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Medical Treatment of Cysticercosis: Ineffective vs Effective

Hector H. Garcia, MD; Robert H. Gilman, MD
Arch Neurol. 1995;52(10):941-941. doi:10.1001/archneur.1995.00540340017003
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In the section "Controversies in Neurology" of the January issue of the Archives, Kramer1 and Del Brutto2 do a commendable job of defending opposed positions about the role of antiparasitic therapy in the management of neurocysticercosis. We would like, however, to discuss the final statements of the section editor, Dr Hachinski,3 that placebo-controlled therapeutic trials for neurocysticercosis are not plausible for ethical reasons.

The actual knowledge of the evolution of untreated cysticercosis is scarce and based on anecdotal case reports.4,5 Selection bias affects the validity of these reports: cases with more severe symptoms will be more likely to be chosen for study since patients with milder symptoms will be less likely to seek medical attention. "Historical" controls (patients who had computed tomographic studies performed before treatment) have also shown that lesions do not significantly increase in number or size.6,7 These historical controls were selected from

REFERENCES

Kramer LD.  Medical treatment of cysticercosis—ineffective . Arch Neurol . 1995;; 52:101-102.
Del Brutto OH.  Medical treatment of cysticercosis—effective . Arch Neurol . 1995;;52:102-104.
Hachinski V.  Medical treatment of cysticercosis . Arch Neurol . 1995;;52:104.
Kramer LD, Locke GE, Byrd SE, Daryabagi J.  Cerebral cysticercosis: documentation of natural history with computed tomography . Radiology . 1989;; 171:459-462.
Mitchell WG, Crawford TO.  Intraparenchymal cysticercosis in children: diagnosis and treatment . Pediatrics . 1988;;82:76-82.
Sotelo J, Del Brutto OH, Penagos P, et al.  Comparison of therapeutic regimens of anticysticercal drugs for parenchymal brain cysticercosis . J Neurol . 1990;;237:69-72.
Takayanagui OM, Jardim E.  Therapy for neurocysticercosis: comparison between albendazole and praziquantel . Arch Neurol . 1992;;49:290-294.
Miller B, Grinnell V, Goldberg MA, Heiner D.  Spontaneous radiographic disappearance of cerebral cysticercosis: three cases . Neurology (Cleveland) . 1983;; 33:1377-1379.
Vasquez V, Sotelo J.  The course of seizures after treatment for cerebral cysticercosis . N Engl J Med . 1992;;327:696-702.
Del Brutto OH, Santibanez R, Noboa CA, et al.  Epilepsy due to neurocysticercosis: analysis of 203 patients . Neurology . 1992;;42:389-392.
Diaz F, Garcia HH, Gilman R, et al.  Epidemiology of taeniasisand cysticercosis in Peruvian village . Am J Epidemiol . 1992;;135:875-882.
Garcia HH, Martinez M, Gilman RH, et al.  Diagnosis of cysticercosis in endemic regions . Lancet . 1991;;338:549-551.
Canelas HM.  Neurocisticercose: incidencia, diagnostico e formas clinicas . Arq Neuropsiquiatr . 1962;;20:1-15.

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Kramer LD.  Medical treatment of cysticercosis—ineffective . Arch Neurol . 1995;; 52:101-102.
Del Brutto OH.  Medical treatment of cysticercosis—effective . Arch Neurol . 1995;;52:102-104.
Hachinski V.  Medical treatment of cysticercosis . Arch Neurol . 1995;;52:104.
Kramer LD, Locke GE, Byrd SE, Daryabagi J.  Cerebral cysticercosis: documentation of natural history with computed tomography . Radiology . 1989;; 171:459-462.
Mitchell WG, Crawford TO.  Intraparenchymal cysticercosis in children: diagnosis and treatment . Pediatrics . 1988;;82:76-82.
Sotelo J, Del Brutto OH, Penagos P, et al.  Comparison of therapeutic regimens of anticysticercal drugs for parenchymal brain cysticercosis . J Neurol . 1990;;237:69-72.
Takayanagui OM, Jardim E.  Therapy for neurocysticercosis: comparison between albendazole and praziquantel . Arch Neurol . 1992;;49:290-294.
Miller B, Grinnell V, Goldberg MA, Heiner D.  Spontaneous radiographic disappearance of cerebral cysticercosis: three cases . Neurology (Cleveland) . 1983;; 33:1377-1379.
Vasquez V, Sotelo J.  The course of seizures after treatment for cerebral cysticercosis . N Engl J Med . 1992;;327:696-702.
Del Brutto OH, Santibanez R, Noboa CA, et al.  Epilepsy due to neurocysticercosis: analysis of 203 patients . Neurology . 1992;;42:389-392.
Diaz F, Garcia HH, Gilman R, et al.  Epidemiology of taeniasisand cysticercosis in Peruvian village . Am J Epidemiol . 1992;;135:875-882.
Garcia HH, Martinez M, Gilman RH, et al.  Diagnosis of cysticercosis in endemic regions . Lancet . 1991;;338:549-551.
Canelas HM.  Neurocisticercose: incidencia, diagnostico e formas clinicas . Arq Neuropsiquiatr . 1962;;20:1-15.

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