Drug resistant epilepsies: a multicentre case series of steroid therapy

Purpose Our study aimed to evaluate the effectiveness of corticosteroids on seizure control in drug-resistant epilepsies (DREs). Our primary goal was to assess the response to steroids for various underlying etiologies, interictal electroencephalographic (EEG) patterns and electroclinical seizure descriptions. Our second goal was to compare steroid responsiveness to different treatment protocols. Methods This is a retrospective multicentre cohort study conducted according to the STROBE guidelines (Strengthening the Reporting of Observational Studies in Epidemiology). The following data were collected for each patient: epilepsy etiology, interictal EEG pattern, seizure types and type of steroid treatment protocol administered. Results Thirty patients with DRE were included in the study. After 6 months of therapy, 62.7% of patients experienced reduced seizure frequency by 50%, and 6.6% of patients experienced complete seizure cessation. Findings associated with favourable response to steroids included structural/lesional etiology of epilepsy, immune/infectious etiology and focal interictal abnormalities on EEG. Comparing four different steroid treatment protocols, the most effective for seizure control was treatment with methylprednisolone at the dose of 30 mg/kg/day administered for 3 days, leading to greater than 50% seizure reduction at 6 months in 85.7% of patients. Treatment with dexamethasone 6 mg/day for 5 days decreased seizure frequency in 71.4% of patients. Hydrocortisone 10 mg/kg administered for 3 months showed a good response to treatment in 71%. Conclusions In our study, two-thirds of patients with DRE experienced a significant seizure reduction following treatment with steroids. We suggest considering steroids as a potential therapeutic option in children with epilepsy not responding to conventional antiseizure medicines (ASM).