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

Abstract

Background: Neurocysticercosis is particularly severe when affecting the subarachnoid space. While antiparasitic therapy effectively controls the infection, it can lead to significant complications, especially in subarachnoid neurocysticercosis (SUBNCC). This study aims to characterize a cohort of patients with SUBNCC, with a focus on their clinical course depending on therapeutic interventions. Methods: We conducted an observational, retrospective study involving patients diagnosed with SUBNCC at a tertiary hospital between November 1985 and July 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. Results: Fifteen patients were included, with a median age of 31 years (range 24-54), and 53% were female. The most common countries of origin were Bolivia and Ecuador, with a median duration from immigration of 8.1 years (range 3-16). 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 between episodes treated with antiparasitic medication versus corticosteroids alone revealed no statistically significant difference (27 episodes in total; 17 treated with antiparasitic medication versus 10 with corticosteroids only; p=0.376). Conclusions: 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.