Effectiveness of a hybrid corticosteroid treatment regimen on refractory childhood seizures and a review of other corticosteroid treatments.

Abstract

BACKGROUND:

Many different corticosteroid treatment schedules have been used in order to treat refractory epileptic seizures with encouraging effects on seizure reduction in many epileptic syndromes.

OBJECTIVE:

The objective is to report our experience with a hybrid treatment regimen for refractory seizures in children with epilepsies other than West and Landau-Kleffner syndrome. We hypothesized that a pulse of corticosteroids effectively reduces seizures while low-dosage maintenance treatment reduces side effects. The results are compared with results from a review of reported corticosteroid and ACTH treatments.

METHODS:

In this retrospective observational study, 26 children diagnosed with epilepsy with refractory seizures other than West syndrome and Landau-Kleffner syndrome were eligible for a treatment regimen consisting of three days intravenous methylprednisolone (20 mg per kilogram per day) followed by twelve weeks oral prednisolone (0.5 mg per kilogram on alternate days), concluded with a taper phase. Data on effectiveness and side effects were obtained. End-points were the percentages of patients who became seizure free or responded well.

RESULTS:

Twenty-one patients received the study treatment. Nine (43%) responded well and 6 (29%) became seizure free. All but one patient had a relapse of seizures. Four patients had reversible adverse effects. Data extracted from the literature were consistent with a good response in 48% of 192 children treated with different corticosteroids and in 69% of 103 patients treated with ACTH.

CONCLUSION:

This new hybrid therapy of a pulse of intravenous methylprednisolone and alternate day oral prednisolone is effective with a favourable side effect profile. Results on efficacy and safety justify a randomized controlled trial.

• Authors: Dewi P Bakker, Coriene E Catsman-Berrevoets, Rinze F Neuteboom
• Journal: European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society (Eur J Paediatr Neurol) Vol. 19 Issue 5 Pg. 553-60 (Sep 2015) ISSN: 1532-2130 [Electronic] England
• PMID: 25976064 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Adrenal Cortex Hormones
• Anticonvulsants
• Prednisolone
• Methylprednisolone

Topics

• Administration, Intravenous
• Administration, Oral
• Adolescent
• Adrenal Cortex Hormones (administration & dosage)
• Anticonvulsants (therapeutic use)
• Child
• Child, Preschool
• Epilepsy (drug therapy)
• Female
• Humans
• Male
• Methylprednisolone (administration & dosage)
• Prednisolone (administration & dosage)
• Retrospective Studies
• Seizures (drug therapy)