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Early antiseizure medication tapering in 2-18-year-olds with single parenchymal neurocysticercosis based on risk

P Ghanghoriya1, A Kumar2, B Chakrabarty1

  • 1Pediatric Neurology Division, Department of Pediatrics, AIIMS, New Delhi, India.

Seizure
|April 12, 2026
PubMed

Insights

Early antiseizure medication (ASM) tapering in children with single-lesion neurocysticercosis (NCC) is safe. Most patients remained seizure-free after stopping ASM, reducing medication side effects and healthcare costs.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pediatrics

Background:

  • Optimal duration of antiseizure medication (ASM) for single parenchymal calcified or granular nodular neurocysticercosis (NCC) is unknown.
  • A prospective study stratified children (2-18 years) with single calcified/granular nodular NCC into a low-risk group for early ASM tapering.
  • The hypothesis was that ≥80% of patients would remain seizure-free after early ASM tapering with a minimum six-month follow-up.

Purpose of the Study:

  • To determine the safety and efficacy of early antiseizure medication (ASM) tapering in children with single parenchymal calcified or granular nodular neurocysticercosis (NCC).
  • To assess the risk of seizure recurrence after early ASM discontinuation in a low-risk pediatric NCC cohort.
  • To evaluate the impact of early ASM tapering on adverse effects and healthcare costs.

Main Methods:

  • A cohort of pediatric patients with single calcified/granular nodular NCC and low seizure recurrence risk (based on clinical, EEG, MRI) were identified after 6-18 months of seizure freedom.
  • Antiseizure medication (ASM) was tapered, with a minimum six-month follow-up period.
  • Repeat EEG was permitted three months later for patients not meeting baseline EEG criteria.

Main Results:

  • Thirty-three patients underwent ASM tapering (3-29 calcified, 4 granular nodular).
  • Seizure freedom was maintained in 87.9% of patients over an 18-month follow-up.
  • Early ASM tapering (<12 months vs. ≥12 months) showed no significant difference in seizure freedom rates.

Conclusions:

  • Early antiseizure medication (ASM) tapering (6-18 months) is not associated with an increased risk of seizure recurrence in children with single calcified/granular nodular NCC.
  • This approach can minimize ASM-related adverse effects, reduce healthcare costs, and decrease recurrent hospital visits.
  • The findings support a protocol for early ASM discontinuation in carefully selected pediatric patients with NCC.
Abstract

Keywords:
Early ASM taperingLow-riskSeizure recurrenceSingle calcified/Granular nodular neurocysticercosis

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