A Meta-Analysis of Hormonal Therapy Vs. Valproate in the Treatment of West Syndrome
Abstract number :
2.264
Submission category :
Year :
2001
Submission ID :
1702
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
A. Poduri, MD, Neurology, Children[ssquote]s Hospital of Philadelphia, Philadelphia, PA; R.R. Clancy, MD, Neurology, Children[ssquote]s Hospital of Philadelphia, Philadelphia, PA
RATIONALE: West Syndrome is defined by the triad of infantile spasms, hypsarrhythmia, and developmental plateau or regression. Its potential for serious long-term sequelae necessitates prompt and effective treatment. This meta-analysis compares the remission rates of hypsarrhythmia after hormonal therapy (ACTH, prednisone, prednisolone) vs. valproate (VPA).
METHODS: We examined all studies published in English that reported hormonal or VPA treatment of infantile spasms with hypsarrhythmia. We performed a meta-analysis of the cases from these studies that satisfied specific inclusion criteria, including the elimination of hypsarrhythmia as an outcome endpoint. The data from these studies were contrasted with those in a report of remission in 44 untreated patients with West Syndrome. We compared remission rates among studies evaluating patients at an early time after treatment (within 9 weeks) and at a later time (6 to 10 months).
RESULTS: Five hundred five patients from 9 studies of hormonal treatment and 64 patients from two studies of VPA treatment of West Syndrome satisfied our inclusion criteria. Both hormonal treatment and VPA had significantly greater remission rates than the untreated group (p[lt].05). Analyzing the studies evaluating patients at time periods up to 9 weeks, there was no significant difference between the hormonal treatment group of 298 patients and the VPA treatment group of 64 patients (p[gt].05). When two hormonal studies and one VPA study that evaluated patients at 6 or 10 months were analyzed, there was a significantly higher response rate in the 22 patients treated with VPA than the 262 patients treated with hormonal therapy (p[lt].05).
CONCLUSIONS: West Syndrome has been treated with hormonal therapy far more frequently than VPA in the United States. No direct comparison of their efficacy has been studied in clinical trials. Our meta-analysis suggests that the efficacy of VPA in eliminating hypsarrhythmia might be comparable to that of hormonal therapy. A formal randomized, double-blind trial comparing the two modalities would be necessary to determine which modality should be used to most safely and effectively treat this malignant form of epilepsy.
Support: We did not seek or receive funding for this study.
Disclosure: Honoraria - Dr. Clancy is on the speaker[ssquote]s bureau and has received honoraria for speaking from Abbott.