SEARCHSYSTEMATIC_REVIEWpediatric ophthalmology, neurology

systematic_review·pediatric ophthalmology, neurology, pediatrics, systematic review, clinical trial·PMC10036579

Corticosteroids in childhood epilepsies: A systematic review

Frontiers in Neurology · 2 authors, 4 centres

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TL;DR

This PRISMA-based systematic review identified 160 papers on corticosteroid use in childhood epilepsies but found only three randomized controlled trials excluding epileptic spasms.

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Among 160 identified papers, only three were RCTs excluding epileptic spasms trials. In (D)EE-SWAS (nine studies, 126 patients), 64% of patients showed improvement in EEG or language/cognition. In DRE (15 studies, 436 patients), 50% of patients achieved seizure reduction and 15% seizure freedom. Corticosteroid regimes, dosages, and durations were highly variable across studies. The authors note that the heterogeneity of small study cohorts, variable follow-up periods, inconsistent outcome data, and diverse treatment protocols precluded meta-analysis or formal recommendations.

STUDY TYPE

systematic_review

SPECIALTY

pediatric ophthalmology

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100% · A

ORIGINAL PAPER

PMC10036579

Corticosteroids in childhood epilepsies: A systematic review

Frontiers in Neurology

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ABSTRACT

Corticosteroids have been used for the treatment of patients with epilepsy for more than 6 decades, based on the hypothesis of inflammation in the genesis and/or promotion of epilepsy. We, therefore, aimed to provide a systematic overview of the use of corticosteroid regimes in childhood epilepsies in line with the PRISMA guidelines. We performed a structured literature search via PubMed and identified 160 papers with only three randomized controlled trials excluding the substantial trials on epileptic spasms. Corticosteroid regimes, duration of treatment (days to several months), and dosage protocols were highly variable in these studies. Evidence supports the use of steroids in epileptic spasms; however, there is only limited evidence for a positive effect for other epilepsy syndromes, e.g., epileptic encephalopathy with spike-and-wave activity in sleep [(D)EE-SWAS] or drug-resistant epilepsies (DREs). In (D)EE-SWAS (nine studies, 126 patients), 64% of patients showed an improvement either in the EEG or in their language/cognition following various steroid treatment regimes. In DRE (15 studies, 436 patients), a positive effect with a seizure reduction in 50% of pediatric and adult patients and seizure freedom in 15% was identified; however, no recommendation can be drawn due to the heterozygous cohort. This review highlights the immense need for controlled studies using steroids, especially in DRE, to offer patients new treatment options.

CITATION EXPORT

Lena-Luise Becker, Angela M. Kaindl. Corticosteroids in childhood epilepsies: A systematic review. Frontiers in Neurology. (2023). https://doi.org/10.3389/fneur.2023.1142253

AUTHORS

2 · 4 CENTRES

Lena-Luise Becker, Angela M. Kaindl

1Department of Pediatric Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
2Center for Chronically Sick Children, Charité – Universitätsmedizin Berlin, Berlin, Germany
3German Epilepsy Center for Children and Adolescents, Charité – Universitätsmedizin Berlin, Berlin, Germany
4Institute of Cell- and Neurobiology, Charité – Universitätsmedizin Berlin, Berlin, Germany