Epileptic spasms: Experience with a high-dose oral corticosteroid protocol

Authors

  • Tyson L Ware,

    1. Department of Neurology, The Royal Children's Hospital
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  • Mark T Mackay,

    1. Department of Neurology, The Royal Children's Hospital
    2. Murdoch Childrens Research Institute, Parkville
    3. University of Melbourne, Melbourne, Victoria, Australia
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  • A Simon Harvey,

    1. Department of Neurology, The Royal Children's Hospital
    2. Murdoch Childrens Research Institute, Parkville
    3. University of Melbourne, Melbourne, Victoria, Australia
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  • Jeremy L Freeman

    Corresponding author
    1. Department of Neurology, The Royal Children's Hospital
    2. Murdoch Childrens Research Institute, Parkville
      Dr Jeremy L Freeman, Department of Neurology, The Royal Children's Hospital, Flemington Road, Parkville, Vic. 3052, Australia. Fax: +613 9345 5977; email: jeremy.freeman@rch.org.au
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  • Conflict of interest: None declared.

Dr Jeremy L Freeman, Department of Neurology, The Royal Children's Hospital, Flemington Road, Parkville, Vic. 3052, Australia. Fax: +613 9345 5977; email: jeremy.freeman@rch.org.au

Abstract

Aim:  To audit clinical practice and assess early outcomes for infants with epileptic spasms after an agreed initial treatment protocol was adopted.

Methods:  We reviewed all cases of epileptic spasms diagnosed between July 2007 and June 2009 and assessed adherence to protocol, remission by day 14, spasm recurrence and side effects. The protocol required that infants be treated with high-dose oral prednisolone except those with tuberous sclerosis complex (TSC) who were treated with vigabatrin.

Results:  Twenty-eight infants (age 3–14 months, 17 male) were newly diagnosed. Six (21%) had no cause identified (cryptogenic), six (21%) had TSC and 16 (57%) had other non-TSC symptomatic aetiologies. Twenty-three were treated per protocol and five were not. The proportion with remission by day 14 of treatment was 100% in the cryptogenic group (all treated per protocol), 64% in those with non-TSC symptomatic aetiologies treated per protocol, 20% in those with non-TSC symptomatic aetiologies treated not per protocol and 17% in infants with TSC (all treated per protocol). Of 17 infants who received prednisolone, two were admitted for management of febrile illness.

Conclusion:  Our experience with high-dose oral prednisolone for treatment of epileptic spasms suggests that it is effective and tolerable. The greater proportion of non-TSC symptomatic patients with timely cessation of spasms when treated by this protocol supports the use of high-dose oral prednisolone as the treatment of choice. Given the poor response of children with TSC to treatment with vigabatrin, early use of steroid therapy deserves consideration.

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