Adjuvant Therapies for Echinococcal Infections of the Central Nervous System in Children

The development of more effective chemotherapeutic agents that carry fewer side effects has been important to the successful management of echinococcal disease. Use of these modern agents may even be considered as an initial treatment for the multiple small cysts seen in secondary disease, particularly when they are located in eloquent areas of the brain in patients with minimal neurological deficits. Patients not responding to this chemotherapy can be considered as surgical candidates, especially if they are experiencing progressive neurological signs and symptoms.

General

Antihelminthic agents are available for use to augment the surgical resection of hydatid cysts (16). Two agents are available, mebendazole and albendazole, and both agents have been shown to be effective in the treatment of hydatid cysts in liver and abdomen. Both agents also may reduce the fertility of the cyst. However, these larvacidal agents exhibit no beneficial effects when administered alone for the treatment of cerebral hydatid cysts. No side effects of mebendazole or albendazole are reported either in the literature or in cooperative studies (44).

Indications for antihelminthic drugs

• Intraoperative rupture

Multiple cysts

• Reduction in the cyst size: A cyst deemed inoperable due to its size can be treated with an antihelminthic agent in the hope that by so doing the cyst will become operable (1, 10, 23).
• Hydatid disease of the spine: Lam et al. (31) report that drug therapy is effective in a patient with inoperable spinal hydatidosis. 

Albendazole

• Broad spectrum oral antihelminthic: Albendazole is a broad-spectrum antihelminthic agent with good oral absorption that blocks glucose uptake, depletes the glycogen stores, and thus immobilizes and kills the parasite (6).
• Use as adjuvant to surgery and for secondary disease: Albendazole can be given to patients who have multiple organ involvement or multiple cysts inside the cranial cavity.  Some authors also recommend its use for patients who have residual cysts after surgery or when a cyst ruptures intraoperatively, whereas others  recommend that albendazole not be routinely used when intact removal of intracranial hydatid cyst or cysts is accomplished (16, 27, 43).
• 10–15 mg/day for 3 months: When used in conjunction with surgical removal of the cyst, 10–15 mg/kg/day of albendazole is given for 3 months.