Short-term outcome of intravenous methylprednisolone pulse therapy in patients with infantile spasms

Publication date: Available online 31 March 2017
Source:Pediatric Neurology
Author(s): Hye-Ryun Yeh, Min-Jee Kim, Tae-Sung Ko, Mi-Sun Yum, Su-Jeong You
BackgroundMany studies advocate hormonal treatments including high-dose oral prednisolone as an effective treatment for epileptic spasms. However, little is known about the effects of intravenous methylprednisolone (MPD) pulse therapy on infantile spasms. This study aimed to investigate the short-term response to intravenous MPD pulse therapy for the treatment of infantile spasms.MethodsPatients with newly diagnosed infantile spasms and hypsarrhythmia on EEG at two tertiary centers in Korea were included. Patients received intravenous infusions of 30 mg/kg/day MPD for 3 days with tapering doses of oral prednisolone for 2-4 weeks for the treatment of infantile spasms. Response to MPD pulse therapy was evaluated by seizure frequency and follow-up EEG within 3 weeks.ResultsFourteen patients were included in this study. The mean age at the onset of spasms was 7.0 months (range, 2.0 to 11.0 months). Etiological factors included structural etiologies (N = 10), chromosomal anomaly (N = 2), and unknown (N = 2). Nine of 14 participants (64.3 %) demonstrated complete freedom from spasm and resolution of hypsarrhythmia on EEG within 3 weeks; however, only 5 of 9 responders (55.5 %) remained free of spasms after the discontinuation of oral steroids. Adverse effects, including irritability or infection, were observed in four patients, but were tolerable in all.ConclusionShort-term MPD pulse therapy for the treatment of infantile spasms or hypsarrhythmia demonstrated rapid EEG improvement and cessation of spasms without serious side effects. Further studies are needed to determine the long-term effects of spasm control.



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