Chemotherapy for Central Nervous System Hydatidosis

Abstract

Echinococcosis still is an important public health challenge in many regions of the world. Up until the 1980s, surgery was considered the only therapeutic option for hydatidosis. However, nowadays, clinicians have effective medical chemotherapy available, which may be utilized singularly or in combination with open surgery or puncture-aspiration-injection-reaspiration (PAIR) method. Benzimidazoles, albendazole and mebendazole, remain the chemotherapeutic cornerstone in the medical management of echinococcosis, acting via cellular inhibition of the tubulin cytoskeletal framework to result in cell death through impaired glucose absorption and adenosine-5′-triphosphate utilization. The isoquinoline praziquantel, by increasing cellular permeability of calcium with consequent muscular paralysis of the worm, both as a protoscolicidal agent and in combination with albendazole, has also been shown to be effective for the medical management of echinococcosis. In patients with inactive or degenerating cysts, there is a role for the “watch and wait” approach. Pharmacovigilance remains an important way of evaluating chemotherapeutic success, adverse effects, and complications. Strategies for the prevention of human hydatidosis will be crucial for reducing central nervous system involvement, particularly in developing countries.