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

Aparajita Chatterjee; Ravindranadh Chowdary Mundlamuri; Raghavendra Kenchaiah; Ajay Asranna; M Nagappa; P S Bindu; D V Seshagiri; Lakshminarayanapuram Gopal Viswanathan; A S Shreedhar; Sisir Duble; Anush Rangarajan; Madhuri Khilari; Rose Dawn Bharath; Jitender Saini; K Thennarasu; Arun B Taly; Sanjib Sinha

doi:10.1016/j.eplepsyres.2021.106611

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

Epilepsy Res. 2021 Jul:173:106611. doi: 10.1016/j.eplepsyres.2021.106611. Epub 2021 Mar 11.

Authors

Aparajita Chatterjee¹, Ravindranadh Chowdary Mundlamuri¹, Raghavendra Kenchaiah¹, Ajay Asranna¹, M Nagappa¹, P S Bindu¹, D V Seshagiri¹, Lakshminarayanapuram Gopal Viswanathan¹, A S Shreedhar¹, Sisir Duble¹, Anush Rangarajan¹, Madhuri Khilari¹, Rose Dawn Bharath², Jitender Saini², K Thennarasu³, Arun B Taly¹, Sanjib Sinha⁴

Affiliations

¹ Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, 560011, India.
² Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, 560011, India.
³ Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, 560011, India.
⁴ Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, 560011, India. Electronic address: sanjib_sinha2004@yahoo.co.in.

PMID: 33740698
DOI: 10.1016/j.eplepsyres.2021.106611

Abstract

Objectives: To study the effect of monthly pulses of intravenous methylprednisolone (IVMP) on seizure and global outcomes in children with epileptic encephalopathy (EE).

Methods: This retrospective study was undertaken in a tertiary care epilepsy center in India. Consecutive patients with EE who had received IVMP as adjunctive therapy for a minimum of 3 months and had at least one pre-and post-steroid EEG each, were identified and a structured questionnaire was used to collect information including outcomes at 3 months post-steroid course completion and beyond, as available.

Results: Ninety-seven patients (M:F=71:26) fulfilling the inclusion criteria with a mean age at onset of seizures being 20.52 ± 25.69 months were included. Commonest seizure types were myoclonic (66%); Lennaux-Gastaut and West Syndromes accounted for 57 % and 24 % patients respectively. The etiology was unknown in 52 %. All children were on a combination of standard anti-seizure drugs. The duration of IVMP pulse therapy was 7.72 ± 6.25 months. One-fourth (26 %) patients experienced minor adverse events. Greater than 50 % seizure burden reduction was seen in 66 % patients at 3 months with seizure-freedom in 25 %. A total of 45 (46 %) patients became seizure-free in the cohort eventually with continuation of steroids beyond 3 months. Children with idiopathic EEs, normal neuroimaging, myoclonic jerks, and West syndrome showed the best response. The presence of burst-suppression and generalized paroxysmal fast activity (GPFA) predicted inadequate response.

Conclusions: Adjunct pulse doses of IVMP are safe, well-tolerated, and effective in reducing seizures and improving global outcomes in children with idiopathic EEs, West syndrome, normal neuroimaging, and myoclonic jerks. Seizure freedom might be delayed in a subset of these patients, hence duration of therapy beyond 3 months may be warranted.

Keywords: Epileptic encephalopathy (EE); Outcomes; Pulse intravenous methylprednisolone (IVMP); Seizure frequency.

Publication types

Observational Study

MeSH terms

Child
Electroencephalography
Epilepsy* / drug therapy
Humans
Methylprednisolone / therapeutic use
Retrospective Studies
Spasms, Infantile* / drug therapy

Substances

Methylprednisolone