EDITORIAL COMMENTARY Year : 2022  |  Volume : 25  |  Issue : 5  |  Page : 807  

Oral prednisolone versus dexamethasone for the treatment of infantile epileptic spasms syndrome: Current status and way forward

Jitendra Kumar Sahu, Sandeep Negi
Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission04-Sep-2022Date of Acceptance05-Sep-2022Date of Web Publication31-Oct-2022

Correspondence Address:
Jitendra Kumar Sahu
Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/aian.aian_751_22

  How to cite this article:
Sahu JK, Negi S. Oral prednisolone versus dexamethasone for the treatment of infantile epileptic spasms syndrome: Current status and way forward. Ann Indian Acad Neurol 2022;25:807
How to cite this URL:
Sahu JK, Negi S. Oral prednisolone versus dexamethasone for the treatment of infantile epileptic spasms syndrome: Current status and way forward. Ann Indian Acad Neurol [serial online] 2022 [cited 2022 Nov 2];25:807. Available from: https://www.annalsofian.org/text.asp?2022/25/5/807/359840

West syndrome (renamed infantile epileptic spasms syndrome [IESS]) is one of the most common causes of infantile-onset developmental and epileptic encephalopathy. It is peculiar for its response with hormonal therapy (intramuscular adrenocorticotropic hormone therapy or oral prednisolone), which forms the first-line treatment choice. In this issue of the journal, Deswal and colleagues[1] attempted to compare the short-term effectiveness of oral dexamethasone versus standard oral prednisolone in controlling epileptic spasms at two weeks. The study was based on the assumption that due to a better blood–brain penetration kinetics of dexamethasone, its efficacy should not be inferior to prednisolone. In this pilot randomized controlled trial (RCT), the authors demonstrated comparable effectiveness and adverse effect profile. The study is remarkable for its RCT study design, and allocation of intervention was concealed. The study's limitations were small sample size, heterogeneity of the studied population, and lack of intermediate or long-term outcomes. Overall, the study provides crucial insights into the effectiveness of oral dexamethasone in the management of IESS.

In view of the limited efficacy of hormonal therapy, there is a quest to identify a better treatment choice.[2] The main challenges with such studies are small sample size, short follow-up, and lack of developmental outcome or quality of life assessment. A recently developed and validated Hindi version of Quality of Life of the Infant (QUALIN) for infants might be adopted for outcome assessment in future studies.[3] Children with IESS in developing countries commonly have a structural etiology and a long treatment lag. These two factors might affect the therapeutic response with hormonal therapy.[4],[5] It often limits the external applicability of the findings of the study. The treatment regime of hormonal therapy is quite variable in terms of dose, preparation, and duration. Each component has its influence on the outcome. All these issues need to be considered while designing a RCT in IESS.

Hormonal therapy is associated with systemic adverse events. There is need to develop novel treatment solutions with selective efficacy and minimum side effect. Ganaxolone is a neuroactive steroid and demonstrated potential benefit refractory epileptic spasms.[6] Future randomized clinical trial should explore safety and effectiveness of ganaxolone in children with IESS.

 

   References 
1.Deswal M, Lekhwani S, Vaswani ND, Bala K, Kaushik JS. Oral dexamethasone versus prednisolone for management of children with West syndrome: A open labelled randomized controlled pilot trial. Ann Indian Acad Neurol. 2022. doi: 10.4103/aian.aian_481_22.  
    2.Madaan P, Chand P, Linn K, Wanigasinghe J, Lhamu Mynak M, Poudel P, et al. Management practices for West syndrome in South Asia: A survey study and meta-analysis. Epilepsia Open 2020;5:461–74.  
    3.Devi N, Madaan P, Sahu JK, Bharti B, Bansal D. Translation, adaptation, and validation of hindi version of quality of life of the infant (QUALIN) for use in infants and toddlers. Indian J Pediatr 2022. doi: 10.1007/s12098-022-04132-0.  
    4.Anbarasu A, Sahu JK, Sankhyan N, Singhi P. Magnitude, determinants, and impact of treatment lag in West syndrome: A prospective observational study. J Pediatr Neurosci. doi: 10.4103/jpn.JPN_101_21.  
  [Full text]  5.Aramanadka R, Sahu JK, Madaan P, Sankhyan N, Malhi P, Singhi P. Epilepsy and neurodevelopmental outcomes in a cohort of west syndrome beyond two years of age. Indian J Pediatr 2022;89:765–70.  
    6.Kerrigan JF, Shields WD, Nelson TY, Bluestone DL, Dodson WE, Bourgeois BF, et al. Ganaxolone for treating intractable infantile spasms: A multicenter, open-label, add-on trial. Epilepsy Res 2000;42:133–9.