1921
Volume 100, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Manifestations of neurocysticercosis (NCC) are primarily due to host inflammatory responses directed at drug-damaged or naturally degenerating metacestodes (cysts) of the tapeworm . Prolonged high-dose corticosteroids are frequently required to control this inflammation in complicated disease, often causing severe side effects. Studies evaluating alternatives to corticosteroids are lacking. Here, we describe the clinical course of NCC in 16 patients prescribed etanercept (ETN), a tumor necrosis factor-alpha inhibitor to control inflammation resulting from anthelmintic treatment. Twelve patients with extraparenchymal NCC were administered ETN with corticosteroids (11/12, 91.7%) and/or methotrexate (9/12, 75.0%). The median age of the subgroup with extraparenchymal NCC was 40 years (range 26–57 years) and 66.7% were male. They were administered ETN for a median period of 311 days (range 31–461 days) and then followed for a median of 3.4 years (range 0.3–6.6 years). Among nine assessable patients, all improved clinically after starting ETN and one deteriorated transiently. Of the remaining three, one was lost to follow-up and two patients have improved but had not completed their assigned course. Four additional persons with recurrent perilesional edema (PE) episodes were given ETN for a median of 400.5 days (range 366–854 days) and followed post-ETN for a median of 1.7 years (range 0.2–2.4 years). All PE patients improved and two successfully tapered corticosteroids. Etanercept administration was associated with clinical improvement, stable disease, absence of recurrence, and lack of serious side effects. Etanercept appears to contribute to the control of inflammation and facilitate corticosteroid taper.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. Garcia HH, Nash TE, Del Brutto OH, , 2014. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol 13: 12021215. [Google Scholar]
  2. Bickerstaff ER, Cloake PCP, Hughes B, Smith WT, , 1952. The racemose form of cerebral cysticercosis. Brain 75: 118. [Google Scholar]
  3. Valkounova J, Zdarska Z, Slais J, , 1992 .Histochemistry of the racemose form of cysticercus-cellulosae. Folia Parasitol 39: 207226. [Google Scholar]
  4. Spina-Franca A, Nobrega JP, Livramento JA, Machado LR, , 1982. Administration of praziquantel in neurocysticercosis. Tropenmed Parasitol 33: 14. [Google Scholar]
  5. Nash TE, Mahanty S, Garcia HH, Cysticercosis Group in Peru; , 2011. Corticosteroid use in neurocysticercosis. Expert Rev Neurother 11: 11751183. [Google Scholar]
  6. Oray M, Abu Samra K, Ebrahimiadib N, Meese H, Foster CS, , 2016. Long-term side effects of glucocorticoids. Expert Opin Drug Saf 15: 457465. [Google Scholar]
  7. Mitre E, Talaat KR, Sperling MR, Nash TE, , 2007. Methotrexate as a corticosteroid-sparing agent in complicated neurocysticercosis. Clin Infect Dis 44: 549553. [Google Scholar]
  8. Aguilar-Rebolledo F, Cedillo-Rivera R, Llaguno-Violante P, Torres-Lopez J, Munoz-Hernandez O, Enciso-Moreno JA, , 2001. Interleukin levels in cerebrospinal fluid from children with neurocysticercosis. Am J Trop Med Hyg 64: 3540. [Google Scholar]
  9. Mahanty S, Orrego MA, Cangalaya C, Adrianzen MP, Arroyo G, Calcina J, Gonzalez AE, Garcia HH, Guerra-Giraldez C, Nash TE, Cysticercosis Working Group in Peru; , 2017. TNF-alpha blockade suppresses pericystic inflammation following anthelmintic treatment in porcine neurocysticercosis. PLoS Negl Trop Dis 11: e0006059. [Google Scholar]
  10. Zhou QH, Sumbria R, Hui EK, Lu JZ, Boado RJ, Pardridge WM, , 2011. Neuroprotection with a brain-penetrating biologic tumor necrosis factor inhibitor. J Pharmacol Exp Ther 339: 618623. [Google Scholar]
  11. Ronthal M, Venna N, Hunter GJ, Frosch MP, , 2016. Case 15-2016: a 32-year-old man with olfactory hallucinations and paresthesias. N Engl J Med 374: 19661975. [Google Scholar]
  12. Segal BM, , 2013. Neurosarcoidosis: diagnostic approaches and therapeutic strategies. Curr Opin Neurol 26: 307313. [Google Scholar]
  13. Del Brutto OH, 2001. Proposed diagnostic criteria for neurocysticercosis. Neurology 57: 177183. [Google Scholar]
  14. Nash TE, Ware JM, Mahanty S, , 2017. Natural history of patients with perilesional edema around Taenia solium calcified granulomas. J Infect Dis 215: 11411147. [Google Scholar]
  15. Mejia R, Nash TE, , 2013. Corticosteroid withdrawal precipitates perilesional edema around calcified Taenia solium cysts. Am J Trop Med Hyg 89: 919923. [Google Scholar]
  16. Garcia HH, Gonzales I, Lescano AG, Bustos JA, Pretell EJ, Saavedra H, Nash TE, Cysticercosis Working Group Peru; , 2014. Enhanced steroid dosing reduces seizures during antiparasitic treatment for cysticercosis and early after. Epilepsia 55: 14521459. [Google Scholar]
  17. White AC, Jr. Coyle CM, Rajshekhar V, Singh G, Hauser WA, Mohanty A, Garcia HH, Nash TE, , 2018. Diagnosis and treatment of neurocysticercosis: 2017 clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 66: e49e75. [Google Scholar]
  18. Trickler WJ, Mayhan WG, Miller DW, , 2005. Brain microvessel endothelial cell responses to tumor necrosis factor-alpha involve a nuclear factor kappa B (NF-kappaB) signal transduction pathway. Brain Res 1048: 2431. [Google Scholar]
  19. Mayhan WG, , 2002. Cellular mechanisms by which tumor necrosis factor-alpha produces disruption of the blood-brain barrier. Brain Res 927: 144152. [Google Scholar]
  20. Decourt B, Lahiri DK, Sabbagh MN, , 2017. Targeting tumor necrosis factor alpha for Alzheimer’s disease. Curr Alzheimer Res 14: 412425. [Google Scholar]
  21. Arango-Davila CA, Vera A, Londono AC, Echeverri AF, Canas F, Cardozo CF, Orozco JL, Rengifo J, Canas CA, , 2015. Soluble or soluble/membrane TNF-alpha inhibitors protect the brain from focal ischemic injury in rats. Int J Neurosci 125: 936940. [Google Scholar]
  22. Zhang BF, Song JN, Ma XD, Zhao YL, Liu ZW, Li Y, Sun P, Li DD, Pang HG, Huang TQ, , 2015. Etanercept alleviates early brain injury following experimental subarachnoid hemorrhage and the possible role of tumor necrosis factor-alpha and c-jun N-terminal kinase pathway. Neurochem Res 40: 591599. [Google Scholar]
  23. Cardenas G, Valdez R, Saenz B, Bottasso O, Fragoso G, Sciutto E, Romano MC, Fleury A, , 2012. Impact of Taenia solium neurocysticercosis upon endocrine status and its relation with immuno-inflammatory parameters. Int J Parasitol 42: 171176. [Google Scholar]
  24. Saenz B, Fleury A, Chavarria A, Hernandez M, Crispin JC, Vargas-Rojas MI, Fragoso G, Sciutto E, , 2012. Neurocysticercosis: local and systemic immune-inflammatory features related to severity. Med Microbiol Immunol 201: 7380. [Google Scholar]
  25. Mahanty S, Cysticercosis Working Group in Peru , 2015. Post-treatment vascular leakage and inflammatory responses around brain cysts in porcine neurocysticercosis. PLoS Negl Trop Dis 9: e0003577. [Google Scholar]
  26. Bathon JM, 2000. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med 343: 15861593. [Google Scholar]
  27. Culy CR, Keating GM, , 2002. Etanercept: an updated review of its use in rheumatoid arthritis, psoriatic arthritis and juvenile rheumatoid arthritis. Drugs 62: 24932537. [Google Scholar]
  28. Klareskog L, 2004. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet 363: 675681. [Google Scholar]
  29. Chang R, Knox J, Chang J, Derbedrossian A, Vasilevko V, Cribbs D, Boado RJ, Pardridge WM, Sumbria RK, , 2017. Blood-brain barrier penetrating biologic TNF-alpha inhibitor for Alzheimer’s disease. Mol Pharm 14: 23402349. [Google Scholar]
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Supplemental table

  • Received : 01 Oct 2018
  • Accepted : 31 Oct 2018
  • Published online : 02 Jan 2019

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