Role of pulse methylprednisolone in epileptic encephalopathy: A retrospective observational analysis

Chatterjee, Aparajita; Mundlamuri, Ravindranadh Chowdary; Kenchaiah, Raghavendra; Asranna, Ajay; Nagappa, Madhu; Bindu, Parayil Sankaran; Dv, Seshagiri; Viswanathan, Lakshminarayanapuram Gopal; Shreedhar, AS; Duble, Sisir; Rangarajan, Anush; Khilari, Madhuri; Bharath, Rose Dawn; Saini, Jitender; Thennarasu, Kandavel; Taly, Arun B.; Sinha, Sanjib

doi:10.1016/j.eplepsyres.2021.106611

Cited by 12 publications

(14 citation statements)

References 28 publications

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“…Furthermore, median regression analysis showed up intervention as the only factor that was significantly associated with percentage reduction in seizure frequency. Subgroup analysis showed that 37.5% of children achieved seizure freedom and 62.5% of children achieved more than 75% seizure reduction, which is comparable with retrospective studies in the literature 7 12 13. In previous studies, improvement with steroids ranged from 40% to 73% 7 14–17.…”

Section: Discussionsupporting

confidence: 81%

“…Subgroup analysis showed that 37.5% of children achieved seizure freedom and 62.5% of children achieved more than 75% seizure reduction, which is comparable with retrospective studies in the literature 7 12 13. In previous studies, improvement with steroids ranged from 40% to 73% 7 14–17. The wide variation of response could be due to use of different types of preparations, route and duration of steroids in various studies 7 13 14 16 17.…”

Section: Discussionsupporting

confidence: 76%

“…However, a few recent studies have shown more favourable results. We recently reported the benefits of pulse IVMP in a retrospective study of subjects with EE (n=99), where >50% reduction in seizure burden was noted in 66% of patients at 3 months and seizure-freedom was seen in 25% 7. Gofshteyn et al observed similar results in children with EE other than WS 8.…”

Section: Introductionmentioning

confidence: 69%

“…In previous studies, improvement with steroids ranged from 40% to 73% 7 14–17. The wide variation of response could be due to use of different types of preparations, route and duration of steroids in various studies 7 13 14 16 17. In addition, the seizure frequency decreased irrespective of the type of seizure.…”

Section: Discussionmentioning

confidence: 94%

“…High level of evidence for using steroids in EEs other than West syndrome (WS) is lacking. Steroid therapy in EE, in addition to standard ASMs, has shown benefit in retrospective studies and small case series 4–9. In a systematic review in 2015, there was no conclusive evidence for the role of steroids in EEs other than WS 6.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of pulse intravenous methylprednisolone in epileptic encephalopathy: a randomised controlled trial

Rangarajan

Mundlamuri

Kenchaiah

et al. 2022

J Neurol Neurosurg Psychiatry

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BackgroundHigh-level evidence for using steroids in epileptic encephalopathy (EE), other than West syndrome (WS), is lacking. This study investigated the efficacy and safety of pulse intravenous methylprednisolone (IVMP) in EE other than WS.MethodsThis is an open-label evaluator-blinded randomised controlled study. Children aged 6 months or more with EE other than WS were included. Eighty children were randomised into intervention and non-intervention groups with 40 in each group. At the first visit (T1) seizure frequency, electroencephalographic (EEG) and Vineland Social Maturity Scale (VSMS) were obtained, and antiseizure medication (ASM) were optimised. After 1 month (T2), subjects were randomised to intervention (ASM+3 months IVMP pulse) or non-intervention group (only ASM) with 40 subjects in each group. They were followed up for 4 months (T3) and assessed.ResultsAfter 4 months of follow-up, 75% of patients receiving IVMP had >50% seizure reduction versus 15.4% in control group (χ2=28.29, p<0.001) (RR 4.88, 95% CI 2.29 to 10.40), median percentage change in seizure frequency (91.41% vs 10%, p<0.001), improvement in EEG (45.5% vs 9.4%, χ2=10.866, p=0.001) and social age domain of VSMS scores (Z=−3.62, p<0.001) compared with baseline. None of the patients in the intervention group had any serious side-effects.DiscussionThree-month pulse IVMP therapy showed significant improvement in seizure frequency, EEG parameters and VSMS scores, with no steroid-related serious adverse effects. It can be considered as a safe and effective add on treatment in children with EE other than WS.Trial registration numberCTRI/2019/02/017807.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Efficacy of pulse intravenous methylprednisolone in epileptic encephalopathy: a randomised controlled trial

Rangarajan

Mundlamuri

Kenchaiah

et al. 2022

J Neurol Neurosurg Psychiatry

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Kortikosteroide und adrenocorticotropes Hormon bei Epilepsien der frühen Kindheit jenseits des Säuglingsalters

Korinthenberg,

Bast,

Haberlandt

et al. 2024

Clin Epileptol

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ZusammenfassungIn diesem Bericht fassen wir die Ergebnisse eines systematischen Reviews (SR) zusammen, in dem Daten zur Wirksamkeit und Verträglichkeit von ACTH (adrenocorticotropes Hormon) und Kortikosteroiden (KST) bei Kindern mit anderen Epilepsien als dem infantilen epileptischen Spasmussyndrom (IESS) ausgewertet wurden, die auf Anfallssuppressiva (ASM) nicht angesprochen hatten. Der SR umfasste retrospektive und prospektive Studien, die über mehr als 5 Patienten berichteten und klare Falldefinitionen sowie Beschreibungen der Behandlung und der Ergebnisse enthielten. Achtunddreißig (2 kontrollierte und 5 unkontrollierte prospektive, 31 retrospektive) Studien mit 1152 Patienten wurden eingeschlossen. Die Metaanalyse der aggregierten Daten zur Anfallsreduktion > 50 % und zur Verringerung der EEG(Elektroenzephalogramm)-Spikes am Ende der Initialbehandlung ergab gepoolte Raten (PR) von 0,60 (95 %-KI [Konfidenzintervall] 0,52–0,67) und 0,56 (95 %-KI 0,43–0,68). Die Rückfallquote war hoch (PR 0,33, 95 %-KI 0,27–0,40). Subgruppenanalysen und eine Metaregression zeigten keinen signifikanten Unterschied zwischen den eingesetzten Substanzen, eine etwas bessere Wirkung bei entwicklungsbedingter und/oder epileptischer Enzephalopathie mit Spike-and-Wave-Aktivierung im Schlaf (DEE-SWAS) und eine schwächere Wirkung bei Patienten mit kognitiver Beeinträchtigung und „symptomatischer“ Ätiologie. Die Höhe der kumulativen Dosis der initialen Behandlungsphase hatte keinen Einfluss auf die Behandlungsergebnisse. Adipositas und Cushing-Syndrom waren die häufigsten unerwünschten Wirkungen, die oft in Studien mit kontinuierlicher ACTH- (PR 0,73, 95 %-KI 0,48–0,89) oder KST-Gabe (PR 0,72, 95 %-KI 0,54–0,85), aber selten bei intermittierender intravenöser oder oraler KST-Gabe (PR 0,05, 95 %-KI 0,02–0,10) auftraten. Die Aussagekraft dieser Ergebnisse wird durch ein hohes Verzerrungsrisiko der meisten eingeschlossenen Studien und eine große Heterogenität zwischen den Studiendaten eingeschränkt. Der volle SR wurde unter https://doi.org/10.1111/epi.17918 publiziert.

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Clinical spectrum of pediatric drug refractory epilepsy secondary to parieto-occipital gliosis

et al. 2021

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Role of pulse methylprednisolone in epileptic encephalopathy: A retrospective observational analysis

Cited by 12 publications

References 28 publications

Efficacy of pulse intravenous methylprednisolone in epileptic encephalopathy: a randomised controlled trial

Efficacy of pulse intravenous methylprednisolone in epileptic encephalopathy: a randomised controlled trial

Kortikosteroide und adrenocorticotropes Hormon bei Epilepsien der frühen Kindheit jenseits des Säuglingsalters

Clinical spectrum of pediatric drug refractory epilepsy secondary to parieto-occipital gliosis

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