Intravenous Methylprednisolone Versus Oral Prednisolone for West Syndrome: A Randomized Open-Label Trial

Area of Science:

• Pediatric Neurology
• Clinical Pharmacology

Background:

• West syndrome is a severe form of epilepsy in infants.
• Early diagnosis and effective treatment are crucial for long-term outcomes.
• Corticosteroids are a primary treatment modality for West syndrome.

Purpose of the Study:

• To compare the efficacy and safety of intravenous methylprednisolone (IVMP) versus oral prednisolone (OP) in treating West syndrome.
• To evaluate short-term and long-term remission rates and adverse effects of both treatment regimens.

Main Methods:

• A randomized, open-label trial involving children aged 2-30 months with West syndrome.
• Participants received either IVMP (30 mg/kg/d for 3 days) or OP (4 mg/kg/d for two weeks), both followed by a tapering schedule.
• Primary outcome was spasms cessation at day 14; secondary outcomes included time to response, electroclinical remission at 2 and 6 weeks, and adverse events.

Main Results:

• Spasms cessation at day 14 was similar between IVMP and OP groups (54.8% vs. 68.9%).
• Time to remission was significantly shorter with IVMP (5.4 days) compared to OP (9.5 days).
• Electroclinical remission at 6 weeks was higher in the OP group (75.9%) than the IVMP group (45.2%). Adverse effects differed, with IVMP associated with sleep disturbance and irritability, and OP with weight gain.

Conclusions:

• Oral prednisolone (OP) showed superior efficacy in achieving sustained electroclinical remission at 6 weeks for West syndrome compared to IVMP.
• OP was associated with fewer adverse effects than IVMP, suggesting it may be a preferred treatment option.
• While IVMP offered faster initial remission, OP provided better long-term outcomes and a more favorable safety profile.