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April 1983

Praziquantel Therapy for Cysticercosis-Reply

Author Affiliations

Neurology Service Research 4 Massachusetts General Hospital Fruit Street Boston, MA 02114

Arch Neurol. 1983;40(4):258. doi:10.1001/archneur.1983.04050040088024

In Reply.  —Praziquantel, a remarkably nontoxic drug1 that rapidly kills cysticerci in vitro and in infested animals,2,3 was reported in several nonblind, uncontrolled studies to be effective in human disease.4-8 Although these reports were encouraging, the criteria used to assess improvement were probably not adequate. For example, Botero and Castano5 noted fewer convulsions after treatment, but all of our 136 epileptic patients had good seizure control with anticonvulsant therapy alone (unpublished findings, 1983). Botero and Castano cited cyst disappearance on serial computed tomography (CT) as evidence of praziquantel's efficacy. However, C. Zee, MD, and I have observed large cystic lesions shrink and become radiodense on sequential CT scans without any therapy (unpublished data, 1981). Finally, the period of observation was too brief to determine the ultimate success of praziquantel therapy.The natural history of the various clinical manifestations of neurocysticercosis needs markedly better definition. Computed tomographic visualization of