P10 – 2235: Effectiveness of a corticosteroid treatment regimen of a pulse methylprednisolone followed by alternate day oral prednisolone and a review of published treatment results of corticosteroids on refractory childhood seizures

Abstract

Objective To report our experience with the treatment of refractory seizures in children with epilepsies other than West and Landau-Kleffner syndrome with a new treatment regimen and to put our results in perspective with a review of original papers of all corticosteroid and ACTH treatments for refractory epileptic seizures in children. 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), followed by a taper phase. Data on efficacy and side effects were obtained. End-points were the percentage of patients that became seizure free or showed a good response (50% or more seizure reduction). Results Twenty-one patients were treated according to the protocol. Forty-three percent of the children showed a good response and 29% became seizure free. All but one patient had a relapse of seizures. Four patients had reversible adverse effects. From the data extracted from the literature we found that 52% of 155 children, that were treated with different corticosteroids showed a good response and 69% of 103 patients treated with ACTH. Conclusion Corticosteroids are a promising treatment modality in refractory seizures, but relapses are common. Results on efficacy and safety shown in this paper justify a randomized controlled trial.