Original articleEfficacy and prognosis of a short course of prednisolone therapy for pediatric epilepsy
Introduction
Various therapeutic modalities, including steroid and immunoglobulin therapies, diet therapy, epilepsy surgery, and neurostimulation therapy, have been used in efforts to control seizures and to allow the resumption of development in children with intractable epileptic encephalopathy.1 Steroids, including prednisolone and adrenocorticotrophic hormone (ACTH), have been used as epilepsy treatments for over 50 years,2, 3 and are recognized as relatively safe and effective for infantile spasms.4 However, studies of the use of steroids in the treatment of epileptic conditions other than infantile spasms are limited.
In this study, we evaluated the efficacy and safety of prednisolone, given together with conventional antiepileptic drugs (AEDs), in 41 children with cryptogenic epileptic encephalopathy other than infantile spasms. The prognoses of the patients are discussed.
Section snippets
Patients and methods
A retrospective assessment was made of 41 children (31 boys, 10 girls), aged 16–191 months (mean±SD, 59.1±36.9 months), who had been diagnosed with cryptogenic epileptic encephalopathy other than infantile spasms, and who were treated with prednisolone in addition to conventional AEDs at the Sanggye Paik Hospital from 2002 to 2006. The minimum follow-up period was 12 months (range, 14–90 months). Our anecdotal experience has been that prednisolone is not as effective in patients with focal or
Demographics
Of the 41 patients, 31 were boys and 10 were girls. Their mean seizure onset age was 26.4±33.2 months (range, 1 month to 14 years 8 months). The mean number of AEDs tried before prednisolone was 3.4±1.6 (range, 2–5). The mean age at the commencement of prednisolone therapy was 59.1±36.9 months, and the range was 16 months to 15 years 11 months. The mean period during which seizures were experienced before prednisolone treatment was 32.8±25.7 months (range, 3 months to 9 years 6 months) and the
Discussion
Corticosteroids (predominantly prednisolone) and ACTH have been used in the treatment of infantile spasms and are clearly established as first-line or second-line treatments.8 However, relatively little attention has been paid to the possible utility of corticosteroids in the treatment of epilepsies other than infantile spasms.
In this study, we report our experience with prednisolone in the treatment of cryptogenic epileptic encephalopathies other than infantile spasms. In our patients, the
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Cited by (36)
Efficacy and prognosis of long-term, high-dose steroid therapy for Lennox–Gastaut syndrome
2022, Epilepsy ResearchCitation Excerpt :You et al. (2008) reported that 63% (20/32) of patients with LGS became seizure-free after prednisolone treatment (2 mg/kg per day for 6 weeks, tapered for a further 2 weeks), although 87.5% (28/32) of patients experienced recurrence within 2 years. As such, previous studies included too few patients to discuss efficacy and recurrence rates, and the study by You et al. (2008) only targeted patients with LGS with unknown etiology. Therefore, we suspected that long-term treatment with high steroid doses was required.
The role of inflammatory mediators in epilepsy: Focus on developmental and epileptic encephalopathies and therapeutic implications
2021, Epilepsy ResearchCitation Excerpt :The variability in the response to the therapy, may be partially explained by a lack of a consensus on the medication regimens (Gupta and Appleton, 2005). Pulse intravenous methylprednisolone (10−30 mg/kg/day for 3 days) or oral prednisone (1−2 mg/kg/day for 6 weeks) are often used for the induction regimen, followed by a maintenance with oral prednisone (0.5−2 mg/kg/day tapered over 2–6 weeks) (Bakker et al., 2015; Sinclair, 2003; Bast et al., 2014; Sevilla-Castillo et al., 2009; You et al., 2008). However, the variable therapeutic outcomes experienced in non-WS-DEE patients may underlie the existence of different therapeutic effects of steroids, for which a dose-dependence is been less investigated (Riikonen, 1987; Dontin et al., 2015).
- 1
These two authors contributed equally to this work and are co-first authors.