Treating Pediatric Intractable Epilepsy with Intravenous Immunoglobulins and Prednisone
Abstract number :
3.433
Submission category :
8. Non-ASM/Non-Surgical Treatments (Hormonal, alternative, etc.)
Year :
2022
Submission ID :
2232864
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Richard Tang-Wai, MDCM, FRCPC, CSCN, FAES – Loma Linda University; Stephen Ashwal, MD – Professor, Pediatric Neurology, Loma Linda University; Gamil Fteeh, MD – Southern California Permanente Medical Group; Joshua Leob, MD – Loma Linda University; David Michelson, MD – Loma Linda University; Pilar Pichon Zentil, MD – Loma Linda University; Delphin Sallowm, MD – Southern California Permanente Medical Group; Stanford Shu, MD – Loma Linda University
This is a Late Breaking abstract
Rationale: In pediatric intractable epilepsy (IE), the response to more than 2 anti-seizure medications (ASM) is dismal prompting a need for an effective alternative therapy. Studies treating IE with prednisone and intravenous immunoglobulins (IVIg) have been promising; however, they widely varied in dosing and methodology yielding inconsistent results. This study aims to determine if our experience replicated the findings of a previous study (Seizure. 2017; 47:37-41) using the same treatment methodology in order to confirm an effective dosing protocol for a future randomized controlled trial.
Methods: Children with IE treated with prednisone or IVIg from 2018 to 2022 were reviewed. Only patients treated for the primary purpose of treating epilepsy were included. Patients with poor follow-up, different treatment methodology, autoimmune encephalitis, demyelinating disease, and infantile spasms with hypsarrhythmia were excluded. IVIg was given as 1 g/kg monthly for at least 3 months. Prednisone was given at 2 mg/kg/day for at least 2 weeks followed by a 6-week taper. Full response to therapy was defined as >50% reduction of seizures for > 2 months. Partial response was defined as a reduction of seizures of < 50% or < 2 months duration. Epilepsy type, etiology, percent seizure reduction, time to best response, added ASM during therapy, and duration of effect were collected. Chi-square and Mann-Whitney U tests were used for analysis.
Results: Twenty-three patients (13 prednisone, 10 IVIg) were included. The prednisone cohort had 10 generalized epilepsies. Etiologies were: 10 Genetic, 1 Cryptogenic, 2 Lesional. Four (30.7%) had a full response and 3 (23.1%) had a partial response. Mean seizure reduction was 23.8% (median, 0%), and mean time to best response was 1.9 weeks. Of all responders, 6 (85.7%) required additional ASM and 5 (71.4%) returned to their pretreatment seizure frequency. Mean duration of effect in responders with recurrence was 1.5 months; 2 patients had ongoing response._x000D_
The IVIg cohort had 4 generalized epilepsies. Etiologies were: 2 Genetic, 2 Cryptogenic, 6 Lesional. Eight (80%) had full response and 1 (10%) had partial response. Mean seizure reduction was 66% (median, 85%), and mean time to best response was 6.4 weeks. Of all responders, 2 (22.2%) required additional ASM and 4 (44.4%) returned to their pretreatment seizure frequency. Mean duration of effect in responders with recurrence was 3.2 months; 4 patients had ongoing response._x000D_
The IVIg group had greater full responders (p=0.019), higher seizure reduction (p=0.015), lower number requiring additional ASM (p=0.012), and longer duration of effect. By contrast, mean time to best response was shorter with prednisone.
Conclusions: This study replicated the prior findings and showed that IVIg given monthly at 1g/kg is effective and superior to prednisone in reducing seizures, sparing additional ASM, and providing a longer relief from seizures in pediatric IE.
Funding: None
Non-ASM