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Pulse Methylprednisolone with Oral Prednisolone versus Adrenocorticotropic Hormone in Children with West Syndrome: a
Kanij Fatema1, Mizanur Rahman1, Mohammad Monir Hossain2
1Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Insights
Pulse methylprednisolone is a viable alternative to adrenocorticotrophic hormone (ACTH) for treating infantile spasms in West syndrome. This 6-week treatment showed comparable efficacy and minimal adverse effects, offering a new therapeutic option.
Area of Science:
- Pediatric Neurology
- Epileptology
- Pharmacology
Background:
- West syndrome is a severe infantile epileptic encephalopathy.
- Adrenocorticotrophic hormone (ACTH) is a guideline-recommended treatment, but response varies.
- Limited uniformity in treatment exists due to variable patient responses to ACTH.
Purpose of the Study:
- To compare the efficacy of pulse methylprednisolone versus ACTH for West syndrome treatment.
- To evaluate methylprednisolone as an alternative therapy for infantile spasms.
Main Methods:
- A randomized study included infants aged 3-24 months diagnosed with West syndrome.
- Participants received either ACTH or pulse methylprednisolone followed by oral prednisolone for 6 weeks.
- Treatment efficacy was assessed based on response rates and adverse effects.
Main Results:
- Pulse methylprednisolone achieved a 100% response in 21.87% of patients, compared to 6.97% with ACTH.
- Significant responses (50-100%) were observed in 78.13% of the methylprednisolone group versus 74.41% in the ACTH group.
- Methylprednisolone treatment resulted in no significant or persistent adverse effects.
Conclusions:
- Pulse methylprednisolone followed by oral prednisolone is as effective as ACTH in managing West syndrome.
- Methylprednisolone offers a valuable alternative treatment option for infantile spasms.
- This regimen provides comparable efficacy with a favorable safety profile.
Background And Purpose:
West syndrome is an epileptic encephalopathy of infancy. According to guidelines, adrenocorticotrophic hormone (ACTH) is probably effective for the short-term management of infantile spasm, but there is little uniformity in treatment due to variable response. This study has been done to evaluate the efficacy of pulse methylprednisolone as compared to ACTH in children with West syndrome.
Methods:
Children between 3 months to 24 months with the diagnosis of West syndrome were included and ACTH and pulse methyl prednisolone followed by oral prednisolone were given after randomization. Total duration of treatment was 6 weeks in both groups.
Results:
Total 87 children were enrolled; 12 patients lost in follow up. Finally, 43 received ACTH and 32 received pulse methylprednisolone. In pulse methylprednisolone group, 28.13% showed 50-80% response, 28.13% showed 80-99% response and 21.87% patients showed 100% response. In ACTH group, 41.86% showed 50-80% response, 25.58% showed 80-99% response and only 3 (6.97%) patients showed 100% response. Methylprednisolone treatment regimen did not cause significant or persistent adverse effects.
Conclusions:
Pulse methylprednisolone followed by oral prednisolone for 6 weeks is as effective as ACTH. Thus, methylprednisolone therapy can be an important alternative to ACTH.
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