Five Versus Fourteen Days Dexamethasone In Parenchymal Ncc: An Open Labelled Clustered Randomised Superiority Trial

Background: Neurocysticercosis (NCC) is the most common cause of focal seizures in children. There is a lack of randomized controlled trials evaluating the optimal duration of steroids in the management of NCC. Objective: To compare two durations of dexamethasone in parenchymal NCC on radiological outcome at 6 months post-cysticidal and steroid therapy. Methods: The study is an open-labeled clustered randomized superiority trial involving children aged 2-18 years with up to 5 live parenchymal NCC. Participants were randomized to receive either 14 or 5 days of dexamethasone, in addition to albendazole for 7 days and anti-seizure medications. The primary outcome was cyst status on CECT head at 6 months (calcification, resolution, no response), while secondary outcomes included incident seizures, T2-relaxation time, and edema on MRI 2 to 3 weeks post cysticidal and dexamethasone therapy. Results: A total of 61 children with 79 cysts were randomized. The long-duration dexamethasone arm exhibited fewer calcifications (29%) than the short arm (48%, p=0.06). Breakthrough seizures, cyst T2-relaxation time, and perilesional edema were similar between groups. Post-hoc analysis combining both arms revealed that smaller baseline cyst size and lesser T2-relaxation time of the peri-lesional edema post-therapy correlated with complete or near-complete resolution (cyst size ≤ 5 mm). Incident seizure-free patients showed significantly reduced perilesional edema T2-relaxation time. Conclusion: Increased duration of steroids is associated with reduced calcification. Baseline cyst size and T2- relaxation time of the perilesional edema 2-3 weeks after cysticidal therapy are predictive of outcome.