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High-Dose Prednisolone for Treatment of Infantile Spasms After Presumed Perinatal Stroke
Insights
High-dose prednisolone effectively treated infantile spasms in a child with perinatal stroke, leading to seizure freedom and developmental progress. This suggests it may be a viable first-line therapy for similar cases.
Area of Science:
- Pediatric Neurology
- Neonatal Neurology
- Pediatric Stroke
Background:
- Infantile spasms (IS) are a severe epilepsy syndrome in infants.
- High-dose corticosteroids are used for IS, but efficacy in IS secondary to perinatal stroke is less understood.
- Perinatal stroke is a known cause of IS, often associated with cerebral palsy.
Purpose of the Study:
- To evaluate the efficacy and safety of high-dose prednisolone as a first-line treatment for infantile spasms in a child with perinatal stroke.
- To assess the impact of treatment on seizure control and neurodevelopmental outcomes.
Main Methods:
- A single case study of a 9-month-old girl with new-onset infantile spasms secondary to a perinatal left middle cerebral artery stroke.
- Diagnosis confirmed by video-electroencephalography (EEG) showing modified hypsarrhythmia.
- Treatment with high-dose prednisolone (8 mg/kg/day) for 2 weeks, followed by a 5-week taper.
Main Results:
- The patient became seizure-free after the first dose of prednisolone.
- EEG after treatment completion showed resolution of modified hypsarrhythmia and no epileptiform discharges.
- No significant adverse effects were observed during prednisolone therapy.
- The child maintained excellent developmental progress during and after treatment.
Conclusions:
- High-dose prednisolone may be an effective and safe first-line therapy for infantile spasms associated with perinatal stroke.
- This case highlights the potential of corticosteroids in managing IS in this specific etiology.
- Further research is warranted to confirm these findings in a larger cohort.
Abstract:
BACKGROUND: High-dose prednisone and prednisolone have been increasingly studied as a lower-cost alternative to adrenocorticotropic hormone for the treatment of infantile spasms, but this treatment has not been well studied in children with infantile spasms due to perinatal stroke. METHODS: We identified a girl with new-onset infantile spasms due to presumed perinatal left middle cerebral artery stroke seen in our hospital's pediatric stroke clinic in 2019. RESULTS: This girl developed infantile spasms at 9 months old. She had right hemiplegic cerebral palsy due to her perinatal stroke but had been otherwise previously healthy. Modified hypsarrhythmia was confirmed on prolonged video-electroencephalography. High-dose prednisolone at 8 mg/kg per day was initiated on the sixth day of spasms. She was treated with this dose for 2 weeks and then tapered over 5 weeks. The girl became seizure-free after receiving her first dose of prednisolone and experienced no significant adverse effects during therapy. Routine electroencephalography after completion of prednisolone taper confirmed resolution of modified hypsarrhythmia and no epileptiform discharges. She continued to make excellent development progress during and after treatment. CONCLUSION: This case suggests high-dose prednisolone could be considered for first-line therapy for children with infantile spasms due to perinatal stroke; further study is needed.
