Effectiveness of a hybrid corticosteroid treatment regimen on refractory childhood seizures and a review of other corticosteroid treatments

• ACTH and steroids are suited for the treatment of refractory epilepsy because of their anti-inflammatory and anticonvulsive properties.
• Steroids are a safe and effective treatment option in refractory epilepsy, but relapse after cessation of therapy is common.
• This new hybrid corticosteroid treatment of refractory epilepsy is effective with a favourable side effect profile.

BackgroundMany different corticosteroid treatment schedules have been used in order to treat refractory epileptic seizures with encouraging effects on seizure reduction in many epileptic syndromes.ObjectiveThe objective is to report our experience with a hybrid treatment regimen for refractory seizures in children with epilepsies other than West and Landau–Kleffner syndrome. We hypothesized that a pulse of corticosteroids effectively reduces seizures while low-dosage maintenance treatment reduces side effects. The results are compared with results from a review of reported corticosteroid and ACTH treatments.MethodsIn this retrospective observational study, 26 children diagnosed with epilepsy with refractory seizures other than West syndrome and Landau–Kleffner syndrome were eligible for a treatment regimen consisting of three days intravenous methylprednisolone (20 mg per kilogram per day) followed by twelve weeks oral prednisolone (0.5 mg per kilogram on alternate days), concluded with a taper phase. Data on effectiveness and side effects were obtained. End-points were the percentages of patients who became seizure free or responded well.ResultsTwenty-one patients received the study treatment. Nine (43%) responded well and 6 (29%) became seizure free. All but one patient had a relapse of seizures. Four patients had reversible adverse effects. Data extracted from the literature were consistent with a good response in 48% of 192 children treated with different corticosteroids and in 69% of 103 patients treated with ACTH.ConclusionThis new hybrid therapy of a pulse of intravenous methylprednisolone and alternate day oral prednisolone is effective with a favourable side effect profile. Results on efficacy and safety justify a randomized controlled trial.