Interictal encephalography can influence patient selection for methylprednisolone therapy in pediatric refractory
Eli Heyman1, Eli Lahat, Revital Gandelman-Marton
1Department of Pediatric Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.
Insights
Intravenous methylprednisolone pulse therapy showed significant clinical improvement in children with refractory epilepsy. This treatment, particularly for those with abnormal EEG findings, offers a promising option for difficult-to-treat epilepsy cases.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Refractory epilepsy in children presents significant management challenges.
- Intravenous methylprednisolone pulse therapy is an option for severe epilepsy cases.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous methylprednisolone pulse therapy in children with refractory epilepsy.
- To identify patient characteristics that predict a positive response to this treatment.
Main Methods:
- Retrospective review of eight pediatric patients treated between 2005 and 2010.
- Administration of intravenous methylprednisolone (30 mg/kg/d for 5 days) alongside existing antiepileptic drugs.
- Assessment of clinical improvement and electroencephalogram (EEG) changes.
Main Results:
- Four out of eight patients experienced significant clinical improvement.
- A notable reduction in the amplitude of spike-slow wave discharges on EEG was observed in responders.
- Transient side effects were reported in four patients during therapy.
Conclusions:
- Intravenous methylprednisolone pulse therapy can be effective in select pediatric patients with refractory epilepsy.
- Children with abnormal EEG background and high-amplitude spike-slow wave discharges may be optimal candidates.
- Further research is warranted to optimize treatment protocols and identify predictive biomarkers.
Abstract:
We describe our experience with intravenous methylprednisolone pulse therapy in older children with refractory epilepsy. Patients with refractory epilepsy, who were treated with steroids between 2005 and 2010, were retrospectively selected from the database of the pediatric epilepsy clinic at Assaf Harofeh Medical Center. Eight patients (5 boys) aged 1.1 to 9 years (5.2 ± 2.6) were identified. Intravenous methylprednisolone 30 mg/kg/d was given to all patients for 5 days in addition to a stable dosage of the regular antiepileptic drugs. Transient side effects were reported in 4 of the patients during pulse therapy. Significant clinical improvement was noted in 4 patients, accompanied by a significant reduction of the amplitude of the spike-slow wave discharges on the electroencephalogram (EEG). Children with refractory epilepsy, abnormal EEG background, and high-amplitude spike-slow wave discharges appear to be the best candidates for intravenous methylprednisolone pulse therapy.
