Original article
Efficacy and prognosis of a short course of prednisolone therapy for pediatric epilepsy

https://doi.org/10.1016/j.ejpn.2007.09.003Get rights and content

Abstract

Purpose

To evaluate the efficacy and safety of adjunctive prednisolone therapy in children with cryptogenic epileptic encephalopathy, other than infantile spasms, and to determine its prognosis.

Methods

Prednisolone, 2 mg/kg per day for 6 weeks, tapered for a further 2 weeks, was given in combination with previously prescribed antiepileptic drugs. A retrospective assessment of 41 children thus treated included measurements of seizure frequency, electroencephalographic findings, global assessments of cognitive function, and adverse drug events. Long-term patient prognoses over a mean follow-up period of 3 years and 5 months (range, 14–90 months) were also examined.

Results

Of 41 patients, 32 had Lennox–Gastaut syndrome, 4 had Doose syndrome, 1 had Otahara syndrome, 2 had Landau–Kleffner syndrome, and 2 had other unspecified generalized epilepsies. After prednisolone therapy, 73% (30/41) of patients showed a reduction in seizure frequency of >50%, and 59% (24/41) became seizure free. However, only seven patients (four with Lennox–Gastaut syndrome, two with Doose syndrome, and one with unspecified generalized epilepsy) who became seizure free remained free of seizures at the time of the final follow-up. Electroencephalographic findings and global assessments of cognitive function correlated well with seizure outcomes. No significant demographic factors influenced the efficacy of prednisolone or patient prognoses after prednisolone tapering. Most adverse events were transient, or were tolerated well with conservative management, with maintenance of the medication.

Conclusion

Prednisolone therapy may be a safe and effective adjunct in patients with cryptogenic epileptic encephalopathies, but the high relapse rate is of concern.

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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These two authors contributed equally to this work and are co-first authors.

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