Neuropediatrics 2009; 40(6): 265-268
DOI: 10.1055/s-0030-1249653
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Methylprednisolone for the Treatment of Children with Refractory Epilepsy

R. A. Sevilla-Castillo1 , G. C. Palacios1 , 2 , J. Ramirez-Campos1 , M. Mora-Puga1 , R. Diaz-Bustos1
  • 1Departamento de Neurologia Pediatrica and Departamento de Pediatria, Unidad Medica de Alta Especialidad Hospital de Especialidades No 25 Monterrey, Nuevo Leon, Mexico
  • 2Centro de Investigacion Biomedica del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon, Mexico
Further Information

Publication History

received 02.03.2009

accepted 23.02.2010

Publication Date:
05 May 2010 (online)

Abstract

Epilepsy is a disease characterized by unprovoked epileptic seizures resulting from a bioelectrical brain dysfunction. Antiepileptic treatment controls 75% of all epileptic patients; the other 25% continue to have epileptic seizures in spite of a combination of multiple antiepileptic drugs. The purpose of this work was to evaluate the use of methylprednisolone in the treatment of children with refractory epilepsy. Fourteen children with refractory epilepsy at the Hospital de Especialidades No. 25 of the Instituto Mexicano del Seguro Social in Monterrey, Northeast Mexico were included. For five consecutively days, each patient received methylprednisolone by intravenous administration at a dosage of 15 mg/kg/day each 8 h, once a month for 3 months. The frequency of epileptic seizures and possible related side effects were evaluated every month during the three months before, during, and after administration of methylprednisolone. The frequency of epileptic seizures was reduced by more than 50% in 12/14 patients during methylprednisolone treatment. The median number of seizures before treatment with methylprednisolone was 8, 8, and 7; during the treatment: 1, 1, and 1; and after treatment: 2, 2, and 3 (p=0.000). We conclude that methylprednisolone reduces the frequency of epileptic seizures in children with refractory epilepsy.

References

  • 1 Baram TZ, Mitchell WG, Tournay A. et al . High-dose corticotropin (ACTH) versus prednisone for infantile spasms: A prospective, randomized, blinded study.  Pediatrics. 1996;  97 375-379
  • 2 Bracken M, Shepard M, Holford T. et al . Methylprednisolone or tirilazad mesylate administration after acude espinal cord injury results of the third nacional acute espinal cord injury randomized controlled trial: 1 year follow up.  J Neurosurg. 1988;  89 699-706
  • 3 Brunson K, Khan N, Eghbal-ahmadi M. et al . Corticotropin (ACTH) acts directly on amygdala neurons to down regulate corticotrophin releasing hormone gene expression.  Ann Neurol. 2001;  49 304-312
  • 4 Chengsan S, Zacaria M, Elev E. et al . Diminished neurosteroid sensitivity of synaptic inhibition and altered location of the α4 subunit of GABA A receptors in an animal model of epilepsy.  J Neurosci. 2007;  27 12641-12650
  • 5 Gayatri N, Ferrie CD, Cross HHJ. Corticosteroids including ACTH for childhood epilepsy other than epileptic spasms.  Cochrane database of systematic reviews. 2007;  Issue 1. Art. No.: CD 005222 DOI:10.1002/14651858.CD005222.pub2
  • 6 Gilman JT, Duchowny M, Jayacar P. et al . Medical intractability in children evaluated for epilepsy.  Surg Neurol. 1994;  44 1340-1343
  • 7 Gupta R, Appleton R. Corticosteroids in the management of the paediatric epilepsies.  Arch Dis Child. 2005;  90 379-384
  • 8 International League Against Epilepsy . Definition of epilepsy.  Epilepsia. 2003;  44 (S 06) 15-16
  • 9 International League Against Epilepsy . Refractory epilepsy.  Epilepsia. 2003;  44 (S 06) 81-82
  • 10 Lang TA, Secic M. How to report statistic in medicine.. Annotated guidelines for authors, editors, and reviewers. Philadelphia: American College of Physicians; 1997
  • 11 Lesser RP, Pippenger CE, Lüders H. et al . High dose monotherapy in treatment of intractable seizures.  Neurology. 1984;  34 707-711
  • 12 Maurice T, Phan VL, Urani A. et al . Neuroactive neurosteroids as endogenous effectors for the sigma 1 receptor. Pharmacological evidence and therapeutic opportunities.  Jpn J Pharmacol. 1999;  81 125-155
  • 13 Mitchedlishvili Z, Bertram EH, Kapur J. Diminished allopregnanolone enhancement of GABA(A) receptor currents in a rat model of chronic temporal lobe epilepsy.  J Physiol (Lond). 2001;  537 453-465
  • 14 Peng Z, Huang CS, Stell BM. et al . Altered expressión of the delta subunit of the GABAA receptor in a mouse model of temporal lobe epilepsy.  J Neurosci. 2004;  24 8629-8639
  • 15 Portney LG, Watkins MP. Foundations of clinical research.. Applications to practice. Norwalk, CT: Appleton & Lange; 1993: 191-437
  • 16 Riikonen R, Donner M. ACTH therapy in infantile spasms: Side effects.  Arch Dis Child. 1980;  55 664-672
  • 17 Roman F, Pascaud X, Duffy O. et al . Neuropeptide Y and peptide YY interact with rat brain sigma and PCP binding sites.  Eur J Pharmacol. 1989;  174 301-302
  • 18 Sinclair D, Snyder T, Berg M. et al . Corticosteroid treatment in Landau Kleffner syndrome.  Epilepsia. 2002;  43 (suppl 7) 171
  • 19 Sloka JS, Stefanelli M. The mechanism of action of methylprednisolone in the treatment of multiple sclerosis.  Mult Scler. 2005;  11 425-432
  • 20 Snead O, Benton J, Hosey L. et al . Treatment of infantile spasms with high-dose ACTH: Efficacy and plasma levels of ACTH and cortisol.  Neurology. 1989;  39 1027-1030
  • 21 Verhelts H, Boon P, Busye G. et al . Steroids in intractable childhood epilepsy: Clinical experience and review of the literature.  Seizures. 2005;  14 412-421
  • 22 Wang W, Dow K, Fraser D. Elevated corticotropin releasing hormone/corticotropin releasing hormone-R1 expresion in posmorten brain obtained from children with generalized epilepsy.  Ann Neurol. 2001;  50 404-409
  • 23 Wohlfarth KM, Bianchi MT, Macdonald RL. Enhanced neurosteroid potentiation of ternary GABAA receptors containing the δ subunit.  J Neurosci. 2002;  22 1541-1549

Correspondence

Ricardo A. Sevilla-Castillo

Departamento de Neurologia

Pediatrica & Departamento de

Pediatría

UMAE Hospital de

Especialidades

No. 25, Fidel Velasquez y

Lincoln S/N

Colonia Nueva Morelos

C.P. 64610 Monterrey

Nuevo León

México

Phone: +52/81/8371 4100 Ext.: 41315

Fax: +52/81/8371 4100 Ext.: 41315

Email: ricardosevilla@hotmail.com

    >