Cisternal Neurocysticercosis: A Systematic Review and Meta-Analysis of Therapeutic Efficacy, Safety, and Outcomes.

Abstract

Background: Recent studies show potential benefits of albendazole in managing cisternal neurocysticercosis (NCC), which reduces parasitic burden. This systematic review and meta-analysis aim to evaluate the efficacy of albendazole and other pharmacological treatments in cisternal NCC, considering the heterogeneity of disease manifestations and the need for effective treatment strategies.

Methods: Comprehensive searches were conducted across PubMed, Web of Science, Scopus, CENTRAL, and Embase up to March 2024, focusing on RCTs and observational studies that examined albendazole's impact on cisternal NCC. Data were pooled using a random-effects model, adhering to the Cochrane handbook for systematic reviews and meta-analysis and the preferred reporting items for systematic reviews and meta-analyses guidelines, to calculate relative risks (RRs) for various outcomes, including cyst resolution and side effects.

Results: Eight studies with 2,001 patients treated with albendazole, comparing outcomes against placebo or no treatment. Findings indicated a statistically significant decrease in complete cyst resolution among albendazole recipients (RR = 0.69), with notable heterogeneity across studies. No significant differences were observed in persistent cysts, partial cyst resolution, seizures, nonneurological side effects, death, or calcification rates posttreatment. Adjustments for heterogeneity refined some associations, particularly with persistent cysts after excluding specific studies.

Conclusion: Albendazole demonstrates potential in reducing active cysts in cisternal NCC, though its efficacy varies across different clinical outcomes, necessitating personalized treatment approaches. The observed heterogeneity and the variable impact on cyst resolution and seizures underscore the complexity of managing NCC. Further high-quality, large-scale RCTs are essential to solidify these findings and guide treatment protocols, emphasizing the need for multidisciplinary strategies in addressing this challenging condition.