Steroids in intractable childhood epilepsy: Clinical experience and review of the literature

Abstract

Steroids and adrenocorticotrophic hormone (ACTH) have been used for the treatment of infantile spasms for several years. However, the use of steroids in the treatment of epilepsy beyond infantile spasms has been limited to only a few studies. We report the experience with steroids in 32 children with intractable epilepsy, not including West syndrome. In 47% there was a decrease in seizure frequency, 25% became seizure free, 11% had a seizure reduction of >50% and 11% had a seizure reduction of <50%. Our study confirms the conclusions of few previous reports of effective adjunctive steroid treatment for children with intractable epilepsy. The possible side effects, however, especially during prolonged therapy remain an important concern.

Action of adrenal and gonadal steroid hormones on kainic acid-evoked seizures in a rat model of epileptogenesis

“…The authors suggested that corticosteroids offered better efficacy and longer lasting anticonvulsant action than conventional anti-epileptic drugs. Similar data have been reported elsewhere as well [20,21]. The authors [20,21] concluded that steroid treatment of epilepsy remains yet undefined and needs further studies.…”

“…Similar data have been reported elsewhere as well [20,21]. The authors [20,21] concluded that steroid treatment of epilepsy remains yet undefined and needs further studies. Acknowledging this line of evidence, the aim of the present study was to investigate the effect of steroid adrenal and gonadal hormones on the intensity, dynamics and latency of kainic acid-evoked seizure and lethality in a rat model of epileptogenesis.…”

Efficacy and prognosis of a short course of prednisolone therapy for pediatric epilepsy

“…These findings are similar to those of Sinclair, 9 who found that 46% of 28 children older than 1 year with intractable epilepsy became seizure free and another 40% showed significant reductions in seizure frequency when prednisolone was given at 1 mg/kg per day for 12 weeks (this included 6 weeks of daily therapy and 6 weeks of treatment on alternate days). The report of Verhelst et al, 10 containing data on 36 patients (a heterogeneous pediatric population with intractable epilepsies of diverse etiologies) who underwent various steroid treatments, showed somewhat less favorable results. Although 25% of patients became seizure free and 11% showed reductions in seizure frequency of 450%, the authors concluded that steroids were effective as adjunctive treatments for children with intractable epilepsy.…”

“…In Sinclair's study, 9 it was unclear how long the improvement achieved with prednisolone therapy was maintained. In the work of Verhelst et al, 10 two-thirds of patients who became seizure free relapsed. Oguni et al reported only transient improvements in myoclonic and absence seizures in a few patients treated with ACTH.…”

“…9,16 In view of these potential adverse events, the prolonged use of corticosteroids in the treatment of epilepsies must be determined on a risk-benefit basis. 5,10 In our study, a short course of prednisolone was prescribed over 8 weeks, including 2 weeks of tapering. Our experience of adverse events was similar to those of other published reports 5,9,10 but most adverse events were transient or well-tolerated using conservative management with the maintenance of medication.…”