информационное письмоEFFICACY AND SAFETY OF LOW-DOSE HORMONAL THERAPY FOR EPILEPSY IN CHILDREN
DOI:
https://doi.org/10.31618/asj.2707-9864.2021.1.54.126Keywords:
epilepsy, West syndrome, CSWS, epileptic encephalopathy, neurocognitive regression, tetracosactide, dexamethasone.Abstract
Objective: to evaluate the efficacy and safety of low-dose hormonal therapy of epilepsy in children.
Material and methods: a study was conducted of 32 children aged 3 months to 11 years (21 boys, 11 girls) who received hormone therapy in the lowest clinically effective doses due to the resistance of epileptic seizures to the ongoing therapy with antiepileptic drugs, cognitive, behavioral disorders and regression development. Hormonal preparations were used: tetracosactide (synacthen depot) at a maximum single dose of 0.25-0.5 mg intramuscularly and dexamethasone at a dose of 0.15 mg/kg/day per os. All patients underwent: electroencephalography (EEG) and EEG-video monitoring with the inclusion of sleep, magnetic resonance imaging of the brain, according to indications - tandem mass spectrometry, DNA analysis by clinical sequencing (panel "Inherited epilepsy"), studies aimed at identifying possible side effects of corticosteroid therapy. The duration of follow-up after completion of hormone therapy was 1-4 years.
Research results: a positive result of the therapy was: 1) reduction of epileptiform activity on the EEG, 2) relief of epileptic seizures, 3) restoration (improvement) of impaired higher cortical functions. Long-term positive results were obtained in 62,5% (20/32). The best results were observed in patients with epileptic encephalopathy with continuous spike and wave during sleep, atypical childhood epilepsy with centrotemporal spikes, LandauKleffner syndrome in 100% (8/8). In patients with structural focal epilepsy and continuous spike and wave during sleep, a positive result was achieved in 60% (3/5); in patients with West syndrome, in 57,1% (8/14). A short-term positive result (or lack thereof) was noted mainly in patients with a structure of brain pathology and late initiation of hormone therapy. Side effects were absent or were transient.
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