Reduction of interictal epileptic burden by pulsatile corticoid therapy in children with drug-resistant epilepsy-How
Katharina Schiller1,2,3, Tamir Avigdor1, John Thomas4
1Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada.
Insights
Pulsatile corticosteroid therapy (PCT) significantly reduced epileptic activity in children, with benefits persisting one year after treatment. Sleep physiology also improved, suggesting long-lasting positive effects for cognitive function.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neurophysiology
Background:
- Pulsatile corticosteroid therapy (PCT) is effective in reducing epileptic activity in drug-resistant childhood epilepsy.
- The long-term stability of PCT's therapeutic effects on epileptic activity and sleep physiology remains under investigation.
Purpose of the Study:
- To evaluate the sustained efficacy of PCT by assessing interictal epileptic activity (IEA) burden one year post-treatment.
- To analyze the impact of PCT on sleep spindle activity as an indicator of sleep physiology.
Main Methods:
- A cohort of 20 children with drug-resistant epilepsy received systematic PCT.
- Electroencephalography (EEG) recordings were obtained at baseline, post-PCT, and at one-year follow-up to quantify IEA burden and sleep spindle rates.
- Statistical comparisons were performed to assess changes in IEA burden and sleep spindle activity across time points.
Main Results:
- PCT significantly reduced IEA burden, an effect that persisted at the one-year follow-up.
- While most patients maintained reduced IEA, 33.3% experienced a relapse.
- PCT showed a trend towards increasing fast spindle rates, which remained stable post-treatment and at follow-up.
Conclusions:
- PCT offers long-lasting benefits in reducing epileptic activity in the majority of pediatric epilepsy patients.
- PCT also appears to improve sleep physiology, which is crucial for cognitive development.
- The findings support PCT as a valuable therapeutic option for drug-resistant epilepsy in children.
Objective:
The systematic use of pulsatile corticosteroid therapy (PCT) in children with drug-resistant epilepsy has been shown to reduce epileptic activity. However, it remains unclear how long this effect will last. The objective of this study was therefore to evaluate the stability of the effect of PCT by assessing the interictal epileptic activity burden (% of electroencephalography (EEG) with interictal epileptic activity, IEA) one year after the end of treatment.
Methods:
The final study cohort consisted of 20 children (9 females; mean age 7.6 ± 3.5 years) with various drug-resistant surgically nonremediable epilepsies who underwent systematic treatment with PCT (20 mg/m2 body surface per treatment cycle). EEG recordings during sleep and wakefulness were obtained at baseline, after PCT, and at one-year follow-up. IEA burden and sleep spindles (rate per minute) to evaluate sleep physiology were compared between the different time points.
Results:
IEA burden was significantly reduced after PCT treatment (4.9% [2.4-20.4] vs. .9% [.2-5.5], p = .005, d = -.47) and this effect continued to persist at follow-up (.9% [.2-5.5] vs. 2.7% [.2-7.4], p = .99, d = .02). At time of follow-up, 33.3% patients showed a relapse defined by an increase in IEA burden after an initial decrease of at least 50% through PCT. Fast spindle rate (12-16 Hz) tended to be higher after PCT (1.0 ± .8 vs. 1.6 ± .8, p = .08, d = .59) and remained stable between the end of PCT and follow-up (1.6 ± .8 vs. 1.6 ± .4, p = .98, d = .01).
Significance:
Our findings suggest that in the majority of patients, PCT led to long-lasting benefits not only by reducing epileptic activity but also by improving sleep, important for cognitive functions.
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