Antiparasitic treatment for solitary cysticercus granuloma: to treat or not to treat?

Neurocysticercosis is a major cause of neurologic disease worldwide. In India and other developing countries, single small enhancing computed tomographic lesions representing solitary cysticercus granuloma are a common cause of new-onset seizures. The interesting feature of these solitary enhancing lesions is their spontaneous disappearance within a few weeks. The modalities of treatment that have been evaluated in these patients include antituberculous drugs, albendazole and corticosteroids. In several series, patients received only antiepileptic therapy to control seizures. There is consensus among experts that these patients require antiepileptic therapy. Some experts think that antiepileptic drugs may be withdrawn safely after the lesion has resolved. In several studies, treatment with albendazole has been tried but, because of conflicting results, its role in management of solitary cysticercus granuloma is uncertain. The present study by Thussu et al. also could not establish the exact role of albendazole in the management of solitary cysticercus granuloma. The authors observed that albendazole treatment led to early resolution of the solitary cysticercus granuloma. However, significantly better radiological resolution of lesions did not result in improved seizure-related prognosis. To resolve the issue of effectiveness of albendazole, properly conducted multicentric randomized control studies are needed.