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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
PubMed

Insights

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.
Abstract

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