Efficacy and tolerability of methylprednisolone pulse therapy in childhood epilepsies other than infantile spasms

• Published in: Neuropediatrics Vol. 45; no. 6; p. 378
• Main Authors: Bast, Thomas, Richter, Sarah, Ebinger, Friedrich, Rating, Dietz, Wiemer-Kruel, Adelheid, Schubert-Bast, Susanne
• Format: Journal Article
• Language: English
• Published: Germany 01-12-2014
• Subjects: Adolescent; Child; Child, Preschool; Epilepsy - drug therapy; Female; Humans; Infant; Male; Methylprednisolone - administration & dosage; Methylprednisolone - adverse effects; Pulse Therapy, Drug; Retrospective Studies; Treatment Outcome
• ISSN: 1439-1899
• DOI: 10.1055/s-0034-1387817

This retrospective study included 54 children with epilepsy. The treatment consisted of four pulses with single doses of 20 mg/kg/d methylprednisolone (MPR), administered every week on 3 consecutive days. After this initial phase, the intervals between the pulses were increased based on individual factors. MPR pulses were administered exclusively orally in 39 patients and 7.8% of all pulses were applied intravenously. After four pulses, 30 of 54 (56%) patients were responders, according to several clinical and electroencephalography criteria. A response was obtained in 12 of 20 (60%) cases with genetic, 7 of 17 (41%) with structural metabolic, and 11 of 17 (65%) with unknown etiology. Responder rates were 11 of 15 (73%) in patients with continuous spike-waves in slow sleep (CSWS) or Landau-Kleffner syndrome, 2 of 6 in patients with myoclonic astatic epilepsy or Lennox-Gastaut syndrome, and 17 of 31 (55%) in patients with unclassified epilepsies. A response was not correlated with any epilepsy-related clinical factor. The patients received a median of eight MPR pulses (range, 1-52), and the median duration of the therapy was 11 weeks. The response was maintained in 19 of 30 (63%) patients, and 3 of 24 (13%) without initial response became seizure-free (total responder rate at the end of the therapy 22/54 [41%]). The majority of patients experienced adverse effects that were typically mild and transient.