Efficacy of corticosteroid therapy in treating epileptic encephalopathies and refractory epilepsies other than West syndrome

Uri Kramer*, Nathan Watemberg, Nathanel Zelnik, Eli Shahar, Tally Lerman-Sagie, Hadassah Goldberg-Stern, Bruria Ben-Zeev

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

To evaluate the efficacy of steroid therapy in epileptic encephalopathies and refractory epilepsies other than West syndrome. Retrospective analysis of treatment and outcome data of patients treated with steroids for epileptic encephalopathies. Outcome was analyzed in terms of the patient's epileptic syndrome, age at seizure onset, duration of seizure disorder, age at treatment, abnormalities noted on neurological examination, developmental status and type of steroid. Fifty-eight consecutive patients from six pediatric neurology outpatient clinics were included in the study. The epileptic syndrome and types were as follows: myoclonic epilepsy (n = 16), epilepsy with continuous spike waves during slow-wave sleep (n = 12), partial epilepsy (n = 10), Landau-Kleffner syndrome (n = 6), generalized epilepsy with multiple epileptic seizure types (n=5), Rasmussen's encephalitis (n = 3), Lennox-Gastaut syndrome (n = 2), atypical absence (n = 2) and spasms (n = 2). Sixteen patients (27%) had received adrenocorticotrophic hormone (ACTH) and 42 (7%) had received prednisone (22 of the latter patients were given initial pulse methylprednisolone). Complete cessation of seizures as well as disappearance of epileptic discharges in electroencephalogram were achieved in 16 patients (28%); 15 other patients (26%) had improvement of >50%. Of the 31 patients with >50% improvement and follow-up of at least 1 year, 16 (52%) subsequently relapsed. ACTH was found to be significantly more efficacious than prednisone in controlling seizures and improving function. Initiation of treatment with high-dose methylprednisolone did not increase efficacy. ACTH may be more efficacious than prednisone in treating epileptic encephalopathies and refractory epilepsies other than West syndrome.

Original languageEnglish
Pages (from-to)147-153
Number of pages7
JournalJournal of Pediatric Neurology
Volume4
Issue number3
DOIs
StatePublished - 2006

Keywords

  • Encephalopathy
  • Epilepsy
  • Steroids

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