Ivermectina como alternativa terapéutica en neurocisticercosis resistente al tratamiento farmacológico convencional / Ivermectin as therapeutic alternative in neurocysticercosis that is resistant to conventional pharmacological treatment

La neurocisticercosis es un problema de salud pública con amplia distribución en el mundo, especialmenteen países en vías de desarrollo, y cada vez más creciente en países desarrollados, debido a las altas tasas de inmigración. El tratamiento cisticida en neurocisticercosis ha sido controvertido, porque su eficacia es parcial contra formas quísticasvesiculares y coloidales ante la persistencia del parásito después de un curso de albendazol o praziquantel, las dos únicas opciones terapéuticas disponibles actualmente. La ivermectina es un antiparasitario veterinario y humano de gran eficacia, seguro, con ocasionales y mínimos efectos colaterales, usada desde hace más de 25 años en endoparasitosis de difícil control, como filariasis, oncocercasis, estrongiloidiasis, etc., y también en ectoparasitosis, como pediculosis capitis y miasis.Actúa en la unión mioneural sobre los receptores en el canal de cloro, aumentando su permeabilidad causando parálisis en gusanos adultos, o por un mecanismo inmune mediado cuando actúa sobre formas inmaduras. Casos clínicos. Se presentan cuatro pacientes tratados previamente con albendazol en forma reiterada con evidencia radiológica, que demuestra la persistenciade quistes viables en forma vesicular o coloidal y crisis epilépticas persistentes, a quienes se les suministró ivermectina 10 mg/día durante 15 días consecutivos o 10 mg/día por medio durante 30 días, con excelente evolución clínica y radiológica.Conclusiones. La ivermectina fue eficaz y careció de eventos adversos al tratar a estos cuatro pacientes resistentes al tratamiento convencional con albendazol y/o praziquantel

Neurocysticercosis is a public health problem that can be found in many parts of the world, especiallyin developing countries, and today’s high rates of immigration are making it increasingly more common in developed countries. Cysticidal treatment of neurocysticercosis is a controversial issue because it is only partially effective againstvesicular and colloidal-shaped cysts when the parasite persists after a course of albendazole or praziquantel, the only two therapeutic options that are currently available. Ivermectin is a very effective, safe veterinary and human antiparasitic drug,with occasional very mild side effects. It has been used for over 25 years in cases of endoparasitosis that do not respond well to treatment, such as filariasis, oncocerciasis, strongyloidiasis, etc. and also in ectoparasitoses, such as pediculolsis capitisand myasis. It acts in the myoneural junction on the receptors in the chloride channel by increasing their permeability and causing paralysis in adult worms or by a mediated immune mechanism when it acts on immature forms. Case reports. We report the cases of four patients who were previously treated with albendazole reiteratively with radiological evidence, whichshows the persistence of viable vesicular or colloidal-shaped cysts. These patients were given 10 mg/day of ivermectin for 15 consecutive days or 10 mg/day as an average for 30 days, with excellent clinical and radiological progress. Conclusions.Ivermectin was effective and did not give rise to any side effects when used to treat these four patients, who were resistant to conventional treatment with albendazole and/or praziquantel

[Ivermectin as a therapeutic alternative in neurocysticercosis that is resistant to conventional pharmacological treatment]. / Ivermectina como alternativa terapéutica en neurocisticercosis resistente al tratamiento farmacológico convencional.

INTRODUCTION: Neurocysticercosis is a public health problem that can be found in many parts of the world, especially in developing countries, and today's high rates of immigration are making it increasingly more common in developed countries. Cysticidal treatment of neurocysticercosis is a controversial issue because it is only partially effective against vesicular and colloidal-shaped cysts when the parasite persists after a course of albendazole or praziquantel, the only two therapeutic options that are currently available. Ivermectin is a very effective, safe veterinary and human antiparasitic drug, with occasional very mild side effects. It has been used for over 25 years in cases of endoparasitosis that do not respond well to treatment, such as filariasis, oncocerciasis, strongyloidiasis, etc. and also in ectoparasitoses, such as pediculolsis capitis and myasis. It acts in the myoneural junction on the receptors in the chloride channel by increasing their permeability and causing paralysis in adult worms or by a mediated immune mechanism when it acts on immature forms. CASE REPORTS: We report the cases of four patients who were previously treated with albendazole reiteratively with radiological evidence, which shows the persistence of viable vesicular or colloidal-shaped cysts. These patients were given 10 mg/day of ivermectin for 15 consecutive days or 10 mg/day as an average for 30 days, with excellent clinical and radiological progress. CONCLUSIONS: Ivermectin was effective and did not give rise to any side effects when used to treat these four patients, who were resistant to conventional treatment with albendazole and/or praziquantel.