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[Hydrocortisone therapy of secondary generalized epilepsy in children]
1Hôpital Universitaire des enfants Reine-Fabiola Bruxelles.
Insights
Glucocorticoids can reduce seizure frequency and improve cognitive function in children with secondary generalized epilepsy, especially for tonic and tonic-clonic seizures. Treatment benefits are observed within months, with manageable side effects like weight gain and hypertension.
Area of Science:
- Pediatric Neurology
- Epileptology
- Pharmacology
Context:
- Secondary generalized epilepsy in children over one year old.
- Limited efficacy of conventional antiepileptic drugs.
- Exploration of alternative treatment options.
Purpose:
- To evaluate the efficacy and safety of glucocorticoids in treating secondary generalized epilepsy in pediatric patients.
- To identify factors influencing treatment outcomes.
- To establish optimal dosing and duration for glucocorticoid therapy.
Summary:
- Retrospective study indicates glucocorticoids reduced seizure frequency in 50% and improved cognitive abilities in 66% of children.
- Efficacy was higher for tonic-clonic seizures compared to absence seizures.
- Adverse events (weight gain, hypertension) were transient and reversible upon discontinuation.
Impact:
- Glucocorticoids offer a viable treatment option for refractory epilepsy when standard therapies fail.
- Early intervention (before age 4) and specific seizure types may predict better outcomes.
- Provides evidence-based recommendations for glucocorticoid use, including dosage and duration (minimum 6 months).
Abstract:
Indications for glucocorticoids in the treatment of secondary generalized epilepsy after age one year is discussed. The present retrospective study showed that half of the children exhibited significant reduction of seizure frequency and 2/3 of them improved their cognitive abilities. Results were better in tonic and tonic-clonic seizures than in absences. The mean delay before improvement was 1 month for seizures and 3 months for cognitive abilities. Adverse events were mainly excessive weight gain and arterial hypertension. Both appeared within 2 months of initiating the treatment and disappeared when treatment was discontinued. The following factors seemed to influence the effect of glucocorticoids: the type of seizure, the nature of the epileptic syndrome, the delay between the onset of epilepsy and of treatment, and the beginning of treatment before 4 years of age. Glucocorticoids may be useful when conventional antiepileptic drugs have failed. The initial dose should be 5 mg/kg/day, reduced after 1 month of treatment. Glucocorticoids should be maintained at least for 6 months.