Early antiseizure medication tapering in 2-18-year-olds with single parenchymal neurocysticercosis based on risk assessment: A prospective intervention study.

BACKGROUND: The optimal duration of antiseizure medication (ASM) therapy for single parenchymal calcified or granular nodular neurocysticercosis (NCC) remains unclear. In this prospective interventional study, we stratified children aged 2-18 years with single calcified or granular nodular parenchymal NCC into a low-risk group based on literature review and implemented a protocol for early ASM tapering. We hypothesized that ≥80% of patients in this low-risk group would remain seizure-free after early ASM tapering, with a minimum follow-up of six months.

METHODS: A cohort of patients with single calcified or granular nodular NCC at low risk for seizure recurrence was identified after 6-18 months of seizure freedom, based on clinical, EEG, and MRI parameters. ASM was then tapered, with follow-up for a minimum of six months. For patients who did not meet EEG criteria at baseline, a repeat EEG was permitted three months later.

RESULTS: Thirty-three patients had ASM tapered (4 granular nodular and 29 calcified, 9.5 ± 2.4 years) with seizure freedom reported in 87.9% (95% CI: 61.8-96.6%) over 18 months (1QR:13-24) follow-up. Serial seizures and status epilepticus in treatment-naive viable parenchymal state at initial presentation were associated with seizure recurrence. No significant difference in seizure freedom was seen between ASM tapering at < 12 months (92.9%, 66.1-99.8%) and ≥ 12 months (84.2%, 60.4-96.6%) of seizure freedom.

CONCLUSION: Early ASM tapering (6-18 months) is not associated with increased risk of seizure recurrence in this group. This can minimize ASM-related adverse effects and health costs along with recurrent hospital visits.