Corticosteroids as treatment of epileptic syndromes with continuous spike‐waves during slow‐wave sleep
- 29 July 2009
- Vol. 50 (s7), 68-72
- https://doi.org/10.1111/j.1528-1167.2009.02224.x
Abstract
To assess the efficacy and tolerability of steroids in epileptic syndromes with continuous spike-waves during slow-wave sleep (CSWS), charts of 44 children (25 boys) who received corticosteroids for cognitive and/or behavioral deterioration associated with CSWS were retrospectively reviewed. Awake and sleep electroencephalography (EEG) records, clinical and neuropsychological assessments were available before, during, and after corticosteroid therapy. Evaluation focused on effects on EEG, behavior, and cognition. All but two patients received hydrocortisone (initial dose of 5 mg/kg/day). The treatment was slowly tapered with a total duration of 21 months. There were 18 symptomatic and 26 cryptogenic cases. Mean age was 7 years and mean intelligence quotient/developmental quotient (IQ/DQ) was 65. Mean CSWS duration before corticosteroid treatment was 1.7 years. Twenty patients had tried more than two antiepileptic drugs (AEDs) before steroids. Positive response to steroids was found during the first 3 months of treatment in 34 of 44 patients (77.2%), with normalization of the EEG in 21 patients. Relapse occurred in 14 of them. Hence, 20 patients (45.4%) were long-term responders after a single but prolonged trial of steroids, including all four cases of Landau-Kleffner syndrome. Positive response to steroids was highly significantly associated with higher IQ/DQ. Shorter CSWS duration, but not age, etiology, or previous AED trials, was associated with positive response to steroids. Early discontinuation of the treatment for side effects was encountered in seven patients. We conclude that corticosteroids are safe and efficient for treatment of epilepsy with CSWS. Poor responders are patients with very low IQ and long duration of CSWS.Journal ArticleSCOPUS: cp.jFLWINinfo:eu-repo/semantics/publisheKeywords
This publication has 15 references indexed in Scilit:
- Treatment of epilepsy with electrical status epilepticus during slow sleep and its related disordersBrain & Development, 2006
- Levetiracetam Efficacy in Epileptic Syndromes with Continuous Spikes and Waves during Slow Sleep: Experience in 12 CasesEpilepsia, 2005
- Steroids in intractable childhood epilepsy: Clinical experience and review of the literatureSeizure, 2005
- Early Thalamic Injury Associated with Epilepsy and Continuous Spike–Wave during Slow SleepEpilepsia, 2005
- Corticosteroids for the Treatment of Landau-Kleffner Syndrome and Continuous Spike-Wave Discharge During SleepPediatric Neurology, 2005
- Treatment of electrical status epilepticus by short diazepam (DZP) cycles after DZP rectal bolus testBrain & Development, 1995
- Effect of Early Corticosteroid Therapy for Landau‐Kleffner SyndromeDevelopmental Medicine and Child Neurology, 1991
- Landau‐Kleffner Syndrome: A Pharmacologic Study of Five CasesEpilepsia, 1990
- Proposal for Revised Classification of Epilepsies and Epileptic SyndromesEpilepsia, 1989
- Subclinical "Electrical Status Epilepticus" Induced by Sleep in ChildrenArchives of Neurology, 1971