Treatment with High-Dose Prednisolone in Vigabatrin-Refractory Infantile Spasms

Area of Science:

• Pediatric Neurology
• Clinical Pharmacology

Background:

• Infantile spasms (IS) are a severe epilepsy syndrome in infants.
• Vigabatrin is a first-line anti-seizure medication (ASM) for IS, but a significant proportion of patients are refractory.
• Alternative treatments are needed for IS refractory to vigabatrin.

Purpose of the Study:

• To evaluate the efficacy and safety of high-dose oral prednisolone in children with IS refractory to vigabatrin.
• To compare the electroclinical remission rates of prednisolone with published data for adrenocorticotropic hormone (ACTH) therapy.

Main Methods:

• A consecutive series of children with IS and hypsarrhythmia (or variant) on EEG, refractory to vigabatrin, were treated with oral prednisolone (8 mg/kg/day).
• Electroclinical response (ECR) was assessed at 2 and 6 weeks post-treatment initiation.
• Adverse effects were monitored.

Main Results:

• Of 65 children included, 30.8% achieved complete ECR after vigabatrin.
• In 45 children refractory to vigabatrin, prednisolone led to complete ECR in 77.8% at 2 weeks, sustained in 66.7% at 6 weeks.
• Prednisolone was generally well tolerated.

Conclusions:

• High-dose oral prednisolone is an effective and safe treatment for infantile spasms refractory to vigabatrin.
• Sustained electroclinical remission was achieved in two-thirds of patients treated with prednisolone.
• Prednisolone offers a viable alternative for managing refractory IS.