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Epileptic spasms: experience with a high-dose oral corticosteroid protocol
Tyson L Ware1, Mark T Mackay, A Simon Harvey
1Department of Neurology, Parkville University of Melbourne, Melbourne, Victoria, Australia.
Journal of Paediatrics and Child Health
|October 9, 2012
Summary
High-dose oral prednisolone is effective for infantile epileptic spasms, showing high remission rates in non-tuberous sclerosis complex (TSC) infants. Vigabatrin was less effective in TSC patients, suggesting early steroid therapy consideration.
Area of Science:
- Pediatric Neurology
- Clinical Practice Audit
Background:
- Infantile epileptic spasms (IES) require effective treatment protocols.
- Assessing adherence to and outcomes of a new IES treatment protocol was needed.
Purpose of the Study:
- To audit clinical practice for infantile epileptic spasms.
- To assess early outcomes of infants treated with an agreed initial treatment protocol.
Main Methods:
- Retrospective review of 28 infants diagnosed with epileptic spasms between July 2007 and June 2009.
- Assessed adherence to a protocol using high-dose oral prednisolone (or vigabatrin for tuberous sclerosis complex - TSC) and evaluated remission by day 14, recurrence, and side effects.
Main Results:
- 100% remission by day 14 in cryptogenic IES treated per protocol.
- 64% remission in non-TSC symptomatic IES treated per protocol vs. 20% not per protocol.
- 17% remission in TSC infants treated with vigabatrin per protocol.
Conclusions:
- High-dose oral prednisolone is effective and tolerable for infantile epileptic spasms.
- The protocol supports high-dose oral prednisolone as a treatment of choice for non-TSC symptomatic IES.
- Early consideration of steroid therapy is warranted given poor vigabatrin response in TSC.
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