Treatment of schistosomal myeloradiculopathy with praziquantel and corticosteroids and evaluation by magnetic resonance imaging: a longitudinal study.

Abstract

BACKGROUND:

The best treatment for schistosomal myeloradiculopathy (SMR) remains undefined. There is also no longitudinal study to estimate the value of magnetic resonance imaging (MRI) in the diagnosis and follow-up of this disease.

METHODS:

Patients with the following presentation were considered for study: lumbar and/or lower limb pain; lower limb weakness; anesthesia, hypoesthesia, or paresthesia; bladder and/or intestinal dysfunction; and sexual impotence. Sixteen patients with SMR were treated with oral praziquantel (50 mg/kg in a single dose) and methylprednisolone (15 mg/kg/day intravenously for 5 days) followed by prednisone (1 mg/kg/day orally for 6 months). Clinical outcome was prospectively evaluated in months 2 and 6 of treatment.

RESULTS:

Image alterations were detected by MRI at diagnosis for all patients, and normalization or improvement was reported at the end of treatment. There was statistically significant clinical melioration at both the second and sixth months of therapy for most neurological alterations. However, the best clinical outcome was achieved when the steroid was given for >2 months.

CONCLUSIONS:

Treatment with praziquantel associated with corticosteroids was successful in all cases. MRI proved to be a good method for the diagnosis of SMR and helpful in the evaluation of response to treatment.

• Authors: Luciana C S Silva, Pedro E Maciel, João G R Ribas, Silvio R Souza-Pereira, Carlos M Antunes, José R Lambertucci
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 39 Issue 11 Pg. 1618-24 (Dec 01 2004) ISSN: 1537-6591 [Electronic] United States
• PMID: 15578361 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anthelmintics
• Glucocorticoids
• Praziquantel
• Methylprednisolone

Topics

• Adolescent
• Adult
• Anthelmintics (therapeutic use)
• Drug Therapy, Combination
• Female
• Glucocorticoids (therapeutic use)
• Humans
• Longitudinal Studies
• Magnetic Resonance Imaging
• Male
• Methylprednisolone (therapeutic use)
• Middle Aged
• Neuroschistosomiasis (diagnosis, drug therapy)
• Praziquantel (therapeutic use)
• Prospective Studies
• Radiculopathy (diagnosis, drug therapy, parasitology)