Reduction of interictal epileptic burden by pulsatile corticoid therapy in children with drug-resistant epilepsy-How stable is the effect?

OBJECTIVE: The systematic use of pulsatile corticosteroid therapy (PCT) in children with drug-resistant epilepsy has been shown to reduce epileptic activity. However, it remains unclear how long this effect will last. The objective of this study was therefore to evaluate the stability of the effect of PCT by assessing the interictal epileptic activity burden (% of electroencephalography (EEG) with interictal epileptic activity, IEA) one year after the end of treatment. METHODS: The final study cohort consisted of 20 children (9 females; mean age 7.6 ± 3.5 years) with various drug-resistant surgically nonremediable epilepsies who underwent systematic treatment with PCT (20 mg/m2 body surface per treatment cycle). EEG recordings during sleep and wakefulness were obtained at baseline, after PCT, and at one-year follow-up. IEA burden and sleep spindles (rate per minute) to evaluate sleep physiology were compared between the different time points. RESULTS: IEA burden was significantly reduced after PCT treatment (4.9% [2.4-20.4] vs. .9% [.2-5.5], p = .005, d = -.47) and this effect continued to persist at follow-up (.9% [.2-5.5] vs. 2.7% [.2-7.4], p = .99, d = .02). At time of follow-up, 33.3% patients showed a relapse defined by an increase in IEA burden after an initial decrease of at least 50% through PCT. Fast spindle rate (12-16 Hz) tended to be higher after PCT (1.0 ± .8 vs. 1.6 ± .8, p = .08, d = .59) and remained stable between the end of PCT and follow-up (1.6 ± .8 vs. 1.6 ± .4, p = .98, d = .01). SIGNIFICANCE: Our findings suggest that in the majority of patients, PCT led to long-lasting benefits not only by reducing epileptic activity but also by improving sleep, important for cognitive functions.

Duke Scholars

Author Birgit Frauscher Neurology, Epilepsy and Sleep