Abstracts

RATIONALE: Steroids are often an effective treatment for the West Syndrome. There have been few reports of steroid use in children with epilepsy outside the first year of life. We report our experience with Prednisone for the treatment of older children with intractable epilepsy. METHODS: Twenty-three children (13 boys, 10 girls) age 2-10 years with intractable epilepsy were studied. All patients had failed the first and second line antiepileptic medication. The patients had extensive epilepsy investigations including a seizure history, metabolic studies, EEG, LTV EEG, MRI, and developmental assessments. Prednisone 1/mg/kg/day for 12 weeks (6 weeks daily and 6 weeks alternate therapy) was prescribed in addition to their regular antiepileptic medications. The parents kept seizure diaries, and the patients were regularly assessed for seizure frequency and side effects. The follow up was for 1-5 years. RESULTS: Seven patients had atypical Absence seizures, 5 patients had Severe Myoclonic Epilepsy, 3 patients had Juvenile Myoclonic Epilepsy, 1 patient had the West Syndrome, and 7 patients had the Lennox Gastaut Syndrome. All patients had multiple seizure types, an epileptic EEG, and developmental delay. Ten patients (43%) became seizure free on Prednisone and another 9 (40%) had a significant decrease in seizure frequency. Four patients (17%) had no change in seizure frequency. The best outcome was seen in the atypical absence group in which 6/7 became seizure free. Side effects were uncommon and included weight gain in 4 patients and aggression in 2 patients. CONCLUSIONS: Prednisone pulsing is safe and effective adjunctive treatment for epilepsy. It should be considered as an alternative treament for older children with intractable generalized epilepsy who have failed conventional antiepileptic therapy.