Experience with very high dose (8mg/kg/day, maximum 60mg/day) prednisolone for West syndrome in a resource limited setting

Objectives: To assess efficacy of very high dose (8mg/kg/day, maximum 60mg/day) prednisolone in patients with West syndrome.

Method: This was an observational study conducted at a tertiary level hospital from August 2014 to August 2015. Children, aged 2 to 23 months, presenting with infantile spasms with hypsarrhythmia or its EEG variants, were enrolled. Study participants were started on very high dose prednisolone (8 mg/kg/day, maximum 60mg/day). The primary outcome measure was complete cessation of spasms and clearance of hypsarrhythmia on EEG after 2 weeks of prednisolone treatment. The study was approved by the institutional ethical committee. 

Results: Forty children were started on very high dose prednisolone (8 mg/kg/day, maximum 60mg/day) of whom four did not come for the 2 week follow up and were excluded. Response rate in the remaining 36 patients was 55.6% after 2 weeks of steroid therapy Side effects seen during hormone therapy included increased appetite in 29 (80.6%) patients, irritability in 27 (75.0%) patients and weight gain in 26 (72.2%) patients.

Conclusions: Use of a very high dose prednisolone regime (8mg/kg/day, maximum 60mg/day) resulted in a complete cessation of spasms and clearance of hypsarrhythmia on EEG after 2 weeks in 55.6% of children with West syndrome in this study.

Sri Lanka Journal of Child Health, 2018; 47(2): 137-140