AUTHOR=Becker Lena-Luise , Kaindl Angela M. 

TITLE=Corticosteroids in childhood epilepsies: A systematic review

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1142253

DOI=10.3389/fneur.2023.1142253

ISSN=1664-2295

ABSTRACT=Corticosteroids have been used for the treatment of patients with epilepsy for more than six decades, based on the hypothesis of inflammation in the genesis and/or promotion of epilepsy. We therefore aimed to provide a systematic overview about the use of corticosteroid regimes in childhood epilepsies. 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-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 (DRE). In (D)EE-SWAS (9 studies, 126 patients) 64% of patients showed an improvement either of the EEG or of 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.