EFFICACY AND TOLERABILITY OF PULSE STEROID AS AN ADD-ON THERAPY IN MANAGEMENT OF REFRACTORY CHILDHOOD EPILEPSY

Abstract

Background: Epilepsy is one of the commonest neurological conditions, with an estimated prevalence of 0.5%–1% in developed countries. Steroids have been used for the treatment of certain epilepsy types, such as infantile spasms; however, the use in the treatment of other intractable epilepsies has received limited studies. Objectives: We aimed to evaluate efficacy and adverse effects of high dose intravenous methylprednisolone (pulse steroid therapy) as an add-on therapy for refractory childhood epilepsy and its impact on both clinical and electroencephalographic aspects. Patients and Methods: This interventional comparative study was carried out on 30 patients with refractory epilepsy, at PICU and Pediatric Neurology Unit of Al-Hussein University Hospital, during the period from December 2017 to November 2018. They were divided into two groups: Group A (intervention group) and group B (control group). All patients were aged from 2 months up to 18 years and of both genders. Patients with infantile spasms, autoimmune disorders, or progressive degenerative or metabolic disorders were excluded. History-taking, complete clinical examination and laboratory investigations were registered. Electroencephalography was done on admission and post-control therapy. Adequate rationals of AED polytherapy were given. For the intervention group (group A), intravenous methylprednisolone was added at 30 mg/kg once daily, for 3 consecutive days, followed by oral prednisolone 2 mg/kg/day, in 3 divided doses, for 2 weeks then gradually tapered over 4 weeks. Results: There were no significant differences between the study groups regarding age, gender and onset of seizures. Two main etiologies were recorded among the study groups; Lennox-Gastaut Syndrome (LGS) and idiopathic epilepsy. All patients among group A (100%) had daily seizures while among group B 80% had daily seizures and 20% had weekly seizures. The seizures-type among the study groups was comparable; with 2 main types were recorded, Generalized Tonic Clonic (GTC) and multiple seizures-type. Follow up of all patients for 6 months after start of treatment revealed a significant improvement regarding EEG findings among group A more than among group B. After treatment among group A, 9 patients showed full improvement (normal EEG), 4 patients showed fair control (less frequent spikes on EEG) and 2 patients showed no improvement (same EEG abnormalities). There was no statistically significant difference, before and after treatment, among group B. After treatment among group B, 3 patients showed full improvement (normal EEG), 2 patients showed fair control (less frequent spikes on EEG) and 10 patients showed no improvement (same EEG abnormalities). A significant seizures-reduction was recorded among group A more than among group B after treatment, 66.67% seizures-reduction among group A vs 20% seizures-reduction among group B. Adverse effects of steroids were infrequent, mild and transient with no major adverse effects. Conclusion: Intravenous methylprednisolone as an add-on therapy for refractory childhood epilepsy is effective on both clinical (frequency of seizures) and electroencephalographic aspects.