Efficacy of steroids in childhood drug-resistant epilepsy

Abstract

Background Epilepsy is considered the most frequent chronic neurologic condition in childhood. In childhood epilepsy, the incidence rates range from 0.5 to 8 per 1000 children per year. Drug-resistant epilepsy (DRE) is defined according to the International League against Epilepsy as a failure of adequate trials of greater than or equal to 2 appropriately used, tolerated, and appropriately chosen regimens of antiepileptic drugs to achieve seizure freedom. It has been described that steroids and adrenocorticotropic hormone are effective treatment modalities in DRE children. They may have anticonvulsive properties through their endocrine criteria and their effect on neuronal excitability and stabilization of membrane. They are believed to induce changes in the transmission of neurochemicals due to changes in gamma-aminobutyric acid uptake or serotonin turnover mediated through the mineralocorticoid and glucocorticoid receptors.Objectives The aim of this study was to evaluate the efficacy of oral prednisolone regimen and hybrid corticosteroid regimens in the treatment of DRE and to assess the possible side effects of both regimens.Patients and methods This study was a prospective randomized clinical trial which was conducted at the neurology outpatient clinic and department of the Mansoura University Children Hospital. It included 49 pediatric patients diagnosed as DRE according to the International League against Epilepsy 2010 definition as failure of adequate trials of two or more drugs to achieve freedom from seizures. They were divided into two groups, the first group (25 patients) received oral prednisolone and the second (24 patients) received intravenous methylprednisolone followed by oral prednisolone. Both regimens were applied in addition to conventional antiepileptic drugs. The response to the treatment is graded as: ‘free from seizures,’ ‘response is good’ (reduction of seizures more than 50% including seizure free), or ‘response is poor’ (<50% reduction, considered as therapy failure).Results Our study showed that of the 25 patients enrolled in group 1 and received high-dose oral prednisolone (14/25) 56% showed good response (decrease in seizure frequency by >50%), of whom seven (28%) became seizure free, while (11/25) 44% showed poor response (decrease of seizure frequency by <50%) and of the 24 patients enrolled in group 2 and received hybrid regimen consists of methylprednisolone and low-dose prednisolone (13/24) 54% showed good response, six (25%) of them became free from seizures, while (11/24) 46% showed poor response. And there is no significant difference as regards the efficacy of the steroid regimens used in the two groups (P=0.97) but the regimen used in group 2 showed lesser adverse effects.Conclusion The use of hybrid corticosteroid regimen composed of initial pulses of methylprednisolone followed by low-dose oral prednisolone in the treatment of DRE is as effective as the use of high-dose oral prednisolone from the start but with less adverse-effect profile.