CSWS: DIAGNOSTIC, THERAPEUTIC AND PROGNOSTIC ISSUES IN SIX CHILDREN TREATED WITH CORTICOSTEROIDS

Objectives: To analyze the clinical and electroencephalographic (EEG) features of six children treated with corticosteroids because of continuous spike-and waves during sleep (CSWS or ESES) in the course of idiopathic or symptomatic epilepsy.

Methods: The patients were diagnosed as having primarily Rolandic epilepsy (n=2) or atypical benign childhood epilepsy (n=1), and symptomatic focal epilepsy evolving to ESES (n=3). The treatment was performed using IV methylprednisolon and/or subsequent intramuscular ACTH or oral dexamethason for a total period up to 4 months. The basic antiepileptic therapy was not changed. Sleep EEGs were performed at regular intervals of 2, 4, 8 and 12 weeks after treatment initiation.

Results: The only difference in the clinical and EEG characteristics between the groups with idiopathic and symptomatic epilepsy was the duration of the basic epileptic condition and CSWS, respectively. In the symptomatic group they lasted significantly longer than in children with idiopathic etiology. During the corticosteroid treatment, CSWS responded at various degrees in all children. A significant and long-lasting improvement, however, was observed in idiopathic patients only. In symptomatic children no EEG normalization was achieved and clinical and EEG improvement was mainly noted during the steroid treatment (2 out of 3 patients).

Conclusion: The long CSWS duration clearly worsens the prognosis of the neuropsychological outcome. Another important prognostic factor could be the etiology of the epilepsy, since in our series a persistent improvement and normalization of EEG and overall condition during the corticosteroid treatment was achieved in idiopathic cases only. The side effects were transient and not serious. Therefore, corticosteroids should be considered as an early treatment option in children with CSWS.