Steroid-therapy as therapeutic strategy for drug resistant epilepsies: A retrospective multicenter study

Abstract

The Objectives were twofold, first to evaluate the efficacy of steroids in refractory epilepsy in children, and second, to assess the effectiveness of the steroid treatment protocols used. We included 30 patients with medically refractory epilepsy, according to the international definition for the disorder. The data analyzed included epilepsy type and etiology, seizure reduction, and type of the steroid treatment protocols associated with the best seizure outcome. Our data showed a statistically significant seizure reduction in children with structural etiology and immune-mediated/infectious etiologies at 15 days after the steroid treatment initiation which was still sustained after at 30 days after starting steroids. In comparison, refractory epilepsy secondary to genetic causes did not show similar response to steroid treatment. While there isn't significant steroid response on seizure control to follow-up at 6 months, regardless of the etiological cause. The second aim of this study was to evaluate the efficiency of the 4 steroid treatment protocols used for seizure control in children with medically refractory epilepsy. Out of the four therapeutic used in our study, the protocols with best efficacy were the IV methylprednisolone 30 mg/Kg/day for 3 days and IV methylprednisolone 15 mg/Kg/day for 5 days. In the DRE, inflammatory mediators are likely to significantly contribute to the onset and recurrence of seizures. What our study adds, is providing supportive evidence on efficacy of steroids in drug resistant epilepsy. Use of steroids for refractory seizures appears to be safe, and it is associated with clinical reduction of seizures as well as EEG improvement.