High-dose prednisone therapy for infantile spasms and late-onset epileptic spasms in China: The addition of topiramate provides no benefit

•The high-dose prednisone alone is effective and well-tolerated in patients with ES.•The combination therapy had not a better spasms outcome than monotherapy.•The addition of moderate-dose TPM provides no more benefit for IS or late-onset ES.•Higher-dose regimens of topiramate might be more effectiv...

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Published in:Seizure (London, England) England), 2019-10, Vol.71, p.174-178
Main Authors: Yi, Zhaoshi, Wu, Huaping, Yu, Xiongying, Zha, Jian, Chen, Hui, Chen, Yong, Zhong, Jianmin
Format: Article
Language:English
Subjects:
Age of Onset
Anticonvulsants - administration & dosage
Anticonvulsants - pharmacology
Child, Preschool
China
Drug Therapy, Combination
Female
Glucocorticoids - administration & dosage
Glucocorticoids - pharmacology
High-dose prednisone
Humans
Hypsarrhythmia
Infant
Infantile spasms
Late-onset epileptic spasms
Male
Outcome Assessment, Health Care
Prednisone - administration & dosage
Prednisone - pharmacology
Spasms, Infantile - drug therapy
Topiramate
Topiramate - administration & dosage
Topiramate - pharmacology
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Summary:•The high-dose prednisone alone is effective and well-tolerated in patients with ES.•The combination therapy had not a better spasms outcome than monotherapy.•The addition of moderate-dose TPM provides no more benefit for IS or late-onset ES.•Higher-dose regimens of topiramate might be more effective. To compare the clinical efficacy of high-dose prednisone monotherapy and the combination of hormone and moderate-dose topiramate (TPM) therapy in children with infantile spasms (IS) and late-onset epileptic spasms (ES), and to evaluate whether the addition of TPM would provide more benefits for patients. All patients were assigned to receive either high-dose prednisone alone (the maximum doses was 60 mg a day) or high-dose prednisone with TPM (the moderate doses was 5 mg/kg/day). The primary outcome was the proportion of children who achieved cessation of spasms at day-49 or day-56 after initial treatment (the minimum duration of treatment were 49 days). 77 patients were randomly divided into two groups. The control rate of spasms on day-14 in hormone monotherapy was similar to combination therapy (71.8% vs 76.3%, p = 0.796). The cessation of spasms rate of patients on day-49 or day-56 was also similar between the two groups (71.8% vs 65.8%, p = 0.569). After 4 months, the cessation of spasms rate of patients in the group of hormone monotherapy was higher than the group of combination therapy, but there was no significant difference (61.5% vs 50.0%, p = 0.308). The efficacy of the combination therapy was not better than that of the monotherapy in achieving spasm freedom at 14-days, 49-days or 56-days and day-120 in the patients. Adding-on moderate-dose TPM did not help more children achieve spasm freedom and provided no benefit for prevention of IS and late-onset ES in short term. Higher-dose regimens of TPM might be more effective.
ISSN:1059-1311
1532-2688
DOI:10.1016/j.seizure.2019.07.016