Clinical Research Of High-dose Methylprednisolone Effect On Infantile Spasms

Background and PurposeInfantile spasms also known as West syndrome is most common in infants ofrefractory epilepsy syndrome,The incidence of up to0.2‰~0.35‰,the peak age ofonset is4to6months of age,most children in the first year of onset;The main clinicalmanifestations include clusters of seizures,loss of height interictal EEG law,accompanied by movement abnormalities and mental retardation.Some childrenincreasing age after the onset of treatment can be gradually stopped, and someconverted to other forms of epilepsy.Until now the treatment of this disease isrelatively difficult,the relatively poor prognosis.The main treatment for this diseasehas hormones,antiepileptic drugs and the ketogenic diet;the adrenocorticotropichormone is preferred,but a shortage of the drug making the therapy is oftendifficult.Therefore,our hospital clinical effect of high dose methylprednisolone pulsetherapy of infantile spasms were discussed to provide a reference for finding areasonable treatment and improve prognosis in children. 1Materials and methods1.1General information:Children with infantile spasms in our hospital from November2002toNovember2012for nearly10years were retrospectively analyzed,selected high dosemethylprednisolone pulse therapy of infantile spasms,66cases were withoutanti-epileptic drugs and hormone therapy in children with newly diagnosed.66caseswere hormone therapy before giving large doses of vitamin B6therapy, treatmentbefore guardian must sign the application of high-dose methylprednisolone informedconsent.Among them,45males and21females; aged1to32months (9.7±6.4months); the onset age from0.5to20.0months (6.2±4.1); duration of0.5~23.0(3.5±4.3) months; duration≤2months for the23patients,>2months to43cases;developmental scales or clinical evaluation of mental retardation in60cases,accounting for90.9%.1.2Diagnostic criteria for infantile spasms:Reference to the1989International League Against Epilepsy develop diagnosticcriteria, IS has the following features:Clinical seizures,EEG mainly highlydysrhythmia,often accompanied by mental retardation;and has the followingcharacteristics as cryptogenic IS:(1)without any cause seizures associated with beforeand after birth;(2)normal development before the onset of cramps, nervous systemand imaging is normal;(3)In no other type of epilepsy before seizure;(4)thebackground EEG showed bilateral wave height rhythm disorders,Without limitationof abnormal brain electrical performance.1.3Therapeutic method:66cases of patients were using intravenous pulse methylprednisolone20mg/(kg.d) continuous application5d,later changed to oral prednisone tablets2mg/(kg.d),6to8:00in the morning on an empty stomach,2weeksafter the start of thereduction, the total course of8to12weeks.To start strong impact methylprednisolonetherapy in children two weeks after the drugs were added antiepileptic drugs,such as valproic acid,topiramate.1.4Curative effect judgment standard:To start with hormone therapy to one week when the percentage decrease in thenumber of attacks as evaluation criteria,Invalid:reduce the number of clinicalepisodes of<50%or aggravate seizures;Markedly:50%≤reduce seizurefrequency<100%.1.5Statistical methods:Using the statistical software SPSS17.0,the data in the relative number of countdata indicated that the results of the measurement data are expressed asmean±standard deviation(X±S) represented;Statistical methods using forward stepwise Logistic regression analysis andX2test;and to α=0.05as significant differencetest standards.2Results1Within this66cases,51cases were effective, total effective rate of was77.2%;28cases achieved complete remission, full remission rate was42.4%.2Ages had no influence on curative effect (P>0.05).3The beginning ages of the patients to use methylprednisolone therapy had noinfluence on curative effect (P>0.05).4The curative impact on course of disease:within23cases of two monthsbabies,the effective rate was91.3%, within43cases of more than2months babies,the effective rate was69.7%.Two groups of different effective rate had statisticalsignificance (χ2=3.958,P<0.05).5The curative effect of Etiology: effective rate of50cases in symptomaticetiology was78.0%;, effective rate of16cases in cryptogenic etiology was75.0%;Compared within this two groups,the effective rates had no statisticalsignificance(χ2=0.0087,P>0.05).6Long-term of following-up41cases,14of them had full remission (34.15%),29of them was effective(70.73%),3of them had a recurrence (10.34%). 3ConclusionHigh dose impulse method of IS with methylprednisolone is simple, the recentcontrol was effective, and it had a less adverse reaction; the curative effect is relatedto the course of the disease, the shorter the duration, the better curative effect; and thelong-term effect is good, the recurrence rate is low, the method can be recommendedin clinical application.