Treatment with High-Dose Prednisolone in Vigabatrin-Refractory Infantile Spasms.

Abstract

OBJECTIVES:

This research aimed to study the short-term seizure outcomes following treatment with 8 mg/kg/day prednisolone in children with infantile spasms (IS) refractory to vigabatrin. We hypothesized that high-dose prednisolone may result in similar rates of electroclinical remission when compared to published ACTH rates.

METHODS:

All consecutive children with hypsarrhythmia or hypsarrhythmia variant on EEG with/without IS, who had been treated with vigabatrin as first-line anti-seizure medication (ASM) followed by high-dose oral prednisolone (8 mg/kg/day; maximum 60 mg/day) in cases who did not respond to vigabatrin, were included. Clinical and electroclinical response (ECR) at 2 weeks following initiation of treatment and adverse effects were assessed.

RESULTS:

Sixty-five children were included. A genetic etiology was seen in 38.5% cases. Complete ECR was seen in 30.8% (20/65) of the patients 2 weeks after vigabatrin. Complete ECR was noted in 77.8% (35/45) of the patients, 2 weeks after prednisolone initiation in children who failed vigabatrin, and this was sustained at 6 weeks in 66.7% (30/45) patients. Prednisolone was generally well tolerated.

CONCLUSIONS:

High-dose (8 mg/kg/day) oral prednisolone resulted in sustained complete ECR (at 6 weeks) in two-thirds of the children with hypsarrhythmia or hypsarrhythmia variant on EEG with/without parentally reported IS. It was generally well tolerated and found to be safe.

• Authors: Wafaa Al-Shehhi, Vann Chau, Jennifer Boyd, Carter Snead, Rohit Sharma, Elizabeth Donner, Cristina Go, Puneet Jain
• Journal: The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques (Can J Neurol Sci) Vol. 49 Issue 4 Pg. 532-539 (07 2022) ISSN: 0317-1671 [Print] England
• PMID: 34212837 (Publication Type: Journal Article)

Chemical References

• Anticonvulsants
• Prednisolone
• Vigabatrin

Topics

• Anticonvulsants (therapeutic use)
• Child
• Humans
• Infant
• Prednisolone (adverse effects, therapeutic use)
• Spasms, Infantile (drug therapy)
• Treatment Outcome
• Vigabatrin (therapeutic use)