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.