Treatment with High Dose Oral Prednisolone (8 Mg/kg/day) in Children with Infantile Spasms Who Failed Vigabatrin: A Retrospective Study
Abstract number :
V.047
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2021
Submission ID :
1826070
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Wafaa Al Shehhi, MD - The Royal hospital; 3. Jennifer Boyd - neurology - Hospital for Sick Children; Vann Chau - neurology - Hospital for Sick Children; Elizabeth Donner - neurology - Hospital for Sick Children; Cristina Go - neurology - Hospital for Sick Children; Puneet Jain - neurology - Hospital for Sick Children; Rohit Sharma - neurology - Hospital for Sick Children; Carter Snead - neurology - Hospital for Sick Children
Rationale: This study aimed to study the short-term seizure outcomes following treatment with 8 mg/kg/day prednisolone in children with infantile spasms refractory to vigabatrin. We hypothesized that high-dose prednisolone may result in similar rates of electroclinical remission as compared to published ACTH rates.
Methods: All consecutive children with hypsarrhythmia, hypsarrhythmia variant, or multiple independent spike foci (MISF) on EEG with/without infantile spasms, who had been treated with vigabatrin as first line anti-seizure medication (ASM) followed by high dose oral prednisolone (8 mg/kg/day) in cases who did not respond to vigabatrin, were included. Clinical and electroclinical remission at 2 weeks following initiation of treatment and adverse effects were assessed.
Results: Sixty-five children were included. A genetic etiology was seen in 38.5% of cases. The median estimated delay from onset of spasms to treatment was 11 days. Preceding normal development was seen in 33.8% of cases. Complete ECR was seen in 30.8% (20/65) of the patients two weeks after vigabatrin. Complete ECR was noted in 77.8% (35/45) of the patients, two weeks after prednisolone initiation in children who failed vigabatrin, and this was sustained at 6 weeks in 66.7% (30/45) patients. Prednisolone was generally well-tolerated.
Conclusions: High dose (8 mg/kg/day) of oral prednisolone resulted in complete electroclinical response (at 2 weeks) in more than three-fourth of children with hypsarrhythmia or hypsarrhythmia variant on EEG with/without parentally reported infantile spasms who had failed vigabatrin. This was sustained at 6 weeks in two-thirds of the children. It was generally well-tolerated and found to be safe. It may be a reasonable and more feasible alternative to ACTH for the treatment of infantile spasms. Further trials exploring the comparative effectiveness of 8 mg/kg/day prednisolone with ACTH, dose-response relationship with prednisolone, and exploring various drug combination therapies to improve efficacy are warranted.
Funding: Please list any funding that was received in support of this abstract.: There is no financial disclosure for this project.
Clinical Epilepsy