Oiginal Articles The role of oral prednisolone in the management of infantile spasms in resource-limited countries: experience from Sudan

Abstract

Background: Infantile spasms; one of the commonest childhood epileptic encephalopathies, is usually
associated with a characteristic electroencephalographic (EEG) pattern known as hypsarrhythmia. In the
past, numerous clinical trials have investigated the role of different treatment regimens; yet it is one of
the most notorious childhood epilepsies. This study aims to assess the role of oral Prednisolone in the
management of Infantile Spasms (IS) among our patients.
Methods: This is a cross sectional, prospective, hospital based study conducted in 2013, at the two main
pediatric epilepsy outpatient clinics in Khartoum State, Sudan. All patients received oral prednisolone in
usual dose (2 mg/kg/day) for the first six weeks and then tapered over another four to six weeks. It included
54 patients who were interviewed using a designated questionnaire before starting the prednisolone and
reassessed at 6-8 weeks for seizure frequency, duration and side effects of steroids. The EEG was done at
presentation and repeated at 10-12 weeks post treatment. Other investigations were requested as deemed
appropriate.
Results: The peak age at onset of the seizure was between 6 -12 months. Thirty-two patients (59.3%)
showed complete clinical cessation of the spasms and 22(40.7%) patients showed reduction in the spasm
frequency in 6-8 weeks duration. The EEG was repeated at 10-12 weeks after treatment, and out of 43 patients
with typical hypsarrhythmia 36(83.7%) patients showed complete disappearance of the hypsarrhythmia
compared to 6(54.5%) of those with polyspikes and waves. Fourteen patients (25.9 %) had experienced
side effects of Prednisolone.
Conclusion: Oral Prednisolone is effective in the initial management of IS, associated with clinical and
electrographic remission in our population. Because of its availability and low cost, it can be considered as
the drug of choice in developing countries like ours.