Yeh Hye-Ryun, Kim Min-Jee, Ko Tae-Sung, Yum Mi-Sun, You Su-Jeong
Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, Seoul, Korea.
Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, Seoul, Korea.
Pediatr Neurol. 2017 Jun;71:50-55. doi: 10.1016/j.pediatrneurol.2017.03.017. Epub 2017 Mar 31.
Many studies advocate hormonal treatments including high-dose oral prednisolone as an effective treatment for epileptic spasms. However, little is known about the effects of intravenous methylprednisolone pulse therapy on infantile spasms. We investigated the short-term response to intravenous methylprednisolone pulse therapy for the treatment of infantile spasms.
Patients with newly diagnosed infantile spasms and hypsarrhythmia on electroencephalography (EEG) at two tertiary centers in Korea were included. Patients received intravenous infusions of 30 mg/kg/day methylprednisolone for three days with tapering doses of oral prednisolone for two to four weeks for the treatment of infantile spasms. Response to methylprednisolone pulse therapy was evaluated by seizure frequency and follow-up EEG within three weeks.
Fourteen patients were sudied. The mean age at the onset of spasms was 7.0 months (range, 2.0 to 11.0 months). Etiological factors included structural abnormalities (N = 11), chromosomal anomaly (N = 1), and unknown (N = 2). Nine of 14 participants (64.3%) demonstrated complete freedom from spasm and resolution of hypsarrhythmia on EEG within 3 weeks; however, only five of nine responders (55.5%) remained free of spasms after the discontinuation of oral steroids. Adverse effects, including irritability or infection, were observed in four patients but were tolerable in all.
Short-term methylprednisolone pulse therapy for the treatment of infantile spasms or hypsarrhythmia demonstrated rapid improvement in EEG and cessation of spasms without serious adverse effects. Further studies are needed to determine the long-term effects of spasm control.
许多研究提倡使用包括大剂量口服泼尼松龙在内的激素治疗作为癫痫性痉挛的有效治疗方法。然而，关于静脉注射甲泼尼龙冲击疗法对婴儿痉挛症的影响知之甚少。我们研究了静脉注射甲泼尼龙冲击疗法治疗婴儿痉挛症的短期反应。
纳入韩国两个三级中心新诊断为婴儿痉挛症且脑电图（EEG）显示高峰失律的患者。患者接受静脉输注30mg/kg/天的甲泼尼龙，持续三天，并逐渐减量口服泼尼松龙两至四周，用于治疗婴儿痉挛症。在三周内通过癫痫发作频率和随访脑电图评估对甲泼尼龙冲击疗法的反应。
研究了14名患者。痉挛发作的平均年龄为7.0个月（范围为2.0至11.0个月）。病因包括结构异常（n = 11）、染色体异常（n = 1）和不明原因（n = 2）。14名参与者中有9名（64.3%）在3周内痉挛完全缓解且脑电图高峰失律消失；然而，9名有反应者中只有5名（55.5%）在停用口服类固醇后仍无痉挛发作。4名患者出现了包括易怒或感染在内的不良反应，但所有不良反应均可耐受。
短期甲泼尼龙冲击疗法治疗婴儿痉挛症或高峰失律可使脑电图迅速改善且痉挛停止，无严重不良反应。需要进一步研究以确定痉挛控制的长期效果。
