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

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Epileptic Disorders Pub Date : 2025-05-10 DOI:10.1002/epd2.70036

Katharina Schiller, Tamir Avigdor, John Thomas, Daniel Mansilla, Chifaou Abdallah, Aline Kortas, Gabriele Unterholzner, Raluca Pana, Markus Rauchenzauner, Birgit Frauscher

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Abstract

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.

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搏动性皮质激素治疗减轻耐药癫痫患儿间期癫痫负担的效果有多稳定？

目的：系统应用搏动性皮质类固醇治疗（PCT）可降低耐药癫痫患儿的癫痫活动。然而，目前尚不清楚这种影响将持续多久。因此，本研究的目的是通过评估治疗结束一年后癫痫间期活动负担（癫痫间期活动占脑电图（EEG）的百分比，IEA）来评估PCT效果的稳定性。方法：最终研究队列包括20名儿童(9名女性；平均年龄7.6±3.5岁)，患有各种手术无法治愈的耐药癫痫，接受PCT系统治疗（每个治疗周期体表20 mg/m2）。在基线、PCT后和一年随访时获得睡眠和清醒期间的脑电图记录。比较不同时间点的睡眠生理负荷和睡眠纺锤波（每分钟速率）。结果：PCT治疗后IEA负担明显减轻(4.9%[2.4-20.4]对.9% [.2-5.5],p =。005, d = - 0.47)，这种效果在随访中持续存在(。9% [.2-5.5] vs. 2.7% [.2-7.4], p =。99, d = .02)。随访时，33.3%的患者在通过PCT治疗初期至少减少50%的IEA负担后出现复发，PCT治疗后的快速纺锤波率（12-16 Hz）趋于较高（1.0±1.6 Hz）。8 vs. 1.6±。8、p =。08, d = .59)，并在PCT结束至随访期间保持稳定(1.6±。8 vs. 1.6±。4、p =。98, d = .01)。意义：我们的研究结果表明，在大多数患者中，PCT不仅通过减少癫痫活动，而且通过改善睡眠（对认知功能很重要）带来了持久的益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epileptic Disorders 医学-临床神经学

CiteScore

4.10

自引率

8.70%

发文量

138

审稿时长

6-12 weeks

期刊介绍： Epileptic Disorders is the leading forum where all experts and medical studentswho wish to improve their understanding of epilepsy and related disorders can share practical experiences surrounding diagnosis and care, natural history, and management of seizures. Epileptic Disorders is the official E-journal of the International League Against Epilepsy for educational communication. As the journal celebrates its 20th anniversary, it will now be available only as an online version. Its mission is to create educational links between epileptologists and other health professionals in clinical practice and scientists or physicians in research-based institutions. This change is accompanied by an increase in the number of issues per year, from 4 to 6, to ensure regular diffusion of recently published material (high quality Review and Seminar in Epileptology papers; Original Research articles or Case reports of educational value; MultiMedia Teaching Material), to serve the global medical community that cares for those affected by epilepsy.