The use of steroids in adult epilepsy: A systematic review.

Abstract

Objective: The objective of this study is to systematically review the clinical studies investigating the use of steroids in adult epilepsy.

Methods: This systematic review utilized Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) to examine literature on the use of steroids in adult epilepsy. Three databases, Embase, PubMed and Medline, were searched and clinical studies fitting the inclusion and exclusion criteria were included for review.

Results: There were 4333 articles retrieved after duplicates were removed and 16 met the inclusion criteria. Three of these studied corticosteroid use in seronegative autoimmune epilepsies. There was one study that examined the use of corticosteroids in adult-onset Rasmussen's Encephalitis. There were three studies which described the use of neurosteroids in various forms of adult epilepsy. The remaining 9 studies were pertaining to the use of corticosteroids in refractory status epilepticus.

Significance: Steroids show favorable outcomes in many forms of adult epilepsy. Yet, there is a paucity of data supporting implementation of this treatment in practice. High-level evidence such as Randomized-Controlled Trials investigating the use of corticosteroids in adult epilepsy are required, particularly those examining seronegative autoimmune epilepsy and refractory status epilepticus given the prevalence of these conditions and lack of treatment options.

Plain language summary: Epilepsy, characterized by repeated seizures often without a known cause, is initially treated with anti-seizure medications. However, about one third of patients do not become seizure-free with medication. Steroids, known for their anti-inflammatory effect, are now being trialed as a seizure treatment for difficult to control seizures because uncontrolled seizures are thought to cause inflammation in the brain. However, the use of steroids as a treatment for uncontrolled seizures has not been researched widely. This article reviews studies exploring the use of steroids in adult epilepsy and finds that there is some evidence that steroids may be able to improve seizures in some cases. Yet, further research is needed to better understand the effect and benefits of steroids in managing epilepsy.