\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.507399577167018%\" valign=\"top\"\u003e\n \u003cp\u003eArachnoiditis and HC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.010570824524313%\" valign=\"top\"\u003e\n \u003cp\u003ePraziquantel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.424947145877379%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eM: Male, F: Female. IRM: magnetic resonance imaging. HC: hydrocephalus. VPS: Ventriculoperitoneal shunt\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Neurocysticercosis, Subarachnoid Space, Complications, Antiparasitic Agents, Recurrence.","lastPublishedDoi":"10.21203/rs.3.rs-4577448/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4577448/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eNeurocysticercosis is particularly severe when affecting the subarachnoid space (SUBNCC). While antiparasitic therapy effectively controls the infection, it can lead to significant complications. This study aims to characterize a cohort of patients with SUBNCC, with a focus on their clinical course depending on therapeutic interventions. We conducted an observational, retrospective study involving patients diagnosed with SUBNCC at a tertiary hospital between 1985 and 2022. The primary endpoint was to delineate the clinical progression and demographic features of the cohort. A secondary objective was to compare relapse rates between patients receiving antiparasitic treatment and those who did not. Fifteen patients were included, with a median age of 31 years, mainly from South America. Approximately 46.7% of patients experienced at least one relapse, with rates of 46% in patients initially treated with antiparasitic medication and 50% in those treated with steroids alone. Complication rates were similar between both groups. Comparison of time to relapse revealed no statistically significant difference (17/27 treated with antiparasitic medication versus 10/27 with corticosteroids only; p=0.39). In patients with SUBNCC, clinical relapses managed with corticosteroids alone do not appear to result in worse outcomes in terms of complications and relapse rates compared to those managed with antiparasitic medication.\u003c/p\u003e","manuscriptTitle":"Is antiparasitic treatment beneficial in chronic subarachnoid neurocysticercosis? A comparative case series","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-13 02:32:26","doi":"10.21203/rs.3.rs-4577448/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"de845ecf-4f23-4f62-9730-7fa1f90931a7","owner":[],"postedDate":"July 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33911375,"name":"Biological sciences/Microbiology/Antimicrobials/Antiparasitic agents"},{"id":33911376,"name":"Health sciences/Neurology/Neurological disorders"}],"tags":[],"updatedAt":"2024-08-27T14:38:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-13 02:32:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4577448","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4577448","identity":"rs-4577448","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}