Neuropediatrics 2014; 45(06): 378-385
DOI: 10.1055/s-0034-1387817
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Efficacy and Tolerability of Methylprednisolone Pulse Therapy in Childhood Epilepsies Other Than Infantile Spasms

Thomas Bast
1   Kork Epilepsy Center, Kehl, Germany
*   Both the authors contributed equally to the study.
,
Sarah Richter
2   Department of Neuropediatrics, University Medical Center Schleswig-Holstein (UKSH, Campus Kiel), Kiel, Germany
*   Both the authors contributed equally to the study.
,
Friedrich Ebinger
3   Pediatric Clinic, St. Vincenz Hospital, Paderborn, Germany
,
Dietz Rating
§   Dr. Rating was previously associated with University Children's Hospital, Heidelberg, Germany. He has now retired.
,
Adelheid Wiemer-Kruel
1   Kork Epilepsy Center, Kehl, Germany
,
Susanne Schubert-Bast
4   University Children's Hospital, Heidelberg, Germany
› Author Affiliations
Further Information

Publication History

06 March 2014

21 June 2014

Publication Date:
03 September 2014 (online)

Abstract

This retrospective study included 54 children with epilepsy. The treatment consisted of four pulses with single doses of 20 mg/kg/d methylprednisolone (MPR), administered every week on 3 consecutive days. After this initial phase, the intervals between the pulses were increased based on individual factors. MPR pulses were administered exclusively orally in 39 patients and 7.8% of all pulses were applied intravenously. After four pulses, 30 of 54 (56%) patients were responders, according to several clinical and electroencephalography criteria. A response was obtained in 12 of 20 (60%) cases with genetic, 7 of 17 (41%) with structural metabolic, and 11 of 17 (65%) with unknown etiology. Responder rates were 11 of 15 (73%) in patients with continuous spike–waves in slow sleep (CSWS) or Landau–Kleffner syndrome, 2 of 6 in patients with myoclonic astatic epilepsy or Lennox–Gastaut syndrome, and 17 of 31 (55%) in patients with unclassified epilepsies. A response was not correlated with any epilepsy-related clinical factor. The patients received a median of eight MPR pulses (range, 1–52), and the median duration of the therapy was 11 weeks. The response was maintained in 19 of 30 (63%) patients, and 3 of 24 (13%) without initial response became seizure-free (total responder rate at the end of the therapy 22/54 [41%]). The majority of patients experienced adverse effects that were typically mild and transient.

 
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